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.

Treatment of Patients with Cirrhosis

Posted by • August 25th, 2016

In patients with compensated cirrhosis, the 10-year probabilities of ascites, hepatic encephalopathy, and gastrointestinal bleeding are 47%, 28%, and 25%, respectively. These are ominous landmarks; 15% of patients who receive a diagnosis of ascites die within 1 year, and 44% within 5 years. This guide to the practical treatment of patients with cirrhosis summarizes recent… Read More…

A Woman with Back Pain

Posted by • August 25th, 2016

A 28-year-old woman presented with intractable back pain with radiation to the leg. Examination of biopsy specimens revealed a giant-cell tumor of bone, which accounts for 5% of primary bone tumors and occurs most commonly around the knee. These tumors are usually highly vascular; in some instances it is possible to actually feel the tumor… Read More…

A Man with Rectal Pain

Posted by • August 18th, 2016

Conditions that have a similar appearance to hemorrhoids include skin tags (which may be tender if they are associated with Crohn’s disease or chronic fissures), condylomata acuminata, condylomata lata, and anal tuberculosis. A 33-year-old man presented with painful bowel movements and rectal bleeding. Physical examination and sigmoidoscopy revealed sentinel skin tags, multiple fissures, and mucosal… Read More…

Genital Herpes

Posted by • August 18th, 2016

Herpes simplex virus type 1 and type 2 cause genital herpes. Antiviral therapy is used for symptomatic outbreaks, and as daily suppressive therapy, it reduces recurrences of symptoms, asymptomatic viral shedding, and the risk of HSV-2 transmission. Only 10 to 25% of patients with serologically confirmed HSV-2 infection are aware that they have genital herpes…. Read More…

Thymectomy in Myasthenia Gravis

Posted by • August 11th, 2016

Wolfe et al. conducted the Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone Therapy (MGTX), an international, randomized, single-blind (rater-blinded) trial, to determine whether extended transsternal thymectomy combined with a standardized prednisone protocol would be superior to prednisone alone after 3 years, with respect to lessening myasthenic weakness, lowering the total dose of prednisone,… Read More…

Raynaud’s Phenomenon

Posted by • August 11th, 2016

Although laboratory testing provides important information about the hemodynamic and physiological features of Raynaud’s phenomenon, clinical assessment by means of history or direct observation remains the best approach for diagnosis. Most experts agree that at least biphasic (white [pallor] and blue [cyanosis]) change in the skin color of the digits is needed. A new Review… Read More…

Prevention as Precipitant

Posted by • August 4th, 2016

Two days after undergoing uncomplicated bilateral total knee arthroplasties, a 72-year-old man had a temperature of 101°F and a pruritic, erythematous rash that originated on his trunk and spread peripherally to his arms and upper thighs over the course of 24 hours. Although rare, cutaneous drug reactions such as acute generalized exanthematous pustulosis, the drug reaction… Read More…

Fire-Related Inhalation Injury

Posted by • August 4th, 2016

Despite the fact that we have had many years’ experience with treating injuries related to fires, the complex physiological process of inhalation injury remains poorly understood, diagnostic criteria remain unclear, specific therapeutic interventions remain ineffective, the individual risk of death remains difficult to quantify, and the long-term implications for survivors remain ill defined. Fire-related inhalation injury… Read More…

A Man with Somnolence after Surgery

Posted by • July 28th, 2016

Although several theories have been postulated to explain the pathogenesis of the fat embolism syndrome, the end result is the embolization and agglutination of lipids, a process that causes obstruction of local blood flow in end organs (such as the lungs, brain, and skin) and leads to symptoms. A 46-year-old man had worsening somnolence 1 day… Read More…

Liraglutide in Type 2 Diabetes

Posted by • July 28th, 2016

To assess the long-term effects of liraglutide on cardiovascular outcomes and other clinically important events, the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial was initiated in 2010. Patients with type 2 diabetes who had a glycated hemoglobin level of 7.0% or more were eligible if they either had not… Read More…