NEJM â Collection Updates for Gastroenterology

IMAGES IN CLINICAL MEDICINE: Bleeding Esophageal Varices

Euriko Torrazza-Perez, M.D. and Norberto Carreno, M.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

A 52-year-old man with cirrhosis associated with alcohol abuse presented to the emergency department with hematemesis and lightheadedness, which had developed 3 hours earlier, after binge drinking. He had no...

EDITORIAL: Rotavirus Vaccine â A Powerful Tool to Combat Deaths from Diarrhea

Mathuram Santosham, M.D., M.P.H. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

Rotavirus infection, the leading cause of severe childhood diarrhea in both developed and developing countries, results in over half a million deaths each year.1 Currently, two rotavirus vaccines (Rotarix [GlaxoSmithKline...

IMAGES IN CLINICAL MEDICINE: Gallstone Ileus

Te-Ming Liu, M.D. and Hsin-Hui Chiu, M.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

A 64-year-old woman who had no known medical conditions or surgical history presented with a 2-day history of epigastric fullness and vomiting. The physical examination was unremarkable except for abdominal...

ORIGINAL ARTICLE: Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Live pentavalent humanâbovine reassortant rotavirus vaccine is recommended in the United States for routine immunization of infants. We describe three infants, two with failure to thrive, who had dehydration and...

ORIGINAL ARTICLE: Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: A phased introduction of a monovalent rotavirus vaccine occurred in Mexico from February 2006 through May 2007. We assessed the effect of vaccination on deaths from diarrhea in Mexican...

ORIGINAL ARTICLE: Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: Rotavirus is the most common cause of severe gastroenteritis among young children worldwide. Data are needed to assess the efficacy of the rotavirus vaccine in African children.

Methods: We conducted...

EDITORIAL: â Beyond Antibiotics

Lorraine Kyne, M.D., M.P.H. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

In this decade, the prevention and control of Clostridium difficile infection in health care settings has become a global public health challenge. Infection rates have increased dramatically, and several large...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Dr. Rima A. Arnaout (Medicine): A 47-year-old man was admitted to this hospital because of abdominal pain.

The patient was in his usual state of health until 5 weeks before admission,...

ORIGINAL ARTICLE: Treatment with Monoclonal Antibodies against Toxins

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Background: New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

Methods: We performed a randomized, double-blind, placebo-controlled study of two neutralizing,...

EDITORIAL: Preoperative Biliary Stents in Pancreatic Cancer â Proceed with Caution

Todd H. Baron, M.D., and Richard A. Kozarek, M.D. — Thu, 14Â JanÂ 2010 00:00:00 -05:00

Pancreatic cancer is a common and deadly disease that is diagnosed in more than 40,000 patients annually in the United States, where it is the fourth leading cause of cancer-related...

ORIGINAL ARTICLE: Preoperative Biliary Drainage for Cancer of the Head of the Pancreas

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Background: The benefits of preoperative biliary drainage, which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head, are unclear.

Methods:...

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

Laura McGevna, M.D. and Zarry Tavakkol, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis....

CLINICAL PROBLEM-SOLVING: Painful Purple Toes

Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 57-year-old man presented to the emergency department with painful purple toes. On the day of presentation, he had first been seen in another hospital but left against medical advice...

CLINICAL PRACTICE: Barrett's Esophagus

Prateek Sharma, M.D. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

A 56-year-old obese man with long-standing gastroesophageal reflux who recently received a diagnosis of Barrett's esophagus presents for a follow-up visit. He has been taking omeprazole at a dose of...

INTERACTIVE MEDICAL CASE: Painful Purple Toes

Thu, 17Â DecÂ 2009 00:00:00 -05:00

A 57-year-old man presented to the emergency department with painful purple toes. He had first noted pain and discoloration in his left great toe 2 weeks earlier. One week before...

IMAGES IN CLINICAL MEDICINE: Hernia through the Foramen Omentale

Adhish Basu, M.D. and Michael Jacobs, M.D. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

An otherwise healthy 48-year-old woman with no medical history presented to the emergency room with colicky abdominal pain, vomiting, and diarrhea of 2 days' duration. The results of a physical...

IMAGES IN CLINICAL MEDICINE: Ileocecal Intussusception

John D. Whitfield, M.D. and Gamal Mostafa, M.D. — Thu, 10Â DecÂ 2009 00:00:00 -05:00

A 45-year-old man with no notable medical or surgical history presented with a 24-hour history of intense pain in the right side of the abdomen with associated nausea and vomiting....

ORIGINAL ARTICLE: Identification of a Novel Antibody Associated with Autoimmune Pancreatitis

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Background: Autoimmune pancreatitis is characterized by an inflammatory process that leads to organ dysfunction. The cause of the disease is unknown. Its autoimmune origin has been suggested but never proved,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Hedgehog Pathway and Pancreatic Cancer

Manuel Hidalgo, M.D., and Anirban Maitra, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

Aberrant activation of the hedgehog pathway has been observed in multiple human cancers, including pancreatic cancer. For this reason, several small-molecule inhibitors of the pathway have been advanced to clinical...

EDITORIAL: Interleukin-10 in Inflammatory Bowel Disease

Brian Kelsall, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

In this issue of the Journal, Glocker et al.1 provide the first substantial support for a functional role for the immunosuppressive cytokine interleukin-10 in the pathogenesis of inflammatory bowel disease...

IMAGES IN CLINICAL MEDICINE: Air in the Portal and Mesenteric Veins

Diego de Mendoza-Asensi, M.D. and Kenneth Planas, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

A 73-year-old man with history of smoking, hypertension, chronic obstructive pulmonary disease, and type 2 diabetes mellitus presented with respiratory distress. The trachea was intubated, and the patient was admitted...

REVIEW ARTICLE: Inflammatory Bowel Disease

Clara Abraham, M.D., and Judy H. Cho, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

The idiopathic inflammatory bowel diseases comprise two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. Accumulating evidence suggests that inflammatory bowel disease results from an inappropriate inflammatory response...

