Authors


Anne Mctiernan, MD, PhD

Latest:

Breast Cancer:

In this article, I review several interventions that have been shown or are postulated to reduce breast cancer risk in women with no history of the disease; these include chemoprevention, physical activity, weight control, diet, alcohol use, and avoidance of specific carcinogens.


Anne R. Sveen, MD

Latest:

Is There a Medical Explanation?

A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.


Anne V. Herdman, MD

Latest:

Worsening Neurological Symptoms in an Older Man With History of Rectal Cancer

A 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.


Anthony Donato, MD

Latest:

Giant Bullous Emphysema

A 54-year-old man presented to the ED with palpitations identified as atrial flutter and RVR. Medical history included stage IV renal-cell carcinoma, end-stage COPD, NYHA class IV heart failure, and recent pulmonary embolism. A CT scan of the thorax was ordered.


Anthony J. Ricketti, MD

Latest:

An HIV-infected patient with bilateral pneumonia

A 43-year-old homeless woman presented with a 2-week history of fever, chills, sweats, generalized pain, and cough that was productive of purulent green-yellow sputum mixed with blood. She reported a 15-lb weight loss over the past 6 weeks.


Anthony J. Schueth, MS

Latest:

Inside the Southeast Michigan ePrescribing Initiative

Despite clear evidence of its benefits, widespread adoption of electronic prescribing (ePrescribing) has been slow. The vast majority of prescriptions are still written by hand, a process plagued with errors and inefficiencies. The Southeast Michigan ePrescribing Initiative (SEMI), a collaborative effort of employers, health plans, physician groups, and others, was launched in 2005 to speed the adoption of ePrescribing. SEMI has accomplished much in 4 years, enrolling more than 3000 physicians who have transmitted nearly 9.5 million electronic prescriptions while improving patient safety and winning over physicians. (Drug Benefit Trends. 2009;21:23-26)


Anthony Morrison, MD

Latest:

Woman With Acromegaly Presenting as Unilateral Vision Loss

A 36-year-old woman presented to the emergency department with loss of vision in the right eye that had initially involved the peripheral field and progressed over 2 months to the central and nasal fields. During this period, she also had headaches, vomiting, and generalized weakness. She had had amenorrhea for 1 year.


Anthony Pietropaoli, MD

Latest:

Case In Point: Woman With Cough and Dyspnea

A 51-year-old woman with chronic obstructive pulmonary disease presents with nonproductive cough and slowly progressive dyspnea of 3 months' duration. She denies fever, chills, and night sweats. Over the past 3 months, she has received several different courses of treatment; the latest was cefixime, a 2-week tapering dose of prednisone, and bronchodilators. These treatments have failed to alleviate her symptoms.


Anthony Saleme, MD

Latest:

Purpuric Rash After Upper Respiratory Tract Infection

Two 7-year-olds show the purpuric rash of the lower body and legs that is typical of Henoch-Schönlein purpura. This disease is a vasculitis that chiefly affects small vessels of the skin, joints, gastrointestinal tract, and kidney.


Anthony Stone, MD

Latest:

Benign Prostatic Hyperplasia:

Traditionally, urologists have cared for patients with benign prostatic hyperplasia (BPH). However, because of demographic fluctuations, changes in the health care system, and the development of effective pharmacologic therapy for BPH, primary care physicians are increasingly involved not only in initial patient evaluation but also in continuing management. Here we provide guidelines for treatment of uncomplicated BPH--with special emphasis on medical therapies.


