Objective: To determine whether drug samples are associated with physicians prescribing fewer generic, less costly medications. Methods: We conducted a retrospective study at a large university-affiliated internal medicine practice containing over 70 physicians. Using a pharmacy database, we identified all prescriptions written to uninsured or Medicaid patients that belonged to…
Background: Collateral circulation is considered key for left ventricular (LV) function recovery in patients with chronic total occlusion (CTO). However, there are conflicting reports about the influence of collaterals on LV recovery after revascularization. Methods: Echocardiographic assessment of regional myocardial perfusion, wall motion score (WMS), and left ventricular ejection fraction…
Background: Metabolic syndrome has been linked to nonalcoholic fatty liver disease (NAFLD). Objectives: The purpose of the current study was to evaluate metabolic syndrome as a risk factor for NAFLD in Taiwanese adults. Methods: A cross-sectional study was conducted in which 876 subjects were enrolled. The diagnosis of NAFLD was…
Background: Vitamin D deficiency is increasingly being recognized as a highly prevalent and undertreated problem. This study was conducted to determine the prevalence of vitamin D deficiency/insufficiency in hospitalized adults in northeast Tennessee. Methods: A prospective cohort study was conducted on 99 inpatients admitted to an internal medicine teaching service…
Background: Disseminated tuberculosis (TB) accounts for 1 to 3% of all TB cases. This retrospective study reviews the clinical, radiological, laboratory findings and outcome in patients with disseminated tuberculosis in an endemic area. Methods: Medical records were reviewed for patients with disseminated TB admitted to two tertiary centers in Tehran,…
Expert committees in the United States and Europe formulated their currently recommended target blood pressures of <140/90 mm Hg or <130/80 mm Hg in persons with diabetes, chronic kidney disease, or coronary artery disease based on the totality of clinical data available at the time. However, accumulating evidence indicates that…
Background: Single-photon emission computed tomography (SPECT) is useful in identifying patients who may respond to lumbar facet injections. There are two methods for performing lumbar facet joint injections: intraarticular and medial branch nerve blocks. A consensus has yet to be reached among physicians as to which method is the most…
Abstract: This is a systematic review of the available literature and our own personal experience regarding the optimal management of the rhinoplasty patient. The routine utilization of nasal splinting, casting and perioperative antibiotics is supported. The management of a number of common early complications is also discussed. Meticulous technique based…
Abstract: A 19-year-old woman presented with recurrent hypokalemic paralysis, followed by apparently persistent symptoms due to coexisting osteomalacia. Distal renal tubular acidosis type 1 (dRTA1) linked the metabolic abnormalities and occurred as an extraglandular feature of Sjögren syndrome (SS). This case highlights the fact that in the setting of recurrent…
This case presents a rare type of crescentic glomerulonephritis characterized as IgA deposits predominantly along the glomerular basement membranes (GBM). The patient clinically manifested with rapidly progressive glomerulonephritis (RPGN) without pulmonary hemorrhage or vasculitis-related systematic symptoms. No positive results were found on antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), or…
A past history of sporadic solid cancers is disclosed in 10% of gastrointestinal stromal tumor (GIST) patients. Simultaneous occurrence with other malignancies is encountered in 14 to 16%, but the synchronous occurrence of GIST and hepatocellular carcinoma (HCC) has been reported only once in the English literature. An 81-year-old male…
This manuscript describing a case of intravascular lmphoma, displays the difficulties underlying its diagnosis. We emphasize that intravascular lymphoma should be considered in patients with multisystemic manifestations without obvious etiology. Despite the heterogeneous presentation of this lymphoma, some clinical and biological investigations should prevail clinicians to do tissue biopsy which…
While the combination of a patent foramen ovale (PFO) and thromboembolic disease is thought to portend increased morbidity and mortality, PFO presence in the setting of major pulmonary embolism (PE) may serve as a means to rescue patients from immediate hemodynamic collapse and death. We present two patients with major…