ORIGINAL ARTICLE: Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: The molecular cause of inflammatory bowel disease is largely unknown.

Methods: We performed genetic-linkage analysis and candidate-gene sequencing on samples from two unrelated consanguineous families with children who were affected...

IMAGES IN CLINICAL MEDICINE: Extensive Bowel Infarction

Janice Cheng, M.B., B.S. and Girish Pande, M.B., B.S. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

A 45-year-old man presented to the emergency room with abdominal pain that had been increasing over the previous week and hematemesis and melena that had begun in the preceding 12...

REVIEW ARTICLE: Norovirus Gastroenteritis

Thu, 29Â OctÂ 2009 00:00:00 -05:00

The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack...

CLINICAL PRACTICE: Bacterial Diarrhea

Herbert L. DuPont, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 47-year-old man reports a 1-week history of diarrhea, with grossly bloody stools for the past 5 days. He reports no history of travel, contacts with sick persons, or underlying...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and Surgical Critical Care): A 26-year-old man was admitted to this hospital because of abdominal distention and shock.

The patient had been well until...

CLINICAL PROBLEM-SOLVING: The Writing on the Wall

Thu, 01Â OctÂ 2009 00:00:00 -05:00

A 52-year-old man presented to the emergency department with abdominal discomfort. His symptoms began 5 weeks earlier, when nonradiating discomfort developed in the epigastric region. The pain worsened after eating...

IMAGES IN CLINICAL MEDICINE: Pelvic Spleen

Chang-An Tseng, M.D. and An-Liang Chou, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

A healthy, 23-year-old, nulliparous woman presented with lower abdominal pain, which she reported having had intermittently for the previous year. She had no other symptoms of gastrointestinal distress. A peripheral-blood...

IMAGES IN CLINICAL MEDICINE: Uvular Necrosis after Endoscopy

Nathan Joseph Shores, M.D. and Richard Seth Bloomfeld, M.D. — Thu, 17Â SepÂ 2009 00:00:00 -05:00

A 28-year-old man presented with a sore throat 72 hours after undergoing upper endoscopy. The patient had a 6-month history of intermittent solid-food dysphagia; upper endoscopy revealed a Schatzki ring....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Dr. Jenica N. Upshaw (Medicine): An 81-year-old man was admitted to the hospital because of cough, weight loss, odynophagia, and failure to thrive.

The patient had been in his usual state...

INTERACTIVE MEDICAL CASE: The Writing on the Wall

Thu, 10Â SepÂ 2009 00:00:00 -05:00

A 52-year-old man with diabetes mellitus was admitted to the hospital after presenting to the emergency department with abdominal discomfort. His symptoms began 5 weeks earlier, when epigastric discomfort developed...

IMAGES IN CLINICAL MEDICINE: De Garengeot's Hernia

Augustine Chung, B.A. and Amitabh Goel, M.D. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

An 83-year-old woman presented with a 1-week history of an enlarging, painful bulge in the right groin. Examination of the abdomen revealed a diffusely tender and erythematous right-groin mass extending...

CLINICAL THERAPEUTICS: Parenteral Nutrition in the Critically Ill Patient

Thomas R. Ziegler, M.D. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical...

REVIEW ARTICLE: Intestinal Transplantation

Thomas M. Fishbein, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

The results of intestinal transplantation have improved over the past decade. During this period, the number of intestinal transplant procedures performed in North America has increased by a factor of...

IMAGES IN CLINICAL MEDICINE: Sigmoid Volvulus

Ping-Hsien Chen, M.D. and Chiao-Hsiung Chuang, M.D. — Thu, 03Â SepÂ 2009 00:00:00 -05:00

An 87-year-old man with Parkinson's disease presented with a 7-day history of progressive abdominal distention and constipation. The physical examination revealed hypoactive bowel sounds and diffuse abdominal tenderness with rebound;...

IMAGES IN CLINICAL MEDICINE: Pneumatosis Cystoides Coli

Melina C. Vassiliou, M.D. and Gina L. Adrales, M.D. — Thu, 20Â AugÂ 2009 00:00:00 -05:00

A 25-year-old woman presented with recurrent abdominal pain that had first developed 10 years earlier. Physical examination revealed mild tenderness in the left upper quadrant, without rebound or guarding. Laboratory...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2009 â A 34-Year-Old Man with Cystic Fibrosis with Abdominal Pain and Distention

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Dr. David M. Dudzinski (Medicine): Fever and abdominal pain and distention developed in a 34-year-old man with cystic fibrosis during an admission to this hospital for pulmonary care.

The patient was...

IMAGES IN CLINICAL MEDICINE: Rectovesical Fistula

Ethan Rogers, M.D. and Michael Mohseni, M.D. — Thu, 20Â AugÂ 2009 00:00:00 -05:00

An 84-year-old man presented with a foreign body hanging from his rectum. Eleven years earlier, he had undergone a radical prostatectomy for prostate cancer. One week before presentation, he underwent...

IMAGES IN CLINICAL MEDICINE: Esophageal Foreign Body

Thu, 13Â AugÂ 2009 00:00:00 -05:00

A 50-year-old man presented to the emergency department with marked dysphagia, dyspnea, and paroxysmal cough. He had swallowed a spoon while trying to extract a fish bone that was stuck...

IMAGES IN CLINICAL MEDICINE: Tortuous Varicosities in Chronic Schistosomiasis

AndrÃ© Rodrigues DurÃ£es, M.D. and Lilian Souza Araujo — Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 34-year-old Brazilian man presented with a 24-year history of prominent, progressively dilating superficial veins. The veins of the lower limbs dilated first, gradually becoming discolored and indurated (Panel A)....

