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Statin-Associated Autoimmune Myopathy
Statins significantly reduce the incidence of cardiovascular disease, are generally safe, and have an acceptable side-effect profile. It is now recognized, however, that in very rare cases, an...
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Testosterone Treatment in Older Men
Testosterone concentrations in men decrease with increasing age. Many symptoms and conditions similar to those that are caused by low testosterone levels in men with pituitary or testicular disease...
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A Boy with Abdominal Cramping
Colorectal carcinoma is extremely uncommon in children. Hereditary cancer syndromes may confer a predisposition to colorectal carcinoma in children. A 10-year-old boy was seen in the gastroenterology...
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Aspirin before Coronary Artery Surgery
Most patients with coronary artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing...
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Uncomplicated Skin Abscess
Between 1993 and 2005, annual emergency department visits for skin and soft-tissue infections in the United States increased from 1.2 million to 3.4 million, primarily because of an increased incidence...
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Portal Hypertension
Portal hypertension, which is most often caused by cirrhosis, is seen frequently in medical practice. Noncirrhotic portal hypertension is much rarer, particularly in the developed world. A 54-year-old...
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Another LEAP Forward: Testing the Stability of Peanut Tolerance after Early...
Over the past few decades, allergies have been on the rise worldwide, particularly in the United States. Immunotherapy (or allergy shots), in which incremental exposure to allergens sensitizes the...
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Mesenteric Ischemia
Although mesenteric ischemia is an uncommon cause of abdominal pain, accounting for less than 1 of every 1000 hospital admissions, an inaccurate or delayed diagnosis can result in catastrophic...
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A Man with an Ileocecal Mass
Misdiagnosis of Crohn’s disease in a patient with intestinal tuberculosis would generally result in treatment with glucocorticoids and biologic agents, which then has the potential to cause disease...
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Carotid artery stenting versus carotid endarterectomy: Results of two...
As a 4th year medical student I rotated on the vascular surgery service at a local hospital. One of the vascular surgeons loved music (all music!) and would quiz me on the musicians as each song came...
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Motivating Change in Physicians’ Prescribing Behavior
High-risk prescribing Drug prescribing is one of the armamentarium in a physician’s tool box to help manage disease and alleviate suffering. However, the risks of certain drugs in particular clinical...
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Asymptomatic Carotid Stenosis
Carotid-artery stenting has emerged as a therapeutic alternative to endarterectomy for the treatment of severe cervical carotid-artery stenosis. Rosenfield et al. conducted the Asymptomatic Carotid...
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A Man with Lung Infiltrates
Chronic eosinophilic pneumonia causes a relatively specific pattern of histologic reaction, but a specific cause of this pattern is not usually identified. A 71-year-old man presented with recurrent...
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Early versus Late Parenteral Nutrition in Critically Ill Children
During our intensive care unit rotations as residents, patient nutrition is a daily talking point. While it is easy to get lost in the details of the critical illnesses that bring patients to the ICU,...
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Chronic Stable Angina
Angina is the initial manifestation in approximately half of all patients who present with coronary artery disease. The presence of chronic angina approximately doubles the risk of major cardiovascular...
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A Man with Dyspnea and Chest Pain
In every patient with a large pulmonary embolus, one may consider the possibility that the embolus is caused by a benign cardiac tumor, primary cardiac cancer, or a metastasis to the heart. A...
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Therapy for Symptoms Attributed to Lyme Disease
PLEASE, may we understand persistent symptoms attributable to Lyme disease? There are few diseases that have created divisions between the medical establishment and some patients, or that have engaged...
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Care in Crisis
I initially envisioned this post as an upbeat piece of advice for graduating residents who will soon go out into the world as healers. For me, this transition was both anxiety-provoking and rewarding,...
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A Man with Sickle Cell Disease and Headache
Approximately 17% of patients with sickle cell disease have cerebrovascular symptoms; 75% of those patients have cerebral infarction, 20% have either cerebral or subarachnoid hemorrhage, and a small...
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Opioid Abuse in Chronic Pain
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients’ needs, the...
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