Lower limb ischemia may occur when a superficial femoral artery (SFA) is injured in blunt or penetrating trauma. Surgical repair of the injured artery can be challenging and time-consuming when there is an associated fracture. Two cases of traumatic SFA injury treated with endovascular stent grafting are described. Key Points…
To the Editor:Left ventricular hypertrabeculation/noncompaction (LVHT) is a rare congenital cardiomyopathy that remains frequently overlooked and is known to have an increased tendency to lead to thromboembolic events.1 Because of the serious potential for cardiovascular complications, early recognition is essential. We report the case of a 14-year-old boy with Down…
What is the impact of free prescription drug samples upon the US healthcare system? Is this a timely and important question to ask? According to studies using the US Medical Expenditure Survey (MEPS), 12% of Americans have received at least one free sample of a prescription drug. The value of…
The terms “hibernating” or “stunned” myocardium refer to the continued viability of individual cardiomyocytes, despite a chronic, angiographically totally occluded coronary artery supplying that distribution. Although the subtended myocardial segment appears akinetic or noncontractile, function may return upon restoration of blood supply by mechanical revascularization. The phenomenon is believed to…
A 90-year-old man was diagnosed with monoarticular arthritis due to pseudogout and Abiotrophia defectiva infection. A. defectiva is recognized as a cause of endocarditis, but is rarely described in septic arthritis. To our knowledge, this is one of the few case reports of septic arthritis due to this organism, and…
Hypersexual behavior can be exhibited by patients with autism. Several medications have been used in hypersexual paraphiliac male and elderly patient populations, including antiandrogens, estrogen, gonadotropin-releasing hormone analogues, and selective serotonin reuptake inhibitors. Due to limited research in autistic patients exhibiting hypersexuality, physicians must base their medication selection on outcomes…
Cryosurgery has proven effective in managing malignant tracheobronchial tumors, yet its role in benign lesions is not well established. A case of isolated tracheal papillomas recurring 15 years following laser surgery is reported. Cryosurgery allowed improvement in symptoms and adequate control of the papillomas. Key Points * Recurrent respiratory papillomas…
Abstract:Thrombotic thrombocytopenic purpura (TTP) rarely occurs in the setting of systemic lupus erythematosus (SLE); when it does occur it has a high mortality rate and is refractory to conventional treatment. No clear treatment guidelines exist when refractory TTP occurs in the setting of SLE. A 24-year-old male patient presented with…
Esophageal Crohn disease is a difficult disease both to diagnose and treat. The diagnosis is made in patients with other extraintestinal manifestations of Crohn disease in whom other esophageal pathology has been ruled out. This often requires integration of clinical, endoscopic, radiographic, and histologic findings. Despite its relative rarity, it…
Pain Relief with Intraarticular of Medial Branch Nerve Blocks in Patients with Positive Lumbar Facet Joint SPECT Imaging1. How is a lumbar facet syndrome diagnosed?A. By history and physical examination.B. It is a diagnosis by exclusion.C. By SPECT imaging.D. By diagnostic medial branch nerve blocks.2. SPECT imaging may aid in…
The association between hypertension and cardiovascular disease is beyond dispute.1 A continuum of cardiovascular risk exists across blood pressure (BP) strata, commencing around 115/75.2 Despite this, data provided by the National Health and Nutrition Examination Survey (NHANES) demonstrates less-than-optimal blood pressure control, with only 54% of the 65 million Americans…
In this issue of the SMJ, Feagans et al1 provide a review of the literature on Crohn disease. Crohn disease manifests in a number of clinical and pathological symptoms which all result from focal and asymmetrical inflammation of the digestive tract. The incidence of this disease has doubled over the…
Hypokalemic periodic paralyses (hypoPP) are rare disorders characterized by recurrent episodes of muscle weakness occurring at irregular intervals, typically with complete recovery between attacks.HypoPP are divided into primary (hereditary) and secondary (acquired) forms. Primary hypoPP are due to mutations in different genes encoding for subunits of voltage-gated ion channels of…
