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Joseph S. Alpert

Diet Redux: Which Food Type Leads to Heart Attacks?

No topic has been more hotly debated over recent decades than the role of various foods in the development of atherosclerosis. The earliest animal experiments demonstrated that diets rich in fat and cholesterol produced arterial lesions that resembled atherosclerosis in humans.1 Over subsequent decades, a great deal of animal and human research has been performed exploring […]

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Sudden Creatine Kinase Elevation When an Athlete Starts Boxing: Looking Deeper Prior to Knocking the Statin Out

A 55-year-old Caucasian man with a prior computed tomography calcium score in the 75th percentile for age, sex, and race at age 39 years, and on long-term high-intensity statin therapy presented with episodic myalgia. He reported 3 episodes within the past year of sudden severe quadriceps pain that self-resolved within 2 days. His activities included biking […]

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(A) Three-dimensional reconstruction of the computed tomography scan demonstrating aneurysmal dilation of the entire length of descending thoracic and abdominal aorta. (B) Computed tomography angiogram showing thoracic aorta aneurysm. (C) Computed tomography angiogram showing abdominal aortic aneurysm with a focal saccular aneurysm in the infrarenal part with periaortic stranding (arrow).

Thoracoabdominal Aneurysm in a Professional Body Builder

To the Editor: A 33-year-old otherwise healthy man presented with worsening epigastric and flank pain for 3 weeks. He denied having vomiting, diarrhea, fever, urinary symptoms, or history of kidney stones. His vital signs were significant for a blood pressure of 140/72 mm Hg and pulse rate of 94 beats/min. Acute coronary syndrome was excluded by electrocardiography. A […]

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Diffuse nonpainful ecchymoses on posterior thighs in dependent areas.

Scurvy, a Not-So-Ancient Disease

A 65-year-old man with a history of alcohol and tobacco use and few medical interactions presented with 1 week of progressive dyspnea. Examination revealed a cachectic man with large areas of nonpainful ecchymoses on the posterior thighs (Figure). Additional skin findings included spider angiomata on the face and chest, scattered bruising on upper extremities, and […]

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Proportion of patients with at least one unnecessary test based on chart review, frequency with which testing led to a change in patient management and the overall outcome of testing on patients.

The Frequency of Unnecessary Testing in Hospitalized Patients

Testing is an important part of medicine across all specialties and settings. As a result, the volume of testing is enormous, with an estimated 4-5 billion tests performed in the United States each year.1 Unnecessary laboratory testing and diagnostic imaging is believed to be common. Studies looking at testing of patients have found 40%-60% of tests […]

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vegetable juices and veggies on a table

How Pure is PURE? Dietary Lessons Learned and Not Learned From the PURE Trials

The Prospective Urban Rural Epidemiology (PURE) cohort studies add a new level of understanding of some key environmental components of health.1 The population is diverse, and represents individuals from various socioeconomic levels with a long period of follow-up. The dietary macronutrient analysis of this cohort conducted by the study group2 has yielded interesting findings, undoubtedly warranting additional […]

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