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Displaying 171 - 180 of 7608 in ACP Online

Engaging Physicians in Medical Societies on Wellness

Chapter Well-Being Initiatives and Collaboration

Championing Well-being Together Partnering with Your Chapter and Chapter Staff

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Patients Before Paperwork

Patients Before Paperwork Update: On August 3, 2020 the Centers for Medicare & Medicaid Services (CMS) issued its Physician Fee Schedule and Quality Payment Program proposed rule. A number of the proposals are aimed at reducing administrative burden, especially in the telehealth services space.

Noteworthy Resources

Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence By Jennifer B. Feist, J. Corey Feist, and Pamela Cipriano

New ACP Webinars

Well-being Champion Webinar: Feelings and Needs Kerri Palamara, MD, FACP Tuesday, September 22, 2020, 2:00–3:00 p.m. ET

In the News

“It's Time to Stop Stigmatizing Mental Health Among Healthcare Workers” By Jessica Gold, Forbes This summer, physicians took to Twitter to discuss their own mental health struggles and treatment in hopes that transparency will help break the stigma of mental illness and seeking help, and ultimately change the culture of medicine.

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Displaying 171 - 180 of 500 in Annals of Internal Medicine: Clinical Cases

Buckled Micro-Transesophageal Echocardiography Probe During Patent Foramen Ovale Closure | Annals of Internal Medicine: Clinical Cases

As transcatheter cardiac treatment options continue to increase in number, most hospitals are forced to find solutions for sparse anesthesia resources. Conscious sedation with the help of a micro-transesophageal echocardiography (microTEE) probe can be considered in some procedures. However, new methods can induce unexpected problems. Here, we report 2 cases of buckled microTEE probes under patent foramen ovale closure. Fluoroscopy revealed different mechanisms of buckling in our patients. Esophageal buckling was solved by advancing the microTEE probe to the ventricle, whereas pharyngeal buckling was solved by careful retracting and straightening of the microTEE probe in the pharynx.

Chloronychia: Goldman–Fox Syndrome—Case Report | Annals of Internal Medicine: Clinical Cases

Chloronychia, or Goldman-Fox syndrome, is characterized by the presence of green discoloration of the nail plate, proximal chronic paronychia, and distal onycholysis. It is caused by Pseudomonas aeruginosa infection that affects nails, principally on the thumbs. The diagnostic represents a challenge because of a possible confusion within other illnesses such as subungual hematomas, melanoma, onychomycosis, and viridionychia.

Unusual Case of Hypereosinophilia in Hodgkin Lymphoma in a Nigerian Woman | Annals of Internal Medicine: Clinical Cases

Hodgkin lymphoma (HL) is characterized by Reed–Sternberg cells. Eosinophilia is an expected finding in patients with HL. However, there are few reports of hypereosinophilia in HL. We report a 45-year-old woman with fever, lymphadenopathy, and abdominal distention. Her complete blood count at presentation showed a total leukocyte count of 60 800 cells/mm3 with an eosinophil count of 46 000 cells/mm3. Lymph node biopsy revealed lymphocyte-rich HL, with eosinophil count dropping to 90 cells/mm3 after chemotherapy. Hypereosinophilia is unusual and needs to be extensively investigated. In HL, hypereosinophilia is thought to occur from cytokine secretion by Reed–Steinberg cells.

Coronary Stent Infection Complicated by Persistent Methicillin-Sensitive Staphylococcus aureus Bacteremia Myocardial Abscess and Pericardial Effusion | Annals of Internal Medicine: Clinical Cases

A 52-year-old man presented with coronary stent infection complicated by persistent methicillin-sensitive Staphylococcus aureus bacteremia, myocardial abscess, and pericardial effusion treated successfully with medical management. We presented an updated literature review of diagnosis, treatment, and outcomes of coronary stent infections. We recommend that providers have a high index of suspicion in patients with fevers, leukocytosis, bacteremia, and/or new acute coronary syndrome within 30 days of coronary stent placement. Multimethod imaging, including echocardiography, computed tomography, magnetic resonance imaging, and cardiac positron emission tomography, can assist in diagnosis. Although early-onset infection may be effectively treated with medical therapy alone, late-onset infections appear to benefit from antimicrobials and surgical intervention.