EDITORIAL: Surgical Treatment of Obesity â Weighing the Facts

Malcolm K. Robinson, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

There has been an explosion in the number of bariatric surgical procedures performed worldwide. It is estimated that in 2005, the number of procedures performed in the United States was...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

John H. Stone, M.D., M.P.H., Paul A. Caruso, M.D., and Vikram Deshpande, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Dr. John H. Stone: A 26-year-old woman was seen in the rheumatology clinic of this hospital because of painful swelling on both sides of the neck.

She had been well until...

ORIGINAL ARTICLE: Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Background: To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization.

Methods: We performed a prospective, multicenter, observational study of 30-day outcomes...

IMAGES IN CLINICAL MEDICINE: Lupus-Associated Intestinal Vasculitis

De-Feng Huang, M.D. and Wei-Sheng Chen, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

A 28-year-old woman presented, and was admitted, to our hospital with a 2-day history of periumbilical postprandial abdominal pain with nausea and vomiting; she was receiving a maintenance regimen of...

EDITORIAL: The Capsule and Colorectal-Cancer Screening â The Crux of the Matter

Michael Bretthauer, M.D., Ph.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

In the United States and other countries, colonoscopy has emerged as the primary screening test for colorectal cancer. Colonoscopy is believed to prevent colorectal cancer because polyps are removed during...

IMAGES IN CLINICAL MEDICINE: Segmental Diverticulitis

Robert S. Fisher, M.D. and Siva P. Doma, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

An 80-year-old man with a history of irritable bowel syndrome presented with a 5-day history of abdominal pain in the left lower quadrant, without aggravating or relieving factors. His last...

ORIGINAL ARTICLE: Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Background: An ingestible capsule consisting of an endoscope equipped with a video camera at both ends was designed to explore the colon. This study compared capsule endoscopy with optical colonoscopy...

IMAGES IN CLINICAL MEDICINE: Telltale Triangle of Pneumoperitoneum

Ming-Yuan Huang, M.D. and Wen-Han Chang, M.D., Ph.D. — Thu, 02Â JulÂ 2009 00:00:00 -05:00

A 56-year-old man presented to the emergency department with a 3-day history of diarrhea and dull epigastric pain. The diarrhea had responded to antidiarrheal agents. However, the epigastric pain had...

IMAGES IN CLINICAL MEDICINE: Ingested Magnets

Luigi Avolio, M.D. and Giuseppe Martucciello, M.D. — Thu, 25Â JunÂ 2009 00:00:00 -05:00

A 9-year-old boy ingested 23 magnets (Panel A). Four days later, he had clinical and surgical evidence of intestinal perforation and peritonitis due to pressure necrosis of the bowel. In...

IMAGES IN CLINICAL MEDICINE: Perforated Umbilical Hernia

Radheshyam Miryala, M.D. and Ryan Neilan, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

A 68-year-old man with alcoholic cirrhosis, portal hypertension, ascites, and an umbilical hernia presented to the emergency department after an episode of coughing that was followed by a rush of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2009 â A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Dr. Stephanie Heon (HematologyâOncology): A 63-year-old woman was seen in the Cancer Center at this hospital for management of adenocarcinoma of the gastroesophageal junction.

The patient had been well until approximately...

EDITORIAL: Radiofrequency Ablation â Great for Some or Justified for Many?

Jacques J.G.H.M. Bergman, M.D., Ph.D. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

In the past four decades, the incidence of esophageal adenocarcinoma has increased by 500%, paralleled by a similar increase in the rate of death associated with this often fatal disease.12...

ORIGINAL ARTICLE: Radiofrequency Ablation in Barrett's Esophagus with Dysplasia

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Background: Barrett's esophagus, a condition of intestinal metaplasia of the esophagus, is associated with an increased risk of esophageal adenocarcinoma. We assessed whether endoscopic radiofrequency ablation could eradicate dysplastic Barrett's...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Dr. Mathias Lichterfeld (Infectious Disease): A 25-year-old man was admitted to this hospital because of coma after cardiac arrest.

He had been well until 4 hours before admission, when he was...

IMAGES IN CLINICAL MEDICINE: Fecaliths in Crohn's Disease

Agnes K. Liman, M.D. and Blazej Zbytek, M.D., Ph.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

A 74-year-old man presented with a 5-day history of diffuse abdominal pain, constipation, nausea, and vomiting. His abdomen was tympanitic without peritoneal signs. Radiography of the abdomen revealed a dilated...

BOOK REVIEW:

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Pancreatic Cancer is the latest title in the M.D. Anderson Solid Tumor Oncology Series from Springer. It is the second book in the series to address pancreatic cancer; the first...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2009 â A 36-Year-Old Man with Chest Pain, Dysphagia, and Pleural and Mediastinal Calcifications

Henning A. Gaissert, M.D., Nitra Piyavisetpat, M.D., and Eugene J. Mark, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 36-year-old man was admitted to the hospital because of chest pain, dysphagia, dyspnea, and pleural and mediastinal calcifications.

He had been well until approximately 6 years before admission, when a...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Crohn's Disease, Autophagy, and the Paneth Cell

Daniel J. Klionsky, Ph.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

Because of its very nature, the gastrointestinal tract is potentially subject to inflammation and infection. Much of its surface is designed to be highly exposed and absorptive, yet it faces...

EDITORIAL: Silent Acid Reflux and Asthma Control

Koichiro Asano, M.D., and Hidekazu Suzuki, M.D., Ph.D. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

There are some patients with asthma who have a good response to standard therapy, but there are always some whose symptoms are not well controlled despite treatment with standard asthma...

ORIGINAL ARTICLE: Efficacy of Esomeprazole for Treatment of Poorly Controlled Asthma

The American Lung Association Asthma Clinical Research Centers — Thu, 09Â AprÂ 2009 00:00:00 -05:00

Background: Gastroesophageal reflux is common among patients with asthma but often causes mild or no symptoms. It is not known whether treatment of gastroesophageal reflux with proton-pump inhibitors in patients...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2009 â An 81-Year-Old Man with Massive Rectal Bleeding

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Dr. John C. Lamattina (Surgery): An 81-year-old man was admitted to this hospital because of massive rectal bleeding.

