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. These posts can now be found on NEJM Resident 360.

A Man with Diplopia and Polyuria

Posted by • October 13th, 2016

The histologic diagnosis of IgG4-related disease is predicated on the presence of characteristic histologic features, which include the presence of a dense lymphoplasmacytic infiltrate accompanied by storiform fibrosis (fibrosis with a whorled or starlike pattern that resembles a woven mat), obliterative phlebitis, or both. Another essential component of the diagnostic algorithm is the presence of… Read More…

Ten-Year Follow-up in the ProtecT Trial

Posted by • October 13th, 2016

The management of clinically localized prostate cancer that is detected on the basis of prostate-specific antigen (PSA) levels remains controversial. The National Institute for Health Research–supported Prostate Testing for Cancer and Treatment (ProtecT) trial was designed to evaluate the effectiveness of the three major contemporary treatment approaches to reducing prostate-cancer mortality and improving clinical outcomes… Read More…

Daratumumab for Myeloma

Posted by • October 6th, 2016

The incorporation of proteasome inhibitors and immunomodulatory drugs into the standard of care has improved outcomes in patients with multiple myeloma over the past 10 years, but most patients still eventually have a relapse. In the October 6, 2016, issue of the New England Journal of Medicine, Dimopoulos et al. report the results of a… Read More…

The Health Effects of Electronic Cigarettes

Posted by • October 6th, 2016

Although the sale of e-cigarettes is prohibited in some countries, it is legal in most, including the United States, where the FDA recently finalized rules for the regulation of e-cigarettes as a tobacco product. The U.S. market for e-cigarettes is now estimated to be worth $1.5 billion, a number that is projected to grow by… Read More…

Influenza Vaccination

Posted by • September 29th, 2016

The effects of influenza traditionally have been assessed by comparing hospitalizations and deaths during an influenza season with a baseline model. These calculations suggest that seasonal influenza epidemics in the United States are responsible for between 55,000 and 431,000 hospitalizations due to pneumonia and influenza each year and as many as 49,000 deaths. The highest… Read More…

Azithromycin Prophylaxis for Cesarean Delivery

Posted by • September 29th, 2016

Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of… Read More…

Primary Sclerosing Cholangitis

Posted by • September 22nd, 2016

Primary sclerosing cholangitis is an idiopathic, heterogeneous, cholestatic liver disease that is characterized by persistent, progressive biliary inflammation and fibrosis. There is no effective medical therapy for this condition. End-stage liver disease necessitating liver transplantation may ultimately develop in affected patients. This new Review Article summarizes the pathogenesis and management of this condition. Clinical Pearl • How… Read More…

Craniectomy for Traumatic Intracranial Hypertension

Posted by • September 22nd, 2016

Intracranial hypertension after traumatic brain injury (TBI) is associated with an increased risk of death in most case series. The monitoring of intracranial pressure and the administration of interventions to lower intracranial pressure are routinely used in patients with TBI, despite the lack of level 1 evidence. Hutchinson et al. conducted the Randomised Evaluation of… Read More…

A 31-Year-Old Woman with Infertility

Posted by • September 15th, 2016

Tuberculous endometrial granulomas take a while to become caseated; women of reproductive age, who regularly shed their endometrial lining, may do so before caseation has had the opportunity to develop. In older women, who have longer cycles or do not have cycles, caseating granulomas in the endometrium are more likely to develop. A 31-year-old Nepalese… Read More…

Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older

Posted by • September 15th, 2016

An investigational herpes zoster subunit vaccine (HZ/su) is being evaluated for the prevention of herpes zoster and postherpetic neuralgia in adults 50 years of age or older. A previous trial (Zoster Efficacy Study in Adults 50 Years of Age or Older [ZOE-50]) showed that HZ/su had a vaccine efficacy against herpes zoster of 97.2%, which… Read More…