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Genetically Informed Medicine

  As many readers will remember from an earlier editorial entitled “What’s in a Word? Using Words Carefully,”1 I pointed out the danger in using words without first carefully considering the implications of the written or spoken terms for individuals and for society. In this editorial, I described one of my patients who had mistakenly been […]

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Glaucomatous excavation of the optic nerve: Loss of optic nerve tissue results in excavation or “cupping” of the optic nerve head, which is best viewed by direct ophthalmoscopy. (A) Vertical cup-to-disk (C:D) ratio within the normal range. (B) Glaucomatous cupping has an increased C:D ratio.

Emerging Concepts in Glaucoma and Review of the Literature

Glaucoma is the most commonly acquired optic neuropathy. It represents a public health challenge because it causes an irreversible blindness. Emerging evidence indicates that the pathogenesis of glaucoma depends on several interacting pathogenetic mechanisms, which include mechanical effects by an increased intraocular pressure, decreased neutrophine-supply, hypoxia, excitotoxicity, oxidative stress, and the involvement of autoimmune processes. […]

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Left lower eyelid with a yellow, raised mass (left) with ulceration through the conjunctiva and tarsus (right)

Eyelid Metastasis in Non-Small Cell Lung Cancer: Diagnosis and Management

A 75-year-old man presented with a left lower eyelid lesion that had progressively enlarged over 2 months without bleeding, irritation, or change in vision. Shortly after noticing the eyelid lesion, he also noted hoarseness of his voice and enlarged lymph nodes in the left side of his neck. His review of systems was otherwise negative […]

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An Evidence-Based Approach to Differentiating the Cause of Shoulder and Cervical Spine Pain

  Differentiating the cause of pain and dysfunction due to cervical spine and shoulder pathology presents a difficult clinical challenge in many patients. Furthermore, the anatomic region reported to be painful may mislead the practitioner. Successfully treating these patients requires a careful and complete history and physical examination with appropriate provocative maneuvers. An evidence-based selection […]

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Lipid Management Guidelines from the Departments of Veteran Affairs and Defense: A Critique

In December 2014, the US Department of Veterans Affairs and Department of Defense (VA/DoD) published an independent clinical practice guideline for the management of dyslipidemia and cardiovascular disease risk, adding to the myriad of recently published guidelines on this topic. The VA/DoD guidelines differ from major US guidelines published by the American College of Cardiology/American […]

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Pneumopericardium Following Pericardiocentesis

A 73-year-old woman with metastatic adenocarcinoma of the lung including diffuse pulmonary involvement presented with profound dyspnea. An echocardiogram demonstrated a large circumferential pericardial effusion with tamponade physiology. Palliative echo-guided pericardiocentesis was performed, with removal of 550 mL of fluid, and a multi-sidehole pericardial catheter was left to gravity drainage. Despite evacuation of the effusion, […]

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