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.

Violence against Health Care Workers

Posted by Carla Rothaus • April 28th, 2016

Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored. According to the Joint Commission, a major accrediting body for health care organizations, institutions that were once considered to be safe havens are now confronting “steadily increasing rates of crime, including violent crimes such as assault, rape,… Read More…

Aphasia during a Transatlantic Flight

Posted by Carla Rothaus • April 28th, 2016

In more than 60% of patients with ischemic stroke, the cause is readily established and is most often atherosclerosis or heart disease. However, in a young patient with no traditional vascular risk factors and a large clot burden, the search can be broadened to include, at minimum, thrombophilia, arterial dissection, paradoxical embolism, and unusual arteriopathies. A… Read More…

Surgery in Patients with Ischemic Cardiomyopathy

Posted by Carla Rothaus • April 22nd, 2016

The original Surgical Treatment for Ischemic Heart Failure (STICH) trial by Velazquez et al. was designed to test the hypothesis that coronary-artery bypass grafting (CABG) plus guideline-directed medical therapy for coronary artery disease, heart failure, and left ventricular dysfunction would improve survival over that with medical therapy alone. The authors now report the results of… Read More…

A Boy with a Breast Mass

Posted by Carla Rothaus • April 22nd, 2016

When evaluating a boy with breast enlargement, diagnostic considerations include gynecomastia, benign breast lesions, and cancer. An 8-year-old boy presented with a mass in the right breast that had been present for 18 months and had enlarged during the previous 6 months. On examination, a firm, mobile mass (2 cm by 2 cm) was present under the… Read More…

Surgery for Lumbar Spinal Stenosis

Posted by Carla Rothaus • April 14th, 2016

Lumbar spinal stenosis has become the most common indication for spinal surgery, and studies have shown that surgical treatment in selected patients is more successful than conservative alternatives. The aim of the Swedish Spinal Stenosis Study was to investigate whether fusion surgery as an adjunct to decompression surgery resulted in better clinical outcomes at 2… Read More…

Pioglitazone after Ischemic Stroke

Posted by Carla Rothaus • April 8th, 2016

The thiazolidinedione class of peroxisome proliferator–activated receptor γ (PPAR-γ) agonists are among the most potent insulin-sensitizing drugs available. One medication in this class, pioglitazone, may reduce the risk of cardiovascular events, including stroke, in patients with type 2 diabetes, for whom the drug is currently approved as a glucose-lowering agent. Kernan et al. designed the… Read More…

A Deficient Diagnosis

Posted by Carla Rothaus • April 8th, 2016

Humans, unlike most animals, require exogenous intake of ascorbic acid for the biosynthesis and hydroxylation of hormones, neurotransmitters, and mature collagen. A previously healthy boy, 2 1/2 years old, presented with a 6-week history of progressive inability to bear weight on his right leg. His mother noted no recent trauma. His medical history was notable only for… Read More…

Opioid Abuse in Chronic Pain

Posted by Carla Rothaus • April 1st, 2016

Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an… Read More…

A Man with Sickle Cell Disease and Headache

Posted by Carla Rothaus • April 1st, 2016

Approximately 17% of patients with sickle cell disease have cerebrovascular symptoms; 75% of those patients have cerebral infarction, 20% have either cerebral or subarachnoid hemorrhage, and a small percentage have cerebral sinovenous thrombosis. A 22-year-old man with sickle cell disease presented with headache and difficulty speaking after smoking marijuana. He had anomia, apraxia, and alexia and was… Read More…

A Man with Dyspnea and Chest Pain

Posted by Carla Rothaus • March 25th, 2016

In every patient with a large pulmonary embolus, one may consider the possibility that the embolus is caused by a benign cardiac tumor, primary cardiac cancer, or a metastasis to the heart. A 29-year-old man presented with severe dyspnea and chest pain on the right side. Computed tomographic angiography revealed a filling defect in the main and… Read More…