Posts in the ‘Physicians-In-Training’ Category

The posts below are excerpted from the NEJM Resident e-Bulletin, a free weekly email of teaching topics. Including the content here in Now@NEJM enables you to have a conversation or ask questions about clinical points that interest you. To receive the email version, register as a student or resident on NEJM.org.

Barrett’s Esophagus

Posted by Sara Fazio • August 29th, 2014

A new review article covers the epidemiology, pathogenesis, and natural history of Barrett’s esophagus and management options for the disorder. It has been estimated that 5.6% of adults in the United States have Barrett’s esophagus, the condition in which a metaplastic columnar mucosa that confers a predisposition to cancer replaces an esophageal squamous mucosa damaged… Read More…

10-Month-Old Boy with Microcephaly and Episodic Cyanosis

Posted by Sara Fazio • August 29th, 2014

A 10-month-old boy with microcephaly and developmental delay was admitted to the hospital because of episodes of respiratory distress and cyanosis. Microcephaly was present at birth, and hypotonia was noted at 5 months. On admission, brain MRI revealed decreased myelination. Microcephaly literally means “small head.” It is diagnosed when the head circumference is more than… Read More…

A 21-Month-Old Boy with Lethargy, Respiratory Distress, and Abdominal Distention

Posted by Sara Fazio • August 22nd, 2014

In the latest Case Record of the Massachusetts General Hospital, a 21-month-old boy presented to the emergency department because of lethargy, respiratory distress, and abdominal distention. Initial laboratory evaluation was notable for anion-gap metabolic acidosis. A diagnostic test result was received. The differential diagnosis of acutely altered mental status in a toddler includes trauma (accidental… Read More…

Aortic-Valve Stenosis — From Patients at Risk to Severe Valve Obstruction

Posted by Sara Fazio • August 22nd, 2014

A new review article on aortic-valve stenosis comes from Dr. Catherine Otto at the University of Washington School of Medicine in Seattle and Dr. Bernard Prendergast at John Radcliffe Hospital in Oxford, UK. Valvular aortic stenosis is a progressive disease in which the end stage is characterized by obstruction of left ventricular outflow, resulting in… Read More…

Syndromes of Thrombotic Microangiopathy

Posted by Sara Fazio • August 15th, 2014

A new review article covers the diverse pathophysiological pathways that can lead to microangiopathic hemolytic anemia and a procoagulant state with or without damage to the kidneys and other organs. An interactive graphic shows the nine primary syndromes of thrombotic microangiopathy (TMA), and narrated animations describe the causes, clinical features, initial management, and underlying mechanisms… Read More…

37-Year-Old Man with Ulcerative Colitis and Bloody Diarrhea

Posted by Sara Fazio • August 15th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 37-year-old man with ulcerative colitis was admitted to the hospital because of abdominal cramping, diarrhea, hematochezia, fever to a peak temperature of 38.8°C, and drenching night sweats. Several weeks earlier, he had performed home fecal transplantation. Bloody diarrhea is characteristic of infections caused by… Read More…

A Gut Instinct

Posted by Sara Fazio • August 8th, 2014

In the latest Clinical Problem-Solving article, a 30-year-old female physician presented to the emergency department in mid-August, with a 4-day history of anorexia, nausea, vomiting, and diarrhea. She had no fever or respiratory symptoms but had mild abdominal discomfort. Tuberculosis is a well-recognized occupational hazard for those involved in health care. In a systematic review… Read More…

Kidney Transplantation in Children

Posted by Sara Fazio • August 8th, 2014

A new review discusses unique aspects of kidney transplantation in children that necessitate specialized approaches and have resulted in clinical advances leading to higher success rates in young children than in any other age group. The most common primary causes of kidney failure are congenital or inherited disorders such as renal dysplasia, obstructive uropathies, or… Read More…

Brain Abscess

Posted by Sara Fazio • August 1st, 2014

Despite advances in diagnostic techniques and treatment, brain abscess remains a challenging clinical problem with substantial case fatality rates. Delays in diagnosis and treatment can result in a poor outcome. A new review summarizes current approaches to effective treatment. Despite advances in imaging techniques, laboratory diagnostics, surgical interventions, and antimicrobial treatment, brain abscess remains a… Read More…

Scorpion Envenomation

Posted by Sara Fazio • August 1st, 2014

Each year more than a million cases of scorpion envenomation occur worldwide, causing substantial morbidity and, among children, a risk of death. A new brief review discusses the effects and treatment of scorpion envenomation. Every year, more than 1 million cases of scorpion envenomation are reported worldwide. Although the resultant mortality is lower than that… Read More…