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Download Entire Pdf: The Medicine Forum, Vol 8, 2006

The Medicine Forum

Download entire PDF: The Medicine Forum, Vol 8, 2006

Anomalous Origin Of Left Circumflex Artery From The Right Coronary Artery, Sivakumar Srinivasan, Md, Sandeep Anreddy, Md

The Medicine Forum

A 56 year-old male with past medical history significant for diabetes and obesity presented for an elective diagnostic cardiac catheterization.

Persistently Elevated Troponin Levels With A Negative Cardiacworkup: Now What?, Pamela Cines, Md

The Medicine Forum

A 44 year-old female with a past medical history significant only for iron deficiency anemia and syncope presented to an outside hospital with abdominal pain. The patient initially noted the pain while shopping; she described it a sharp sensation, regionalized to the right-epigastric region. When the pain recurred with greater intensity an hour later now with resulting nausea and right-arm radiation, she proceeded to her nearest ED.

Woman With Polyuria And Polydipsia, Jeffrey Clough, Msiv

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A 20 year-old Caucasian female with a past medical history significant only for occasional headaches and anemia presents with a chief complaint of increasing thirst for two weeks. The patient was in her usual state of health until approximately two weeks prior to admission when she noted the gradual onset of increasing thirst and began drinking more and more water over the next few days. Her thirst increased to the point where she drank an estimated 18 liters of fluid during the 24 hours prior to admission. This thirst was accompanied by frequent urination, which would often awaken her during …

Woman With Aids And Status Epilepticus, Bonnie Callahan, Md

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A 42 year-old female with a medical history of HIV presented to the Emergency Department with nausea and vomiting for the past five days. Six days prior to presentation, she had one week of symptoms of progressive dyspnea and non-productive cough which were evaluated by her primary care physician. At that time, blood work revealed a CD 4 count of 150 cells/mm3 and a chest x-ray was suggestive of pneumonia. She was given a prescription of trimethoprim-sulfamethoxazole (TMP/SMX) and guaifenesin with codeine. Within twenty-four hours of starting the prescribed medications, she developed nausea and vomiting, and she stopped taking both …

Man With Methadone-Induced Polymorphic Ventricular Tachycardia, Sivakumar Srinivasan, Md

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A 55 yr old male with past medical history significant for end stage liver disease, intravenous drug abuse and hypertension presents to the ED with complaints of bright red blood per rectum for the past 3 days and non-specific chest discomfort. Medications on admission were amlodipine, valsartan /HCTZ, xanax, terazosin, and high dose methadone maintenance therapy.

Treatment Of Crohn’S Disease In A Patient With Concomitant Hepatitis C And Hemophilia, Donna Williams, Md

The Medicine Forum

Treatment of Crohn’s disease often involves the use of immunomodulating drugs. Most trials of these drugs have excluded patients with coexisting illness by study design. The purpose of this case report is to describe the treatment of a rare case of Crohn’s disease in the face of concomitant hepatitis C and hemophilia.

Man With Increasing Fatigue And Myalgia, Lax Gadde, Md, Martin Kerrigan, Md

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A 69 year-old male with a past medical history of hyperlipidemia, GERD, and transitional cell carcinoma of the bladder currently in remission was admitted to the hospital with increasing fatigue, arthralgias, and myalgias. He noted that his symptoms began approximately four weeks prior to admission after working outside in his yard and on his swimming pool. He stated that one week later he developed red blotches on his thighs, abdomen and chest followed by arthralgias and myalgias. He noted there were ticks where he was working but could not recall a definite tick bite, nor did he find evidence of …

T-Wave Alternans In A Patient With Left Ventricular Dysfunction, Saum Shamimi-Noori, Md

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A 78 year-old man with a history of type 2 diabetes mellitus, hypertension, hyperlipidemia, seizure disorder, dementia, and alcohol abuse was admitted to the Wilmington VA Medical Center for treatment of deep vein thrombosis of the lower extremity. During the hospital course, the patient had a brief episode of supraventricular tachycardia. An echocardiogram revealed dilated cardiomyopathy, an ejection fraction of 20%, and apical and inferolateral akinesis-hypokenesis. On the following day, the patient developed cardiac arrest with ventricular fibrillation (VF) that was terminated by electric defibrillation. An electrocardiogram (Figure 1) obtained immediately after defibrillation demonstrated sinus bradycardia, a prolonged QT interval, …

Man With Blurry Vision, Brandy Kaneshiro, Md, Albert Yeung, Md

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A 35 year-old Caucasian man with Pre-B cell ALL on day 197 post allogenic stem cell transplant and with a chest tube for pneumothorax post VATS was admitted for pain at his chest tube site. Sixteen days into his admission he developed acute onset of blurry vision. The patient first noticed some difficulty reading a wall clock when he woke up in the morning followed by a subsequent worsening of his visual acuity over the next eight hours. By late afternoon he could only detect light. Review of systems was significant only for an intermittent headache over the preceding week.