Immune-Mediated Necrotizing Myopathy Associated With Myelodysplastic Syndrome | Annals of Internal Medicine: Clinical Cases

Autoimmune diseases can often be diagnosed in patients with myelodysplastic syndrome (MDS). Here, we review the emerging literature linking MDS and rare presentations of autoimmunity, including myositis. We report a patient case that underscores the consideration of myositis as an autoimmune manifestation of MDS: initial presentation included shoulder pain and fevers, and after concurrent diagnoses of MDS and autoimmune myositis, the patient continued to present periodically with recurrent flares despite immunosuppressive treatment. Timely diagnosis of MDS-associated myositis may be challenging due to concurrent fever and hemolytic anemia. Furthermore, accurate diagnosis must exclude statin-induced myopathy, effect of toxins, or infectious etiologies.

A Case of Uncommon Quadricuspid Aortic Valve Stenosis Associated With Noonan Syndrome and Acromegaly | Annals of Internal Medicine: Clinical Cases

Quadricuspid aortic valve (QAV) is a congenital aortic valve malformation usually associated with aortic regurgitation. We encountered a patient with Noonan syndrome (NS) who had severe QAV stenosis caused by degenerative aortic cusps with an unprecedented spherical cyst-like morphology. The patient had also developed adult-onset acromegaly and an elevated serum growth hormone (GH) level that might have caused myxomatous degeneration of the congenital QAV. Although recombinant human GH has been used extensively in NS patients with short stature, this patient's case suggests that it is reasonable to monitor valvular degeneration as a possible outcome of GH action and cardiac hypertrophy.

De Novo Crohn Disease Following Bariatric Surgery: A Unique Presentation of an Increasingly Recognized Condition | Annals of Internal Medicine: Clinical Cases

Due to their robust efficacy in treating obesity and its associated metabolic complications, bariatric procedures are increasingly common. De novo Crohn disease is a poorly understood complication of bariatric procedures, which has historically been reported primarily in female patients following Roux-en-Y gastric bypass. Here, we present a male patient diagnosed with de novo Crohn disease nearly one decade after sleeve gastrectomy. Overall, the case highlights a lesser-known complication of a widely available procedure and provides some insight into potential disease mechanisms.

Systemic Lupus Erythematosus: Initial Manifestation as Cardiac Tamponade? | Annals of Internal Medicine: Clinical Cases

A 49-year-old man presented with 1 hour of retrosternal chest pain and ST-segment elevation. In the ambulance, he was diagnosed with an ST-segment elevation myocardial infarction and received prompt fibrinolysis. On arrival to the percutaneous coronary intervention–capable hospital, he became hemodynamically unstable, and bedside echocardiogram demonstrated a posterior pericardial effusion with tamponade physiology. He was found be profoundly thrombocytopenic secondary to a history of immune thrombocytopenic purpura (not known at the time of prehospital fibrinolysis). Given the position of his pericardial effusion, emergent surgical drainage was performed without complication. Subsequent work-up confirmed effusive pericarditis as his presenting diagnosis secondary to systemic lupus erythematosus.

A Presentation of Rare Heidenhain-Variant Creutzfeldt-Jakob Disease | Annals of Internal Medicine: Clinical Cases

Heidenhain-variant Creutzfeldt-Jakob disease (HV-CJD) is a rare pathologic prion disease characterized by visual symptoms preceding progressive neurodegeneration and death. In HV-CJD, pathologic prions display demyelinating neurotropism for the occipital lobe, yielding characteristic visual changes and hallucinations. Herein, we describe the case of a patient who presented with antecedent visual hallucinations followed by declining neuropsychiatric status, startle myoclonus, gait ataxia, and personality change. Clinical symptoms, electroencephalography, magnetic resonance imaging, and lumbar puncture supported a diagnosis of HV-CJD. This case emphasizes the importance of multidisciplinary management for ruling out alternative medical diagnoses, performing appropriate diagnostic studies, and implementing patient-centered management.

Insights Into a Hypercoagulable Case of Thyrocardiac Disease and Literature Overview | Annals of Internal Medicine: Clinical Cases

Hyperthyroidism is associated with a hypercoagulable state and has been described previously in case studies in the context of cerebral vein thrombosis and pulmonary emboli. In this case report, we present a middle-aged man with a rare combination of rheumatic mitral valve disease and thyroid storm complicated by enormous intracardiac thrombus burden. We aim to highlight the hypercoagulable state associated with thyrocardiac disease and to alert the physician to remain vigilant for not only this clinical entity but also for multiple disease states occurring in 1 patient.

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