Antoine E. Azar, MD

Latest:

A practical evidence-based approach to rhinosinusitis

Abstract: Rhinosinusitis affects millions of persons annually and has a marked impact on quality of life and work productivity. Chronic rhinosinusitis (CRS) is characterized by symptoms that last at least 12 weeks. The history and physical examination should include a search for underlying conditions, such as allergic or nonallergic rhinitis and nasal polyposis. An evaluation of underlying immunodeficiency is warranted in certain patients, particularly those with severe or difficult-to-treat disease or other recurrent infections. When radiologic evaluation is indicated, coronal sinus CT scanning is the procedure of choice. While antibiotics are indicated for bacte- rial rhinosinusitis, intranasal corticosteroids represent the mainstay of treatment for CRS and are particularly useful when polyp disease is present. Nasal irrigation with a saline solution can be a very beneficial adjunctive therapy. Depending on coexisting conditions, additional treatments may include antihistamines, leukotriene modifiers, and immunotherapy. (J Respir Dis. 2006;27(9):372-379)


Antoine T. Jenkins, PharmD

Latest:

Amiodarone Drug Interactions

Amiodarone, a class III antiarrhythmic, has become the drug of choice for the management of supraventricular and ventricular arrhythmias.1,2 Although not an FDA- approved indication, the use of amiodarone to treat atrial fibrillation is supported by practice guidelines from the American College of Cardiology/ American Heart Association (AHA) and the European Society of Cardiology.


Antonina Dolei, PhD

Latest:

Epstein Barr Virus and Multiple Sclerosis: Missing Link Found

Epstein Barr virus activates potentially immunopathogenic and neuropathogenic proteins in cells deriving from peripheral blood mononuclear cells and astrocytes.


Antonios Soutopoulos, MD

Latest:

Fixed Drug Eruption Caused by Amoxicillin

This lesion appeared on the left outer thigh of a 28-year-old man after he took amoxicillin. The antibiotic had been prescribed for an upper respiratory tract infection with fever. Two years earlier, a lesion had appeared in the same anatomical region after ingestion of amoxicillin. A skin biopsy of the current lesion confirmed the diagnosis.



Anwar Awan, MD

Latest:

Endobronchial Sarcoidosis

A 40-year-old man was being treated as an outpatient with inhaled corticosteroids and bronchodilators for a presumed diagnosis of bronchial asthma. Worsening episodes of shortness of breath during the past few months sent him to the emergency department for a second opinion.


Aphrodite Vlachopanou, MD

Latest:

Bilateral Staghorn Calculi

A roentgenogram of the kidneys, ureter, and bladder of a 58-year-old man shows bilateral stones in the renal pelvis and the renal calyces. The patient had a history of recurrent urinary tract infections caused by Proteus mirabilis. A ureteral catheter (pigtail) had been placed in the pelvis of the left kidney to facilitate drainage.


Arash Asgarian Nahavandi, MD

Latest:

Infection of the Cutaneous Apocrine Glands

Hidradenitis suppurativa is a chronic acneiform infection of the cutaneous apocrine glands.


Archana Ahluwalia, MD

Latest:

Prompt diagnosis and therapy are keys to reducing mortality Extrapulmonary tuberculosis, part 5: Pericardial involvement key words: Tuberculosis, Pericarditis, Pericardial effusion

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)


Archana Bhaskaran, MBBS

Latest:

Woman With Edema, Vomiting, and Diarrhea

A 22-year-old woman has had chronic nausea, emesis with green vomitus, and diarrhea for the past 10 months. The diarrhea is frequent (about 3 to 8 times daily) and does not resolve with starvation.


Ari Garber, MD, EdD

Latest:

Sleeping Bowel: A Wake-up Call for Opioid-induced Complications

During the course of pain management with opioids, the line between relief and complications may be thin. At ACG 2015, the problems and solutions were covered.