He had been in his usual state of health until 4 a.m. on...

BOOK REVIEW:

Thu, 12Â MarÂ 2009 00:00:00 -05:00

If multiple authorship is a mark of quality, this book is a must-read. With 189 authors covering the oncology of the gastrointestinal tract from the esophagus to the anus, as...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

Thu, 05Â MarÂ 2009 00:00:00 -05:00

In late January, we presented the case of an unresponsive, 56-year-old homeless patient who had a ruptured aneurysm, a high probability of cancer, and a best prognosis of severe disability...

PERSPECTIVE: Serotonin Rising â The Bone, Brain, Bowel Connection

Thu, 05Â MarÂ 2009 00:00:00 -05:00

In a recent article, Yadav et al.1 elucidated the regulation of gut-produced serotonin by low-density lipoprotein receptorârelated protein 5 (Lrp5) and the deleterious effect of serotonin on bone mass. This...

IMAGES IN CLINICAL MEDICINE: Achalasia

Chi-Yen Liang, M.D. and Ming-Shian Lin, M.D. — Thu, 19Â FebÂ 2009 00:00:00 -05:00

A 68-year-old woman presented with fever and dull pleuritic pain in the left chest wall. Chest radiography revealed a large mass with an air-fluid level in the right hemithorax (Panel...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inflammatory Bowel Disease, Stress, and the Endoplasmic Reticulum

Hans Clevers, M.D., Ph.D. — Thu, 12Â FebÂ 2009 00:00:00 -05:00

The causes of Crohn's disease and ulcerative colitis are poorly understood, despite having been defined many decades ago on the basis of their clinical manifestations. Experiments involving transgenic mice and...

IMAGES IN CLINICAL MEDICINE: A Smooth, Shiny Tongue

Hyo Jin Lee, M.D. and Deog Yeon Jo, M.D. — Thu, 05Â FebÂ 2009 00:00:00 -05:00

A 77-year-old woman presented with an insidious onset of fatigue and a burning sensation of the tongue on swallowing food. Six years earlier, she had undergone a total gastrectomy for...

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

Thu, 05Â FebÂ 2009 00:00:00 -05:00

A 50-year-old woman reported multiple loose bowel movements associated with mild, cramping abdominal pain. She had been well until 2 months earlier, when her bowel habits changed from one formed...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis

Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 56-year-old homeless man was found having a seizure and was transported to the hospital. He was found to have a subarachnoid hemorrhage and acute hydrocephalus. He underwent intubation, and...

BOOK REVIEW:

Thu, 22Â JanÂ 2009 00:00:00 -05:00

There is a traditional belief that a physician can follow one of two distinct career paths: a medical specialty or a surgical specialty. Anyone working in pancreatic medicine, however, recognizes...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

Ioannis Karakis, M.D. and Christos Kosmas, M.D. — Thu, 22Â JanÂ 2009 00:00:00 -05:00

A 56-year-old woman with a medical history notable for epilepsy, scoliosis, and chronic constipation presented with shortness of breath and cough, which she reported having had for the past 10...

CORRESPONDENCE: Reports of Esophageal Cancer with Oral Bisphosphonate Use

Diane K. Wysowski, Ph.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

To the Editor: Between the time of the initial marketing of alendronate in October 1995 through mid-May 2008, the Food and Drug Administration (FDA) received reports of 23 patients in...

ORIGINAL ARTICLE: Decontamination of the Digestive Tract and Oropharynx in ICU Patients

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome...

EDITORIAL: Shared Genetic Risk Factors for Type 1 Diabetes and Celiac Disease

Robert M. Plenge, M.D., Ph.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

Some families seem to be afflicted with more than their fair share of chronic illness â and sometimes more than one. Why does a particular disease develop in some members...

ORIGINAL ARTICLE: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Two inflammatory disorders, type 1 diabetes and celiac disease, cosegregate in populations, suggesting a common genetic origin. Since both diseases are associated with the HLA class II genes on...

BOOK REVIEW:

Thu, 13Â NovÂ 2008 00:00:00 -05:00

The development of intravenous nutrition that enables patients to survive for months or years, even when they are completely dependent on it, should be considered one of the major medical...

REVIEW ARTICLE: â More Difficult Than Ever

CiarÃ¡n P. Kelly, M.D., and J. Thomas LaMont, M.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

In 1935, Hall and O'Toole first isolated a gram-positive, cytotoxin-producing anaerobic bacterium from the stool of healthy neonates.1 They named it Bacillus difficilis to reflect the difficulties they encountered in...

CORRESPONDENCE: Antiemetic Properties of the Antiepileptic Drug Levetiracetam

Thu, 23Â OctÂ 2008 00:00:00 -05:00

To the Editor: Chemotherapy-induced nausea and vomiting is an important problem in patients with brain tumors. Because of the high prevalence of seizures, most patients are given antiepileptic drugs. Motivated...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

Charles M. Wiener, M.D., Victorine V. Muse, M.D., and Eugene J. Mark, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

Dr. Andrew Tinsley (Medicine): A 63-year-old woman was admitted to this hospital because of dyspnea on exertion.

The patient had been in her usual state of health until approximately 3 weeks...

CLINICAL PRACTICE: Gastroesophageal Reflux Disease

Peter J. Kahrilas, M.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

Gastroesophageal reflux disease is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics.1 In the United States, it is estimated that 14 to 20% of adults are affected,...

IMAGES IN CLINICAL MEDICINE: Pneumopericardium

Mehdi Karoui, M.D., Ph.D. and Petru Octav Bucur, M.D. — Thu, 02Â OctÂ 2008 00:00:00 -05:00

A 47-year-old homeless man presented to the emergency department 1 week after the onset of chest pain. He was hemodynamically stable. The physical examination was unremarkable. A routine complete blood...

