Posts Tagged ‘medicine’

Advanced Dementia

Posted by • June 26th, 2015

Advanced dementia is a leading cause of death in the United States. A new Clinical Practice article covers treatment decisions guided by the goals of care — comfort is usually the primary goal, and tube feeding is not recommended. In 2014, Alzheimer’s disease affected approximately 5 million persons in the United States, a number that is… Read More…

A Newborn Girl with Hyperbilirubinemia

Posted by • 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…

New Interactive Medical Case: Test Your Skills

Posted by • June 24th, 2015

Approximately 10 minutes after being stung on the right lower leg by a yellow jacket (a type of wasp), a 45-year-old man began to feel lightheaded and nauseated.  He called emergency medical services, and paramedics arrived 10 minutes later.  They found him to be alert but anxious, with scattered areas of erythema on his trunk… Read More…

Ischemic Optic Neuropathies

Posted by • 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…

A Man with Chest Pain and Shortness of Breath

Posted by • June 19th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 71-year-old man presented with sudden chest pain, diaphoresis, shortness of breath, and hypotension. An electrocardiogram showed new ST-segment elevations. Ten days earlier, an implantable cardioverter–defibrillator had been placed. Diagnostic procedures were performed. Complications of ICD placement are well described, and ICD lead migration or dislodgment… Read More…

Permissive Underfeeding in the ICU

Posted by • June 17th, 2015

Nutrition among critically ill patients is widely considered important, but the ideal caloric targets remain a subject of debate.  Some believe higher caloric intake is helpful and can reduce mortality; others argue the exact opposite, pointing to studies linking caloric restriction to lower morbidity, as long as protein intake is adequate. This debate has prompted… Read More…

Breast-Cancer Screening

Posted by • June 12th, 2015

The International Agency for Research on Cancer (IARC) has updated its 2002 guidelines on screening for breast cancer, drawing on data from studies completed in the past 15 years. In November 2014, experts from 16 countries met at the International Agency for Research on Cancer (IARC) to assess the cancer-preventive and adverse effects of different methods… Read More…

A Woman with Decreased Vision and Diplopia

Posted by • June 12th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 41-year-old woman presented with decreased visual acuity in the left eye and diplopia. MRI of the head and orbits revealed abnormal soft tissue in the left sphenoid sinus and orbital apex, extending to the left cavernous sinus. A diagnostic procedure was performed. Lymphoma of the… Read More…

Vasopressin Antagonists

Posted by • June 5th, 2015

A new review in the Disorders of Fluids and Electrolytes series summarizes the salient discoveries that culminated in the development of vasopressin antagonists, focusing on their actions, side effects, emerging safety concerns, and important gaps in data. The review also considers how and when to use these agents. Ample evidence is available to implicate vasopressin, a… Read More…

In Sight and Out of Mind

Posted by • June 5th, 2015

In the latest Clinical Problem-Solving article, a 21-year-old man presented to the emergency department with fever and rash. His fever had started about 1 week before presentation and was associated with chills, myalgia, nausea, and vomiting. He also had a headache without photophobia. In the United States, recent declines in the rate of vaccination against measles… Read More…