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.

Acute Pericarditis

Posted by Carla Rothaus • December 19th, 2014

Acute pericarditis in the United States is usually idiopathic and presumed to be viral. A history and laboratory tests, a chest radiograph, and an echocardiogram are used in evaluation. Treatment usually includes an NSAID and colchicine.  The latest Clinical Practice review, on this topic, comes from Dr. Martin LeWinter, at the University of Vermont Medical… Read More…

Smoking Cessation

Posted by Carla Rothaus • December 19th, 2014

In a trial involving smokers who called the New Zealand national quitline, cytisine (a partial agonist of the nicotinic acetylcholine receptor) was superior to nicotine-replacement therapy in helping smokers quit. Nausea and sleep disorders were more frequent with cytisine. Four systematic reviews report cytisine to be superior to placebo for short-term and long-term smoking abstinence…. Read More…

Abdominal Aortic Aneurysms

Posted by Carla Rothaus • November 28th, 2014

Rupture of an abdominal aortic aneurysm is associated with a high risk of death. Endovascular repair results in lower perioperative morbidity and mortality than open repair, but the two methods have similar long-term mortality. The latest Clinical Practice review on this topic comes from Dr. K. Craig Kent at the University of Wisconsin School of… Read More…

Delirium Tremens

Posted by Carla Rothaus • November 28th, 2014

Alcohol withdrawal syndromes are underdiagnosed and understudied. Prevention and treatment involve supportive care and administration of benzodiazepines.  A new review article on this topic comes from Dr. Mark A Schuckit at the University of California, San Diego, School of Medicine. About 50% of persons with alcohol-use disorders have symptoms of alcohol withdrawal when they reduce… Read More…

Testicular Cancer

Posted by Carla Rothaus • November 21st, 2014

The treatment of testicular cancer is a success story in oncology. With available methods, 95% of men with this condition can be cured. Emphasis is shifting toward maintaining high cure rates and reducing or effectively managing late effects of treatment.  A new review article on this topic comes from Dr. Nasser Hanna and Lawrence Einhorn… Read More…

Glycemic Control in Type 1 Diabetes

Posted by Carla Rothaus • November 21st, 2014

In a new study, patients with type 1 diabetes and a glycated hemoglobin level of 6.9% or lower (≤52 mmol per mole) were found to have a risk of death from any cause or from cardiovascular causes that was twice as high as that for matched controls. The excess risks of death from any cause… Read More…

The α-Thalassemias

Posted by Carla Rothaus • November 14th, 2014

More than 100 varieties of α-thalassemia have been identified. Their geographic distribution and the challenges associated with screening, diagnosis, and management suggest that α-thalassemias should have a higher priority on global public health agendas.  A new review article on this topic comes from the University of Oxford’s Drs. Frédéric Piel and David Weatherall. The α-thalassemias represent a… Read More…

Fevers, Chest Pain, and Substance-Use Disorder

Posted by Carla Rothaus • November 14th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 31-year-old woman with substance-use disorder was admitted to this hospital because of fevers and chest pain. CT of the chest revealed multiple thick-walled nodular opacities throughout both lungs. Diagnostic tests were performed, and management decisions were made. Between 2007 and 2009 in the United… Read More…

Lung-Cancer Screening

Posted by Carla Rothaus • November 7th, 2014

A large randomized trial showed that low-dose CT screening reduced the risk of lung-cancer death by 20% among long-time smokers. Recent guidelines support consideration of screening but with attention to the possibility of false positive results and associated risks. Read the latest Clinical Practice review on this topic. Despite advances in diagnosis, staging, and treatment,… Read More…

A Chilly Fever

Posted by Carla Rothaus • November 7th, 2014

A 30-year-old graduate student presented with fevers associated with shaking chills and severe headaches. He had been well until 1 week before presentation, when he began to have daily fevers, with temperatures as high as 39.4°C. Any fever in a patient who has had possible exposure to malaria should prompt consideration of this diagnosis. Clinical Pearls… Read More…