Mr. Jackson is a 36-year-old man whom you are caring for in the intensive care unit (ICU). Before this hospitalization, he was healthy and took no medications. He has never smoked, and he drinks three or four beers every week.
Life Lessons from Paul in the Face of Death
My brother Paul, a rabbi, died recently, just shy of 3 years after the diagnosis of widely metastatic colon cancer. The story of his diagnosis and treatment is all too familiar. An apparently healthy 64-year-old man has a sudden onset
Bile Acids, the Microbiome, Immunity, and Liver Tumors
Hepatocellular carcinoma is among the leading causes of tumor-related death, and the liver is among the most common sites of cancer metastasis. Several types of immune cells surveil the liver to detect and kill premalignant and malignant cells and to
Bitot’s Spots
A 4-year-old boy was brought by his father to the ophthalmology clinic with a 1-year history of enlarging white deposits in both eyes and decreased night vision. On examination, the conjunctivae of both the right eye (Panel A) and the
Koilonychia in Iron-Deficiency Anemia
A 54-year-old woman presented to the primary care clinic with fatigue and a 7-year history of intermittent hemorrhoidal bleeding. On examination, she appeared pale and had spoon-shaped nails (koilonychia) on the second and third fingers (Panel A) and the thumb
Case 27-2018: A 3-Year-Old Boy with Seizures
Presentation Of Case. Dr. Caitlin E. Naureckas Li (Pediatrics): A 3-year-old boy was admitted to this hospital during the summer because of a seizure. The patient had been well until 3 days before admission, when one episode of emesis occurred.
“Transparency” as Mask? The EPA’s Proposed Rule on Scientific Data
The Environmental Protection Agency (EPA) recently proposed excluding from consideration in setting environmental standards any studies whose raw, individual-level data are not publicly available. This proposal was preceded by the wholesale exclusion from the EPA’s scientific advisory boards of…
Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis
Patients with infective endocarditis on the left side of the heart are typically treated with intravenously administered antibiotic agents for up to 6 weeks, according to guidelines from the European Society of Cardiology and the American Heart Association. During the
One-Year Outcomes after PCI Strategies in Cardiogenic Shock
Early revascularization has been shown to reduce mortality among patients with acute myocardial infarction that is complicated by cardiogenic shock. Most patients with cardiogenic shock present with multivessel coronary artery disease, which is associated with higher mortality than single-vessel…
Free Drug Samples and the Opioid Crisis
To the Editor: Malpractice on the part of some pharmaceutical companies has been established as a key driver of the opioid crisis. Powerful painkillers are offered under attractive conditions to poorly educated patients who are not aware of the risk
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest
In attempting to reduce the rate of death and disability associated with cardiac arrest worldwide, emergency medical workers have few effective treatments other than early initiation of cardiopulmonary resuscitation (CPR) and prompt defibrillation. For more than 50 years, treatment strategies
Testing Epinephrine for Out-of-Hospital Cardiac Arrest
The administration of epinephrine has been part of the resuscitation of patients with cardiac arrest since the 1960s. The rationale for the use of epinephrine includes evidence from studies in animals and from clinical trials in humans that increasing vasomotor
Immunotherapy for Melanoma Metastatic to the Brain
Most practicing physicians will recall from their training that the average prognosis for patients with central nervous system (CNS) metastases from melanoma was death within a matter of weeks to months. This reflected the natural history of a disease on
Combined Nivolumab and Ipilimumab in Melanoma Metastatic to the Brain
Brain metastases are a common complication of solid tumors and remain a major cause of disabling neurologic complications and death in patients with cancer. Among primary cancers in adults, melanoma has one of the highest propensities to metastasize to the
Adolescents’ Use of “Pod Mod” E-Cigarettes — Urgent Concerns
Adolescents’ use of electronic cigarettes initially took the public health community by surprise. In 2011, less than 2% of U.S. high school students reported having used e-cigarettes in the previous month. But by 2015, the percentage had jumped to 16%.
Editorial
Dear Forensic Scientists, We are here with the new issue of the Bulletin of Legal Medicine in 2018. Apart from being scanned by international indexes such as DOAJ (Directory of Open Access Journals); the Bulletin of Legal Medicine is currently
Parenteral Opioid Shortage — Treating Pain during the Opioid-Overdose Epidemic
The opioid-overdose epidemic now causes more than 30,000 deaths per year in the United States. In response to the increasing death toll, many measures have recently been implemented, including reclassification of hydrocodone as a Schedule II opioid and new requirements
Uremic Frost in End-Stage Renal Disease
A 39-year-old man with end-stage renal disease presented to the emergency department with anorexia, nausea, vomiting, and oliguria. Five months earlier, he had stopped attending his regular hemodialysis sessions; he reported that he had thought that the sessions were not
MRI-Guided Intravenous Alteplase for Stroke — Still Stuck in Time
Time is a critical determinant of patient eligibility for intravenous thrombolysis in acute stroke. In such patients, intravenous alteplase is routinely administered up to 4.5 hours after the onset of symptoms, but even within this window, earlier treatment leads to
Whistling Cough
A 4-year-old boy presented to the otorhinolaryngology outpatient clinic with a 2-day history of persistent cough that had an intermittent whistling character (see video). The patient had no history or symptoms of viral infection of the upper respiratory tract, and
Anesthesia in a Patient with a Large Mediastinal Mass
To the Editor: Large mediastinal masses increase the risks associated with general anesthesia. The most feared complication is airway collapse, which precludes ventilation despite intubation. There is limited understanding of the dynamic behavior of extrinsically compressed airways during…
Lichen Planus
A 69-year-old man presented to the dermatology clinic with a 2-month history of a pruritic rash. The rash had first appeared on his right wrist and within 2 weeks had spread to his arms, legs, and trunk. His medical history
Case 24-2018: A 71-Year-Old Man with Acute Renal Failure and Hematuria
Presentation of Case. Dr. Joshua Z. Drago (Medicine): A 71-year-old man was transferred to this hospital because of worsening renal function and hematuria. Three weeks before this admission, the patient’s wife became ill with chills, fatigue, and myalgias, and she
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