American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs
man holding his chest

Advanced Therapies for Massive Pulmonary Embolism

The report by Secemsky et al1 in this issue of The American Journal of Medicine illustrates the current management of pulmonary embolism at the Massachusetts General Hospital (MGH). A Pulmonary Embolism Response Team sees all patients in whom pulmonary embolism is diagnosed by computed tomography. The team manages these patients during their hospitalization and after discharge for up […]

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Computed tomography of the chest demonstrated bilateral pulmonary nodules.

Not All It’s CrAged Up to Be: Disseminated Cryptococcosis

Phenomena known as cognitive biases, when applied to the details of a patient’s medical history, evidently steered the first attempts at diagnosis in the wrong direction. A 60-year-old man presented after 6 weeks of progressively worsening fevers, weight loss, malaise, night sweats, and confusion. Originally, the fevers were intermittent and low grade at 37.7°C (99.9°F). […]

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William H. Frishman, M.D.

Reform in House Staff Working Hours and Clinical Supervision

  When we were medical interns (WHF and JSA), training in 1969, the weekday work schedule on the ward services was 36 hours on and 12 hours off. Every other weekend, there was a shift from Saturday morning to late Monday afternoon, 56 straight hours. We were off 1 Sunday every 2 weeks. There were […]

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Right arm extensor surface (A) and left arm volar surface (C) prior to steroid therapy, depicting mottled erythema together with subcutaneous calcific deposits at the volar aspect of the upper arm, forearm, and antecubital fossa. Right arm (B) and left arm (D) after initiation of high-dose steroid therapy, showing marked improvement and resolution in erythema.

Febrile Calcinosis in Scleroderma

The collagen vascular diseases can be challenging for the internist and are associated with higher utilization of resources and less favorable outcomes among patients admitted to the inpatient medicine services.1 In this context, the acquisition of proficiency in recognizing a range of disease manifestations, common and uncommon, and familiarity with the appropriate therapeutic interventions are critical […]

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Relevant diagnostics and physical examination data. (A) Initial electrocardiogram on presentation to the critical care unit. (B) Still image of clonus on physical examination (refer to supplementary materials for video). (C) Electrocardiogram on discharge after successful treatment of serotonin syndrome.

Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm

A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received 3 doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for […]

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pregnant woman getting check up

Medical Principles in Obstetrical Consults

The ideal pregnancy should be medically uncomplicated. In contrast, maternal mortality in the United States equates to approximately 3 deaths per day and averages approximately 1 in 4000 live births (a total of 1063 deaths in 2015).1 Moreover, the annual number of maternal deaths has nearly doubled in the last 25 years for the United States, […]

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Apical 4-chamber view of the cardiac metastasis in the right ventricle.

Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell Lung Cancer

Cardiac tumors have generally been considered to be rare. They are often found incidentally, as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac […]

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heart-ecg-background-stock

When Guidelines Cause Hypertension

The 2017 ACC/AHA Hypertension Guidelines1 lowered the threshold for diagnosing hypertension from a blood pressure of ≥140/90 mm Hg to ≥130/80 mm Hg. In the United States, this effectively increases the number of adults diagnosed as “hypertensive” from 72 to 103 million.2 It has been stated that “by reclassifying people formerly considered to have pre-hypertension as having hypertension, […]

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pregnant woman getting her blood pressure taken

Medical Principles in Obstetrical Consults

The ideal pregnancy should be medically uncomplicated. In contrast, maternal mortality in the United States equates to approximately 3 deaths per day and averages approximately 1 in 4000 live births (a total of 1063 deaths in 2015).1 Moreover, the annual number of maternal deaths has nearly doubled in the last 25 years for the United States, […]

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