Man Feeling Tired And “Lousy” Five Days Following Myocardial Infarction, Andra Popescu, Md

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A 70 year-old male presents to his cardiologist’s office with complaints of feeling fatigued and “lousy”. His past medical history is significant for HTN and HL, but until a recent hospitalization, he was non-compliant with his outpatient medical regimen. Of note, he also has a history of heavy alcohol consumption and a 30 pack-year smoking history. The patient reports that he was recently discharged after acute myocardial infarction (AMI) from an outside hospital. At that time, he underwent a diagnostic cardiac catheterization, but no intervention was performed secondary to 100% RCA stenosis and technical difficulties. He was sent home on …

When It Rains, Marshall Fleurant, Md

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You ever stand in the rain,

Especially on a hot summers day,

And feel the rain drops drip from the top of your head,

Straight down till it soaks into the seams of your socks

Woman With Fatigue, Shortness Of Breath, And Chest Pressure, Neilanjan Nandi Md, Sivakumar Srinivasan Md

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A 62 year-old African American female with past medical history significant for scleroderma, Raynaud’s phenomenon, and hypertension presented to the ED with 6 weeks of worsening fatigue, shortness of breath and a new onset of left sided chest pressure. Her outpatient medications included metoprolol 50 mg every 12 hours and nifedipine XR 90 mg once daily. On physical examination, the patient was noted to have a blood pressure of 189/62 mmHg and a pulse of 44 beats per minute. Her laboratory data including chemistry panel, complete blood count, and cardiac enzymes were unremarkable.

Woman With Facial And Neck Swelling, Meredith Chiaccio, Msiii, Donna Mscisz Williams, Md

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A 28 year-old Caucasian female, 3.5 months postpartum, presented to the TJUH ED with facial and neck swelling. She was in her usual state of health until approximately 1 month prior to admission when she noted the gradual onset of neck swelling. The neck swelling progressed to her face 4 days prior to admission; swelling in both areas was progressive and increasingly uncomfortable. Two months prior, the patient was treated for sinusitis with a course of antibiotics by an allergist; this treatment was unsuccessful, and she was referred her to an otolaryngologist, who performed a neck ultrasound and lab work. …

Man With New-Onset Jaundice And Severe Cholestasis, Aarati Malliah, Md

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The patient is a 69 year-old male with new onset jaundice of two weeks and a 6 month history of progressive hyperbilirubinemia with cholestasis who was admitted for evaluation. Physical examination revealed a well developed and well nourished, jaundiced male with scleral icterus, a II/VI systolic murmur at apex, mild abdominal discomfort over epigastrum on palpation without discernable hepatomegaly, normal distal pulses, no lower extremity edema, and no stigmata of chronic liver disease. Laboratory investigation revealed a total bilirubin of 19.3 mg/dL, alkaline phosphatase 693 U/L, and AST and ALT of 140 U/L and 117 U/L, respectively. CT scan of …

Infiltrated Epinephrine, Utpal Sagar, Md, Bonnie Callahan, Md, Ted Martynowicz, Do

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The patient is a 67 year-old male with past medical history of CAD s/p CABG, CHF with EF of 15%, BiV- ICD, who was recently admitted to an outside hospital in Delaware with SOB and weakness, and was found to have frequent bouts of VT. During that hospitalization, he had suffered cardiac arrest as well, and epinephrine was administered emergently through a peripheral IV site located in his right hand. He was thereafter loaded with amiodarone for the ventricular tachycardia. It was later found that the epinephrine had infiltrated into the skin of his right hand from the peripheral IV …

Woman With Anemia And Abdominal Pain, Joanna Kipnes, Md, Marina Serper Md

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The patient is a 36 year-old African American female with a 15 year history of Crohn’s disease complicated by severe perianal involvement not responsive to steroids or immunomodulating medication. The patient had undergone a proctocolectomy and diverting ileostomy two years ago secondary to refractory disease and had been symptom-free until 6 months prior to admission. At that time, the patient noted pain, vaginal discharge, and ulcerations in the perineal region. Three weeks prior to admission, she began to have almost daily vaginal bleeding as well as weakness, dizziness, and increased fatigue. She had no subjective fevers or chills and had …

Acute Myocardial Infarction After Blunt Chest Trauma, Sivakumar Srinivasan, Md, Sandeep Anreddy, Md, Paul Mather, Md

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Coronary artery injury rarely occurs after blunt chest wall trauma. It can, however, lead to extensive myocardial infarction. We report a rare case of acute anterolateral myocardial infarction in a young man after blunt chest trauma.

An Unusual Location For Prostate Brachytherapy Seeds, Sivakumar Srinivasan, Md, Sandeep Anreddy, Md

The Medicine Forum

Vascular migration of radioactive seeds to the lungs after prostate brachytherapy is known phenomenon. Here in we report a case of prostate brachytherapy seed migration into the right ventricle.