IMAGES IN CLINICAL MEDICINE: Colonic Saccular Diverticula

Elizabeth A. Steensma, M.D. and Fred M. Wu, M.D. — Thu, 18Â SepÂ 2008 00:00:00 -05:00

A 61-year-old woman with severe pulmonary hypertension and an 8-year history of the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) and with a positive anticentromere-antibody test was...

BOOK REVIEW:

Thu, 18Â SepÂ 2008 00:00:00 -05:00

Gastrointestinal disease in children is often the orphan of clinical inquiry and scientific investigation. This book provides a thorough update of the pathophysiology and clinical features of gastrointestinal disease in...

IMAGES IN CLINICAL MEDICINE: Primary Small-Bowel Enterolithiasis

Robert L. Wroblewski, M.D. and Robert P. Sticca, M.D. — Thu, 18Â SepÂ 2008 00:00:00 -05:00

A 53-year-old woman with a 2-year history of intermittent abdominal pain, diarrhea, and constipation presented for evaluation. Her medical history was significant for congenital imperforate anus requiring a colostomy at...

IMAGES IN CLINICAL MEDICINE: Hyperinfection

Stephen R. Gorman, D.O., M.S. and Donald E. Craven, M.D. — Thu, 11Â SepÂ 2008 00:00:00 -05:00

A 46-year-old man with Raynaud's disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An...

CLINICAL PROBLEM-SOLVING: Collateral Damage

Thu, 04Â SepÂ 2008 00:00:00 -05:00

A 50-year-old white man presented to the emergency room with an 18-hour history of severe right-sided abdominal and flank pain. The patient had a history of hypothyroidism, autoimmune alopecia, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 â A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

Theodore I. Steinman, M.D., Anthony E. Samir, M.D., and Lynn D. Cornell, M.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated level of serum creatinine. The patient had been in his usual state of health...

REVIEW ARTICLE: Management of Acute Bleeding from a Peptic Ulcer

Thu, 28Â AugÂ 2008 00:00:00 -05:00

Acute upper gastrointestinal hemorrhage, which is defined as bleeding proximal to the ligament of Treitz, is a prevalent and clinically significant condition with important implications for health care costs worldwide....

BOOK REVIEW:

Thu, 14Â AugÂ 2008 00:00:00 -05:00

This textbook is an informative resource concerning core principles and practices in gastrointestinal oncology. It covers a wide range of practice areas, with good examples of pathology and radiologic images...

BOOK REVIEW:

Thu, 14Â AugÂ 2008 00:00:00 -05:00

The pancreas is one of the least accessible abdominal organs, and even in the 21st century it carries an aura of mystery and challenge. Benign diseases of the pancreas are...

CORRESPONDENCE: Glucagon-like Peptide 1âReceptor Scans to Localize Occult Insulinomas

Thu, 14Â AugÂ 2008 00:00:00 -05:00

To the Editor: The precise localization of some insulinomas (islet-cell adenomas that secrete insulin) with the use of conventional imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI),...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Harnessing the Power of Bacteria to Protect the Gut

Maria T. Abreu, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

The small intestine is a lush, dynamic organ with a big job to do. Its villi and microvilli provide a platform for nutrient absorption, but at the same time, the...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Patching a Leaky Intestine

Wayne I. Lencer, M.D. — Thu, 31Â JulÂ 2008 00:00:00 -05:00

In patients with protein-losing enteropathy, the intestinal mucosa completely fails to function as a competent barrier separating the body from the outside world. Serum fluids and proteins quickly leak into...

ORIGINAL ARTICLE: D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer

Thu, 31Â JulÂ 2008 00:00:00 -05:00

Background: Gastrectomy with D2 lymphadenectomy is the standard treatment for curable gastric cancer in eastern Asia. Whether the addition of para-aortic nodal dissection (PAND) to D2 lymphadenectomy for stage T2,...

PERSPECTIVE: Gastric Cancer in Japan â Honing Treatment, Seeking Causes

Thu, 31Â JulÂ 2008 00:00:00 -05:00

In this issue of the Journal, Sasako and colleagues (pages 453â462) present results from a randomized trial of surgery for gastric cancer conducted in 24 specialized hospitals in Japan. The...

IMAGES IN CLINICAL MEDICINE: Sclerosing Peritonitis

Katsuya Shiraki, M.D. and Hiroyuki Sakurai, M.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

A 59-year-old woman with the BuddâChiari syndrome was admitted for increasing abdominal distention, abdominal pain, and vomiting during a period of 8 weeks. She had normal renal function and had...

CLINICAL PROBLEM-SOLVING: A Gut Feeling

Thu, 03Â JulÂ 2008 00:00:00 -05:00

A 72-year-old man presented with a 3-month history of watery diarrhea. This condition was associated with intermittent fevers, abdominal pain, and weight loss of 15 lb (6.8 kg). The patient...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

Thu, 26Â JunÂ 2008 00:00:00 -05:00

Dr. Allyson K. Bloom (Medicine): A 57-year-old woman was admitted to this hospital because of abdominal pain and weakness. One month earlier, a laparoscopic Roux-en-Y gastric bypass and cholecystectomy were...

CLINICAL PRACTICE: Acute Calculous Cholecystitis

Steven M. Strasberg, M.D. — Thu, 26Â JunÂ 2008 00:00:00 -05:00

Acute calculous cholecystitis is a complication of cholelithiasis, a condition that afflicts more than 20 million Americans annually1 and results in direct costs of more than $6.3 billion.2 Most patients...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Tumor Necrosis Factor Î± and Colitis-Associated Colon Cancer

Joanne A.P. Wilson, M.D. — Thu, 19Â JunÂ 2008 00:00:00 -05:00

Colon cancer is one of the most serious complications of chronic inflammatory bowel disease. The cumulative risk ranges from 2% among patients who have had colitis for 10 years to...

