American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs
Fiber-optic bronchoscopic image showing multiple submucosal nodules characteristically sparing posterior membranous (A). Narrow-band imaging not showing the intraepithelial capillary loop pattern with dark brown dots (B). Axial and coronal scan depicting calcifications within the tracheal lumen (C and D).

Polypoidal Trachea: A Clinician’s Predicament

A 44-year-old asymptomatic female patient with no known comorbidities was scheduled for donor kidney harvesting for her husband. During intubation, the anesthetist found multiple polypoidal lesions just below the vocal cords, studding the tracheal wall. A diagnosis of multiple tracheal papillomatosis was made, and the patient was referred to the Otorhinolaryngology Department for further evaluation. […]

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Raised nodular lesions on patient's shins at presentation.

Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease

  A 40-year-old man presented to the outpatient department with complaints of multiple, nontender, raised nodular lesions on his shins bilaterally for the past year (Figure 1). The lesions had an insidious onset and were progressively increasing in size. He was evaluated at an outside clinic. Biopsy was performed multiple times, and possibility of spindle […]

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Gallium scintigraphy findings. (A) Coronal section and (B, C) axial on gallium scintigraphy show marked uptake (arrows).

Reactive Arthritis Caused by Haemophilus parainfluenzae in a Diabetic Patient

We report the first likely known case of reactive arthritis caused by Haemophilus parainfluenzae. An 84-year-old woman developed polyarthritis of the neck, shoulders, and hips. Two months prior to admission, she had received dental treatment for caries; 1 week later, she noted fever and extremity pain. Physical examination revealed that the range of motion of both […]

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Assessment and Treatment of Physician Speechlessness

What does a doctor say when words don’t come? Such was my dilemma several years ago on an inpatient psychiatric service when I responded to an emergency alarm activated by staff in a patient’s room. A young female patient—call her Lisa—had just knotted some latex gloves around her neck, and her face was still plethoric […]

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microscope and test tubes

The Tradeoff of Cancer Drug Regulatory Policy: Faster Approvals for One Means Less Knowledge for Another

The popular narrative surrounding cancer drugs or other therapies for rare diseases is that patients are willing to assume more risk and uncertainty to gain rapid access to investigational agents. This is, in part, the impetus behind the frequent use of surrogate endpoints by the US Food and Drug Administration (FDA)1 and European Medicines Agency,2 as well […]

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Chest computed tomography showing consolidation in lower lobe of right lung.

Connecting the Dots—Acute Abdomen, ST Elevation, and a Consolidating Lung Mass

Community-acquired pneumonia (CAP) is a commonly treated disease and yet may present in unfamiliar ways that if missed may result in unnecessary testing, procedures, and potential harm. Case We present a 38-year-old male with no prior medical history who presented with 3 days of severe, cramping lower abdominal pain. This was intermittent, non-radiating, and exacerbated […]

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Chest radiograph at initial presentation. Cardiomegaly and moderate left pleural effusion noted.

Drugs, the Thyroid, and the Heart: A Lethal Cocktail

A 53-year-old man was referred for evaluation of a raised international normalized ratio blood result. He had been taking warfarin and amiodarone for 2 years following a transient episode of atrial fibrillation following a percutaneous coronary interventional procedure. He was receiving treatment for severe left ventricular systolic dysfunction and type 2 diabetes mellitus (Table 1). […]

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The patient also had hemorrhagic necrosis of the skin and soft tissue of the right thigh.

A Genetic Origin? Purpura Fulminans

Over days, a patient’s relatively small lesion evolved into widespread tissue damage. A previously healthy 49-year-old Arab woman was admitted for a 2-cm painful red lesion on her left breast. She had been well until a few days earlier, when she developed left flank pain and was treated with ofloxacin for a presumed urinary tract […]

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Transitional Care Interventions for Heart Failure: What Are the Mechanisms?

  Two decades ago, heart failure clinics were proposed widely as an effective means of improving care.1 Despite dozens of trials over subsequent years, it has often been difficult to ascertain the true effectiveness of such programs due to poor descriptions of study populations, interventions, comparators, and outcomes. This is compounded by the use of terms […]

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