Fool, Marshall Fleurant, Md

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They say God protects fools and the innocent

They say God protects the innocent and the souls of children

Unfortunately the years of childhood has passed me

I doubt that God looks upon me as innocent

So I pray to be the fool

Woman With Relapsing Fevers, Mary Kate Mccullen, Md

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A 50 year-old Nigerian woman with a past medical history significant for type II diabetes and hypertension presented to the ED with a chief complaint of recurrent fevers and chills. The patient was in her usual state of health until approximately 6 weeks prior to admission, while during a visit with family in Nigeria she noted the onset of high fevers and general malaise. Initially, her fevers occurred daily for a period of one week, and were associated with chills, fatigue, loss of appetite, and myalgias. During this time, she was not evaluated by a physician, nor did she take …

Herpes Zoster Ophthalmicus With Third Nerve Palsy, Bonnie Callahan, Md, Utpal Sagar, Md, Ted Martynowicz, Do

The Medicine Forum

Introduction

Herpes zoster is a recurrent infection of the varicella-zoster virus. When it infects the periorbital region, the virus often involves the ocular structures, and may lead to more disastrous sequelae, including blindness. Despite advancements, including immunization and antiviral therapy, zoster ophthalmicus persists in the population. Therapy mitigates, but does not obviate, many of the complications of infection. Our paper describes a patient with herpes zoster ophthalmicus that presented from the community.

Coronary Heart Disease Prediction And Prevention, Dae Hyun Kim, Md, Mph, Andrew N. Lee, Md

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Introduction

Prediction of coronary heart disease (CHD) is based on multivariable risk equations developed from population-based observational studies in which people without clinical CHD at the initiation of study were examined and followed until their first CHD events. The risk equations from the Framingham Heart Study have been widely used in our clinical practice1-3 and research.4,5 The recent report of the third National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) incorporated the Framingham risk equations to predict ten-year absolute CHD risk and to identify certain patients who are at high risk and more likely to benefit from primary prevention with aggressive …

Changing The Way We Think About Irritable Bowel Syndrome, Roger Coron, Md, Herve Boucard, Md, Zamir Brelvi, Md

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Irritable bowel syndrome has long been considered a functional gastrointestinal disorder. However, recent studies have suggested possible organic causes that can explain the multitude of symptoms in IBS.

Brief History

The irritable bowel syndrome has been thought of as a functional gastrointestinal disorder for many years. As long as three thousand years ago, Hippocrates described a triad of symptoms consisting of abdominal discomfort, irregular bowel movements and bloating. In 1817, William Powell reported a case with similar symptoms as Hippocrates. In 1849, Cumming described a syndrome of irregular bowel habits consisting of alternating diarrhea and constipation.1 In 1928, Bockus and …

Cidofovir And Intravenous Immunoglobulin For Treatment Of Bk Polyomarivus Nephropathy, Anita Mehrotra, Md, Rajani Dinavahi, Md, George C. Francos, Md

The Medicine Forum

BK polyomavirus nephropathy (BKN) is an important cause of renal allograft dysfunction and loss. The mainstay of therapy is reduced immunosuppression, but definitive protocols for the diagnosis and management remain to be defined. We report here a retrospective analysis of 6 patients with BKN treated with cidofovir and intravenous immunoglobulin(IVIG).

Inverse Expression Of Fas Ligand And Asthma-Related Cytokines In An Apergillus Challenge Murine Model Of Asthma, T. Lin, Md, Allyson Larkin, Md, S. Sharma, Md, S. Patel, Md, J. Peterson, Md, S. Kierstein, Md, A. Haczku, Md, J. Zangrilli Md

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Introduction

Resolution of inflammation in asthma is typically thought of as a passive phenomenon in which proinflammatory Th2-type cytokines wane after the initial trigger. We hypothesized that active mechanisms, including anti-inflammatory cytokines and proapoptotic factors, contribute to this process. Fas Ligand (FasL) expression was particularly interesting since important effector cells in asthma (e.g. eosinophils and T helper cells) are Fas-sensitive.

Table Of Contents: The Medicine Forum, Volume 8, 2006

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 8, 2006

From The Editors, Andrew Rose, Md, Karl Kwok, Md, Neilanjan Nandi, Md, Utpal Sagar, Md

The Medicine Forum

As we were completing the final touches on the 8th volume of The Jefferson Medicine Forum, the members of the editing staff could not help but note the vast variety of medicine we are privileged to witness daily. Textbook cases of malaria, herpes zoster ophthalmicus, and Lyme disease mixed among patients with migrating prostatic radiation seeds or reversible encephalophathy due to hypertension are the perfect example of the marvelous diversity of pathology to which we are exposed. Our residents have interests ranging from coronary heart disease to irritable bowel disease and research throughout the spectrum of internal medicine.