Posts Tagged ‘NEJM’

A Man with a Pruritic Rash

Posted by Carla Rothaus • June 24th, 2016

Although human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus, it seems to induce a precancerous state that can lead to adult T-cell leukemia–lymphoma (a subtype of cutaneous T-cell lymphoma), instead of being directly carcinogenic. HTLV-1 is associated with a long latency period, and most affected patients are exposed to the virus early in life…. Read More…

Body-Mass Index in Adolescents

Posted by Carla Rothaus • June 24th, 2016

Overweight and obesity in adolescents have increased substantially in recent decades and affect a third of the adolescent population in some developed countries. Twig et al. assessed the risk of fatal cardiovascular events in adulthood according to the body-mass index range during adolescence, using a national database of 2.3 million Israeli adolescents in whom height… Read More…

Sudden Cardiac Death in the Young

Posted by James Yeh, M.D. M.P.H. • June 22nd, 2016

Fatal heart conditions are shocking and tragic when they are sudden and unexpected, and especially when they occur in the young. Occasionally the public is reminded of this via a news story of a high school or professional athlete who collapses suddenly and dies during a sporting event. Often, the first manifestation of a serious… Read More…

A Woman with a Pleural Effusion

Posted by Carla Rothaus • June 16th, 2016

A 52-year-old woman presented with a unilateral pleural effusion. Several weeks later, uterine bleeding, pelvic fullness, and bloating developed. Magnetic resonance imaging revealed a large pelvic mass. Diagnostic procedures were performed. A new Case Record of the Massachusetts General Hospital summarizes. Clinical Pearl • What is the most common benign solid ovarian tumor? Although only 4% of all ovarian masses… Read More…

Upper Gastrointestinal Bleeding

Posted by Carla Rothaus • June 16th, 2016

Peptic ulcers, which are primarily due to Helicobacter pylori infection or the use of nonsteroidal antiinflammatory drugs (NSAIDs), occur in the stomach or duodenum and are the most frequent cause of upper gastrointestinal bleeding. Most patients who are hospitalized with upper gastrointestinal bleeding should undergo endoscopy within 24 hours, after appropriate resuscitation and transfusion to… Read More…

Is It Time to Be Dis-ENCHANTED with Low Dose Alteplase in Acute Ischemic Stroke?

Posted by Bhavna Seth, M.D. • June 15th, 2016

Ms. M, is hustled in to your emergency room, a septuagenarian with a history of hypertension. She was last noted to be well and playing with her grandchildren 1 hour ago, when her family noticed she began to slur her words, her face drooped to the left and she felt a heaviness & inability to… Read More…

A Woman with Dyspnea

Posted by Carla Rothaus • June 10th, 2016

Bronchiolitis is a disease of the small airways, which are defined as airways less than 2 mm in diameter and without cartilage. The bronchioles are especially vulnerable to infectious or inhalational insults because of their narrow diameter. A 60-year-old woman was seen in a pulmonary clinic because of increasing dyspnea. Chest imaging revealed bronchiectasis and mild,… Read More…

Ablation for Paroxysmal Atrial Fibrillation

Posted by Carla Rothaus • June 10th, 2016

According to a 2012 expert consensus statement, catheter ablation of drug-refractory paroxysmal atrial fibrillation is a class I level A indication, and pulmonary-vein isolation is the standard approach. Kuck et al. conducted a randomized trial to compare the performance of the rather complex yet well-established approach of radiofrequency ablation with that of the apparently simpler… Read More…

A New Combination Therapy to Help Prevent COPD Exacerbations?

Posted by Rachel Wolfson • June 8th, 2016

You walk into your office to see, once again, Mr. Jones, at 64-year-old male who suffers from chronic obstructive pulmonary disorder (COPD). Mr. Jones is recovering from a recent visit to the ED due to his third COPD exacerbation event this year. He’s frustrated with his recurrent COPD exacerbations, and wants to know if his… Read More…

Knife and Gun Club: The Rez Edition

Posted by Ken Bernard • June 7th, 2016

In 1989, Eugene Richards published the visual chronicle of scenes from the Denver Country Hospital Emergency Department.  Anyone who has worked in an emergency department (ED) would recognize the grainy photos that put on display the gruesome injuries that people incur as a result of senseless violence. Let’s face it — in addition to unscheduled primary… Read More…