Arielle Levitan, MD

Latest:

Hyponatremia:

ABSTRACT: Correction of chronic hyponatremia is associated with a very high risk of CNS complications; avoid a rapid increase in serum sodium concentration if you suspect a patient's condition is chronic. Thiazide- or metolazone-induced hyponatremia can develop rapidly-in 1 to 2 weeks-and its only presenting signs may be fatigue and listlessness. Diuretic-induced hyponatremia is 4 times as common in women as in men. Various factors greatly increase the risk of acute hyponatremia after surgery. Hyponatremia that develops after an operation which involves irrigation with a solution of glycine, mannitol, or sorbitol (such as transurethral prostatectomy [TURP] or hysteroscopy) may be hypertonic. An osmolar gap greater than 15 is a clue to this condition. Treatment of hypertonic hyponatremia in post-TURP or posthysteroscopy syndrome may require dialysis and a nephrology consult.


Armand G. Cacciarelli, MD

Latest:

Cytomegalovirus Infection

Cough, fever, diarrhea, and weight loss had disturbed a 52-year-old woman for 1 month. AIDS had been diagnosed 5 years earlier, but she had declined medical treatment. The patient's vital signs were stable when she was admitted to the hospital. Physical examination results were unremarkable except for thrush and mild, diffuse abdominal tenderness.


Armstrong Le (ed)

Latest:

EXERTIONAL HEAT ILLNESSES

After a professional football player died of heatstroke, national attention focusedon heat-related illnesses among athletes. However, many amateur and “weekend”athletes do not fully appreciate the stress that a hot environment places on theirbodies when they exercise. As the popularity of outdoor exercise and sports continuesto grow, the number of persons at risk for heat illnesses increases each year.This book-the first to focus exclusively on exertional heat illnesses-describes howto identify, treat, and prevent these disorders. Among the topics covered are thephysiology of heat stress; classification of heat illnesses; exertional heatstroke; heatexhaustion; exercise-associated collapse; heat syncope; exertional heat cramps; hyponatremia;minor heat illness, such as miliaria and sunburn; and predisposingfactors for exertional heat illnesses. Case reports appear throughout the text. Alsoincluded are reproducible checklists, charts, tables, algorithms, and photographs.


Arnold Rivera, MD

Latest:

Scrotal Lesions:

The differential diagnosis of intrascrotal pathology includes a myriad of benign and malignant entities. Timely detection is imperative to reduce the morbidity associated with many of these disease processes.


Arthur M. Carlin, MD

Latest:

Sports Concussion: Implications of the Exam After Head Injury

As many as 300,000 sportsrelatedconcussions arediagnosed each year inthe United States.1 Thisfigure underestimatesthe true incidence, however, becausemany concussive injuries are notrecognized by the injured persons,trainers, or physicians. A recentstudy found that 4 of 5 professionalfootball players with concussionwere unaware that they had sufferedthis injury.2


Arun Jesudian MD

Latest:

New Antivirals for Hepatitis C: Four Basic Facts

A new era in hepatitis C treatment began in May 2011, with approval of telaprevir and boceprevir. They are effective only for some patients, but new and better options are well on their way to the clinic.


Aruna Timmireddy, MD

Latest:

Diffuse alveolar hemorrhage in a patient with SLE

The authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.



Arveen K. Thethi, MD

Latest:

Osteoarthritis: Complementary Therapies Reviewed

ABSTRACT: Many patients with osteoarthritis (OA) try such complementary therapies as special diets, nutritional and herbal supplements, yoga, t'ai chi, magnets, and acupuncture-but only 40% of these patients tell their physicians. Glucosamine and chondroitin sulfate can produce at least symptomatic relief; in addition, glucosamine (1500 mg/d) may increase or stabilize cartilage in osteoarthritic knees. Alert patients to the potential toxicities of many herbal remedies, as well as the risks of harmful drug interactions and possible contaminants and impurities. Yoga postures may have a beneficial effect on knee OA; t'ai chi may reduce joint pain and swelling and increase mobility. Small studies have shown that applied pulsed electromagnetic fields can reduce pain and improve function in patients with chronic knee OA. Acupuncture has also been shown, in small studies, to alleviate the pain of OA. Autologous chondrocyte transplantation was recently approved for treatment of knee OA. The efficacy and safety of various types of gene therapy are currently being evaluated.

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