REVIEW ARTICLE: Chemotherapy-Induced Nausea and Vomiting

Paul J. Hesketh, M.D. — Thu, 05Â JunÂ 2008 00:00:00 -05:00

The supportive care of patients receiving antineoplastic treatment has dramatically improved over the past two decades. The development of effective means to prevent nausea and vomiting arising from chemotherapy serves...

IMAGES IN CLINICAL MEDICINE: Severe Constipation

Gustavo Cumbo-Nacheli, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

A 46-year-old man with a history of cerebral palsy presented with difficulty in breathing, which had gradually increased during the previous 2 weeks. He was admitted to the intensive care...

EDITORIAL: The Long and Short of a Constipation-Reducing Medication

Arthur J. Moss, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

In this issue of the Journal, Camilleri et al.1 report on their 12-week randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of prucalopride in the treatment of chronic...

EDITORIAL: Opioid Side Effects â Mechanism-Based Therapy

Charles Berde, M.D., Ph.D., and Samuel Nurko, M.D., M.P.H. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

Opioid analgesics generate numerous side effects that complicate their use in postoperative care,1 in the treatment of sickle cell vaso-occlusive episodes, and in the treatment of pain associated with advanced...

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Prucalopride for Severe Chronic Constipation

Thu, 29Â MayÂ 2008 00:00:00 -05:00

Background: In this 12-week trial, we aimed to determine the efficacy of prucalopride, a selective, high-affinity 5-hydroxytryptamine4 receptor agonist, in patients with severe chronic constipation.

Methods: In our multicenter, randomized, placebo-controlled,...

ORIGINAL ARTICLE: Methylnaltrexone for Opioid-Induced Constipation in Advanced Illness

Thu, 29Â MayÂ 2008 00:00:00 -05:00

Background: Constipation is a distressing side effect of opioid treatment. As a quaternary amine, methylnaltrexone, a Î¼-opioidâreceptor antagonist, has restricted ability to cross the bloodâbrain barrier. We investigated the safety...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: How HIV Guts the Immune System

R. Paul Johnson, M.D. — Thu, 22Â MayÂ 2008 00:00:00 -05:00

Although in the absence of treatment, the acquired immunodeficiency syndrome (AIDS) generally develops 8 to 10 years after infection with human immunodeficiency virus (HIV) type 1 (HIV-1), the onslaught on...

CLINICAL PROBLEM-SOLVING: Back to Basics

Ilan Gabriely, M.D., James P. Leu, M.D., and Uriel S. Barzel, M.D. — Thu, 01Â MayÂ 2008 00:00:00 -05:00

A 41-year-old woman was brought by her husband to the emergency department with a history of 72 hours of epigastric pain, nausea, repeated vomiting, and altered mental status. Her blood...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Mast Cells and Pancreatic Cancer

Theoharis C. Theoharides, Ph.D., M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

Pancreatic ductal adenocarcinoma is probably the most lethal cancer, with a median survival of less than 6 months and a 5-year survival rate of less than 5%. The cause of...

CLINICAL PRACTICE: Irritable Bowel Syndrome

Emeran A. Mayer, M.D. — Thu, 17Â AprÂ 2008 00:00:00 -05:00

Irritable bowel syndrome (IBS), characterized by chronically recurring abdominal pain or discomfort and altered bowel habits, is one of the most common syndromes seen by gastroenterologists and primary care providers,...

IMAGES IN CLINICAL MEDICINE: Ascariasis

Myoung Kuk Jang, M.D. and Ki Sung Lee, M.D. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. There was no abdominal tenderness. Laboratory evaluation was notable for...

IMAGES IN CLINICAL MEDICINE: Small-Bowel Obstruction

Fabrice Dedouit, M.D. and Philippe Otal, M.D. — Thu, 27Â MarÂ 2008 00:00:00 -05:00

A 72-year-old woman presented with a 2-day history of abdominal pain associated with nausea and vomiting. Over the previous 10 years, she had had progressive Alzheimer's disease, requiring her to...

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Epigastric Pain

Rangan Murali, M.D. and Bashar M. Attar, M.D., Ph.D. — Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 82-year-old woman presented with respiratory symptoms, and a chest film was obtained. Six years later, she presented with epigastric pain, nausea, and vomiting. What is the diagnosis?...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inflammatory Bowel Disease â Live Transmission

Gail A. Hecht, M.D. — Thu, 31Â JanÂ 2008 00:00:00 -05:00

Inflammatory bowel disease results from a dysregulated immunologic response to commensal microbial flora residing in the intestinal lumen. Although this response is probably due at least in part to a...

IMAGES IN CLINICAL MEDICINE: Leukemic Gingival Infiltration

Aparna Mani, M.S. and David A. Lee, M.D. — Thu, 17Â JanÂ 2008 00:00:00 -05:00

An otherwise healthy 36-year-old man presented with a 6-day history of bleeding gums and abdominal pain in the left upper quadrant. He reported having had fevers, fatigue, decreased appetite, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2008 â A 45-Year-Old Man with Sudden Onset of Abdominal Pain and Hypotension

Thu, 10Â JanÂ 2008 00:00:00 -05:00

Dr. Megan Fix (Emergency Medicine): A 45-year-old man was transferred on an emergency basis to this hospital from a community health center because of abdominal pain and hypotension.

On the day...

ORIGINAL ARTICLE: Capecitabine and Oxaliplatin for Advanced Esophagogastric Cancer

Thu, 03Â JanÂ 2008 00:00:00 -05:00

Background: We evaluated capecitabine (an oral fluoropyrimidine) and oxaliplatin (a platinum compound) as alternatives to infused fluorouracil and cisplatin, respectively, for untreated advanced esophagogastric cancer.

Methods: In a two-by-two design, we...

IMAGES IN CLINICAL MEDICINE: Small-Bowel Intussusception

Colin H. Wilson, M.R.C.S. and Steve A. White, M.D., F.R.C.S. — Thu, 27Â DecÂ 2007 00:00:00 -05:00

A previously healthy 22-year-old man presented with a 3-month history of intermittent abdominal pain and hypochromic microcytic anemia, with a hemoglobin level of 5.1 g per deciliter and a mean...

