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.

Irradiation in Early-Stage Breast Cancer

Posted by Carla Rothaus • July 24th, 2015

Women with breast cancer who are undergoing breast-conserving surgery were assigned to receive whole-breast irradiation with or without regional nodal irradiation. At 10 years, disease-free survival in the nodal-irradiation group was improved but overall survival was not. Many women with early-stage breast cancer undergo breast-conserving surgery followed by whole breast irradiation, which reduces the rate of… Read More…

Gallbladder Disease

Posted by Carla Rothaus • July 24th, 2015

A new review summarizes recent innovations in the approaches to gallbladder disease, including laparoscopic cholecystectomy, cholecystectomy with natural orifice transluminal endoscopic surgery, percutaneous cholecystostomy, and peroral endoscopic gallbladder drainage. Cholecystectomy is a well-established and frequently performed procedure. The demand for safer and less-invasive interventions continues to promote innovations in the management of gallbladder disease. Clinical Pearls •Describe… Read More…

Heparin-Induced Thrombocytopenia

Posted by Carla Rothaus • July 17th, 2015

A new Clinical Practice article provides an overview of heparin induced thrombocytopenia. HIT is characterized by a platelet count fall of more than 50% at 5 to 10 days after the start of heparin and hypercoagulability. Platelet factor 4–heparin antibody testing has a high negative, but low positive, predictive value. Treatment involves therapeutic-dose anticoagulation. In contrast… Read More…

A Man with Sore Throat and Myalgias

Posted by Carla Rothaus • July 17th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 20-year-old man presented with fever and a pericardial effusion. Five weeks earlier, sore throat, fever, malaise, and myalgias had developed. Broad-spectrum antibiotic therapy was administered, without improvement. A diagnosis was made. A number of case reports indicate an association between tamponade and adult-onset Still’s disease…. Read More…

Mastocytosis and Related Disorders

Posted by Carla Rothaus • July 10th, 2015

A new review article provides an overview of recent developments concerning the physiology and pathobiology of mast cells and discusses current diagnostic and therapeutic approaches to mast-cell disorders, with an emphasis on mastocytosis. Pathologic conditions involving mast cells appear to be more common than once thought. The diagnosis and treatment of such disorders are challenging, given… Read More…

A Man with Fever and Bacteremia

Posted by Carla Rothaus • July 10th, 2015

In the latest Case Record of the Massachusetts General Hospital, fever developed in a 37-year-old American man living in Vietnam. He was transferred from a local infirmary to an international hospital. A blood culture grew Streptococcus constellatus; fever resolved with antibiotics. The patient was transferred for further evaluation. The finding of Streptococcus constellatus bacteremia mandates… Read More…

A Man with Fever and Rash

Posted by Carla Rothaus • July 2nd, 2015

In the latest Clinical Problem-Solving article, a 67-year-old man with hairy-cell leukemia presented to the clinic after 3 days of fevers, night sweats, arthralgias, and an erythematous vesicular-appearing rash on his back. He had not had headache, shortness of breath, bleeding episodes, vomiting, or diarrhea. When caring for an immunocompromised patient, the clinician must continually reevaluate… Read More…

Potassium Homeostasis

Posted by Carla Rothaus • July 2nd, 2015

The plasma potassium level is normally maintained within narrow limits by multiple mechanisms. The latest article in the Fluids and Electrolytes series reviews the mechanisms that regulate potassium homeostasis and describes the important role that the circadian clock exerts on these processes. The plasma potassium level is normally maintained within narrow limits (typically, 3.5 to 5.0… Read More…

A Newborn Girl with Hyperbilirubinemia

Posted by Carla Rothaus • June 26th, 2015

In the latest Case Record of the Massachusetts General Hospital, a newborn girl was transferred to this hospital because of hypotension, coagulopathy, anemia, and hyperbilirubinemia. Generalized edema, anuria, and respiratory distress developed, and the trachea was intubated. Diagnostic procedures were performed. Neonatal hemochromatosis is the most common cause of neonatal liver failure and the leading indication… Read More…

Ischemic Optic Neuropathies

Posted by Carla Rothaus • June 19th, 2015

A new review article covers the diagnosis, pathophysiological features, and prognosis of ischemic optic neuropathy, a relatively common cause of visual loss in older patients, including visual loss after cardiac surgery. It must be distinguished from inflammatory optic neuritis. ION refers to all ischemic causes of optic neuropathy. ION is classified as anterior ION or posterior… Read More…