Metabolic syndrome (MBS) is a clustering of multiple medical risk factors. It is defined by the National Cholesterol Education Program’s Adult Treatment Panel III as a constellation of abdominal obesity (waist circumference >102 cm in men and >88 cm in women), hypertriglyceridemia (>150), low HDL cholesterol (<40 in men and…
Background: The prevalence of HIV/AIDS and tuberculosis (TB) within mainland China is unprecedented and the convergence of these two infectious diseases is increasingly and significantly endangering human health for socioeconomic development. To date, the clinical manifestations, laboratory presentation, and epidemiologic features of HIV/TB coinfection cases in mainland China have not…
MenopauseThe negative effects of menopause on the brain are often overlooked or downplayed. The chemical changes occurring in the brain can affect mental functioning (including memory and concentration) as well as psychological well-being (causing mood swings, nervousness, and depression). During menopause, the female body undergoes numerous chemical changes, and, while…
Neck Pain and Its Associated Disorders: A Complex ConundrumIn their Executive Summary, the Task Force addressed the epidemiology, risk factors, course and prognosis, assessment, and treatment options, as well as decision analyses regarding neck pain. Interventions that were focus-driven as to specific aims and goals to improve daily activities were…
Genital Warts: Tough to Effectively Treat and to StudyRecent US studies of the population burden of genital warts have each had their own unique strengths and limitations; however, a consistent finding has been that genital warts affect a substantial proportion of Americans, with corresponding adverse quality of life effects for…
The selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene reduce the risk of estrogen receptor-positive breast cancers. As an alternative approach, nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, also reduce the risk, albeit to a lesser extent. NSAIDs act via an endocrine mechanism, lowering blood estradiol levels. The particular importance of…
The Bed You Sleep On: Friend or Foe?While a host of factors may contribute to lower back pain, many consider the sleep surface, or mattress, to play a part in the relief or exacerbation of the condition. Little research exists involving the relationships between sleeping surfaces, sleep quality, sleep efficiency,…
To the Editor: The use of glucocorticoids in severe sepsis has had its fair share of controversy. In the 1960s, studies in animal models suggested that steroids might have survival benefits in sepsis and paved the way for trials with large doses.1 By the mid-1990s, meta-analysis disproved the efficacy of…
To the Editor: Ischemic colitis is a characteristic disease of the large intestine caused by varying degrees of anatomic or functional vascular insufficiency. Colonoscopy is the gold standard for the identification of colonic ischemia1,2; however, very rarely, colonoscopy itself may induce ischemic colitis under certain conditions.3–5
To the Editor: Glioblastoma multiforme (GBM) is the most aggressive of primary brain tumors with a median survival of approximately 12 months; fewer than 25% of patients survive up to 2 years and fewer than 10% up to 5 years.1 We report a very rare case of a patient who…
To the Editor: Hypertrophic pulmonary osteoarthropathy (HPO) is a rare paraneoplastic syndrome frequently associated with lung cancer. The pathogenesis of HPO is not completely understood, but the presence of arteriovenous shunts (either in the heart or in the lungs) seems to be condicio sine qua non. We support this hypothesis…
To the Editor: Diffuse large B-cell lymphoma (DLBCL) is a rapidly proliferating neoplasm that presents with rapid nodal growth, weight loss, fever, night sweats, or fatigue.1 Untreated, DLBCL causes significant morbidity, and ultimately, death. Fortunately, this disease is responsive to chemotherapy and the monoclonal antibody rituximab. We report on a…
To the Editor: As a constructive comment on the excellent article by Trewet and Ernst1 on “resistant hypertension,” allow me to mention an important factor contributing to hypertension that continues to be overlooked: “diet” products containing aspartame which are being consumed by an estimated two-thirds of the population.
At the Heart of Clinical Knowledge Summaries (CKS), http://www.cks.library.nhs.uk/clinical_knowledge, are concise summaries on how to manage almost 500 clinical situations commonly encountered in primary and first contact care. These summaries are underpinned by detailed and up-to-date clinical knowledge on acute and chronic conditions, as well as disease prevention. So whether…
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