IMAGES IN CLINICAL MEDICINE: Chronic BuddâChiari Syndrome and Abdominal Varices

Sanjay Sharma, M.D. and Harsh Kandpal, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

A 44-year-old man with a 20-year history of chronic liver disease presented with recurrent acute upper gastrointestinal bleeding and worsening mental status. He was emaciated, with marked abdominal distention due...

CLINICAL PROBLEM-SOLVING: The Leading Diagnosis â A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration

Thomas E. Baudendistel, M.D., Amy K. Haase, M.D., and Faith Fitzgerald, M.D. — Thu, 06Â DecÂ 2007 00:00:00 -05:00

A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration. The pain was followed by nausea and episodes of bilious vomiting and...

IMAGES IN CLINICAL MEDICINE: Trichobezoar

Ronald M. Levy, M.D. and Srinadh Komanduri, M.D. — Thu, 22Â NovÂ 2007 00:00:00 -05:00

A previously healthy 18-year-old woman presented with a 5-month history of pain in the left upper quadrant of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2007 â A 30-Year-Old Man with Inflammatory Bowel Disease and Recent Onset of Fever and Bloody Diarrhea

Thu, 15Â NovÂ 2007 00:00:00 -05:00

Dr. Patrick S. Yachimski (Gastroenterology): A 30-year-old Moroccan man was admitted to this hospital because of fever, abdominal pain, and bloody diarrhea.

The patient had a history of inflammatory bowel disease...

CLINICAL PRACTICE: Diverticulitis

Danny O. Jacobs, M.D., M.P.H. — Thu, 15Â NovÂ 2007 00:00:00 -05:00

A previously healthy 45-year-old man presents with severe lower abdominal pain on the left side, which started 36 hours earlier. He has noticed mild, periodic discomfort in this region before...

EDITORIAL: East Meets West in the Treatment of Gastric Cancer

David Cunningham, M.D., and Yu Jo Chua, M.B., B.S. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

Gastric cancer is a leading cause of illness and death from cancer worldwide, with nearly a million new cases diagnosed each year and a 5-year survival rate of less than...

IMAGES IN CLINICAL MEDICINE: Herpes Labialis

Julian W. Tang, M.D. and Paul K.S. Chan, M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A 68-year-old man with a history of asthma and chronic obstructive pulmonary disease was admitted to our hospital with a 1-day history of dyspnea, fever, and epigastric and chest pain....

ORIGINAL ARTICLE: Adjuvant Chemotherapy for Gastric Cancer with S-1, an Oral Fluoropyrimidine

Thu, 01Â NovÂ 2007 00:00:00 -05:00

Background: Advanced gastric cancer can respond to S-1, an oral fluoropyrimidine. We tested S-1 as adjuvant chemotherapy in patients with curatively resected gastric cancer.

Methods: Patients in Japan with stage II...

REVIEW ARTICLE: Celiac Disease

Peter H.R. Green, M.D., and Christophe Cellier, M.D., Ph.D. — Thu, 25Â OctÂ 2007 00:00:00 -05:00

Celiac disease is a unique autoimmune disorder, unique because the environmental precipitant is known. The disorder was previously called celiac sprue, based on the Dutch word sprue, which was used...

IMAGES IN CLINICAL MEDICINE: Medical Mystery â An Unusual Complication of Colonoscopy

Marc A. Gladman, Ph.D., M.R.C.S. and Shukri S. Shami, M.S., F.R.C.S. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

A 69-year-old man presented to the emergency department with a 3-day history of left-sided lower abdominal and groin pain. The pain had begun 36 hours after the patient had undergone...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2007 â A 51-Year-Old Man with Gastric Cancer and Lung Nodules

Edward T. Ryan, M.D., Suzanne L. Aquino, M.D., and Richard L. Kradin, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

Dr. Allison L. McDonough (Internal Medicine): A 51-year-old man with a history of gastric cancer was admitted to the hospital because of a new pulmonary lesion.

The patient had been in...

IMAGES IN CLINICAL MEDICINE: Emphysematous Cholecystitis

Yogesh Shrestha, M.D. and Steven Trottier, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A 70-year-old man with a history of heart disease, hyperlipidemia, and diabetes mellitus presented at the hospital with a 4-day history of increasing abdominal pain, nausea, and vomiting. The temperature...

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

Chuang-Wei Chen, M.D. and Shu-Wen Jao, Ph.D. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

A 20-year-old man presented for consideration of repair of a rectal prolapse that had been present since birth. Physical examination revealed hyperelasticity of the skin (Panel A) with easy bruisability,...

CLINICAL PROBLEM-SOLVING: A Stitch in Time â A 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue

Thu, 06Â SepÂ 2007 00:00:00 -05:00

A 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue. These symptoms...

IMAGES IN CLINICAL MEDICINE: Taenia in the Gastrointestinal Tract

Wen-Shen Liao, M.D. and Ming Jong Bair, M.D. — Thu, 06Â SepÂ 2007 00:00:00 -05:00

A healthy 60-year-old woman presented with hematemesis and melena, which she had had for 1 day. Her physical examination was unremarkable, as were the results of routine blood tests. On...

IMAGES IN CLINICAL MEDICINE: Oral Acanthosis Nigricans

Christina Schnopp, M.D. and Julia Baumstark, M.D. — Thu, 30Â AugÂ 2007 00:00:00 -05:00

A 44-year-old woman presented with increasing oral papillomatosis, predominantly on the lips and less pronounced on the tongue and buccal mucosa. The lips showed filiform papillomas in a symmetrical distribution...

IMAGES IN CLINICAL MEDICINE: PeutzâJeghers Syndrome

Elizabeth Cureton, M.D. and Sunghoon Kim, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

A previously healthy 12-year-old boy presented with abdominal pain, vomiting, and abdominal distention of 3 days' duration. On physical examination, hyperpigmented macules were seen on his lips (Panel A). A...

