Posts Tagged ‘NEJM’

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…

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients

Posted by Andrea Merrill • April 27th, 2016

I’ve sometimes wondered if I’m embarking on the field of surgery in the wrong era.  As a medical student, and now as a resident, the big open operations have always seemed to be the most exhilarating and rewarding.  It always seems more thrilling to have your hands deep in a patient’s abdomen or chest than… 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…

Déjà Voodoo: Readmission or Observation after the Affordable Care Act

Posted by Rena Xu • April 20th, 2016

The hospital where I work has one of the busiest emergency departments in Boston. Patients come in with everything you might imagine, from heart attacks to rabbit bites. A number of these patients, after being evaluated and treated, can be discharged home from the emergency department; others need to be admitted for further management. For… 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…

Fusion for Lumbar Spinal Stenosis?

Posted by Joshua Allen-Dicker • April 13th, 2016

Back pain does not respect traditional boundaries in healthcare.  Patients with back pain are present in our emergency rooms, our minute clinics, our surgical subspecialty offices, and our inpatient units.  As such, many of us—orthopedist or internist, rheumatologist or advanced practitioner—have had to think about advising the patient with lumbar spinal stenosis or lumbar spondylolisthesis,… 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…