IMAGES IN CLINICAL MEDICINE: Endometriosis

Simone Ferrero, M.D. and Valentino Remorgida, M.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

A 36-year-old woman presented with a 2-month history of abdominal distention and pain. She reported having dysmenorrhea, dyspareunia, cyclical right shoulder pain (occurring only at the time of menstruation), and...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Bugging of the Intestinal Mucosa

Clara Abraham, M.D., and Judy H. Cho, M.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

An enormous array of adaptive mechanisms on both sides of the hostâmicrobial interface reflects a complex coevolution. Deciphering the cross-talk at this interface may yield new insights into its relevance...

IMAGES IN CLINICAL MEDICINE: Intravesical Foreign Body

Nicola Mondaini, M.D. and Riccardo Bartoletti, M.D. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

An 82-year-old woman presented with abdominal colic. She had a 20-year history of type 2 diabetes and a 2-year history of recurrent urinary tract infections despite many courses of antimicrobial...

IMAGES IN CLINICAL MEDICINE: An Intraabdominal Cyst

Cornelis H. van der Vlies, M.D. and Olivier R.C. Busch, M.D., Ph.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

A 50-year-old woman presented with abdominal tenderness, fever, and vaginal bleeding. Physical examination showed a periumbilical mass and necrosis of the upper wall of the vagina. Laboratory data were notable...

EDITORIAL: Anti-TNF Antibodies for Crohn's Disease â In Pursuit of the Perfect Clinical Trial

James D. Lewis, M.D., M.S.C.E. — Thu, 19Â JulÂ 2007 00:00:00 -05:00

For decades, many patients with Crohn's disease required prolonged courses of corticosteroids, repeated surgeries, or both, despite treatment with 5-aminosalicylic acid (mesalamine) or immunomodulators such as azathioprine. The introduction of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2007 â A Woman with a Family History of Gastric and Breast Cancer

Thu, 19Â JulÂ 2007 00:00:00 -05:00

A 38-year-old woman was seen in the Gastrointestinal Cancer Genetics Clinic of this hospital because of a family history of breast and gastric cancer.

Approximately 15 months earlier, mild chronic gastrointestinal...

IMAGES IN CLINICAL MEDICINE: Virchow's Node (Troisier's Sign)

Keng Yin Loh, M.Med. and Abd Wahab Yushak, F.R.C.S. — Thu, 19Â JulÂ 2007 00:00:00 -05:00

A 56-year-old woman presented with jaundice and a painless mass in her left supraclavicular fossa that had become progressively enlarged during the preceding 8 weeks. Physical examination revealed a hard...

ORIGINAL ARTICLE: Maintenance Therapy with Certolizumab Pegol for Crohn's Disease

Thu, 19Â JulÂ 2007 00:00:00 -05:00

Background: Certolizumab pegol is a pegylated humanized Fabâ² fragment with a high binding affinity for tumor necrosis factor Î± that does not induce apoptosis of T cells or monocytes.

Methods: In...

ORIGINAL ARTICLE: Certolizumab Pegol for the Treatment of Crohn's Disease

Thu, 19Â JulÂ 2007 00:00:00 -05:00

Background: Certolizumab pegol is a pegylated humanized Fabâ² fragment that binds tumor necrosis factor Î±.

Methods: In a randomized, double-blind, placebo-controlled trial, we evaluated the efficacy of certolizumab pegol in 662...

IMAGES IN CLINICAL MEDICINE: Peripheral Smear with

Parul Bhargava, M.B., B.S. and Lorinda P. Longhi, B.S., M.T. — Thu, 14Â JunÂ 2007 00:00:00 -05:00

A 53-year-old man with crohn's disease, short-bowel syndrome that required total parenteral nutrition, a history of recurrent catheter infections, hypertension, chronic renal insufficiency, and mitral regurgitation presented with fevers of...

IMAGES IN CLINICAL MEDICINE: Diffuse Chemoradiotherapy-Related Enterocolitis

Hon-Yi Lin, M.D. and Yee-Min Jen, M.D., Ph.D. — Thu, 14Â JunÂ 2007 00:00:00 -05:00

An 86-year-old man received a diagnosis of stage IV adenocarcinoma of the rectum, with metastatic disease noted below the aortic bifurcation. He had no history of inflammatory bowel disease. He...

IMAGES IN CLINICAL MEDICINE: Chronic Calcific Pancreatitis

Varsha Babu, M.B.,B.S. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

A 40-year-old man with a 4-year history of diabetes mellitus and no history of gallstones was admitted to the health center after acute alcohol intoxication. He had been consuming about...

ORIGINAL ARTICLE: Bacteremia, Fever, and Splenomegaly Caused by a Newly Recognized Bartonella Species

Thu, 07Â JunÂ 2007 00:00:00 -05:00

Bartonella species cause serious human infections globally, including bacillary angiomatosis, Oroya fever, trench fever, and endocarditis. We describe a patient who had fever and splenomegaly after traveling to Peru and...

CLINICAL THERAPEUTICS: Bariatric Surgery for Morbid Obesity

Eric J. DeMaria, M.D. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A 44-year-old obese woman (height, 1.7 m [65 in.]) has seen her primary care physician for the past 10 years for management of conditions related to her obesity, including diabetes,...

IMAGES IN CLINICAL MEDICINE: Eosinophilic Esophagitis

Rami Hawari, M.D. and Pankaj Jay Pasricha, M.D. — Thu, 17Â MayÂ 2007 00:00:00 -05:00

A 51-year-old woman with a history of childhood asthma presented with a sensation of food impaction. Upper gastrointestinal endoscopy revealed classic âfelineâ esophagus, with mucosal rings (Panel A) and an...

CLINICAL PROBLEM-SOLVING: The Drenched Doctor â A 55-year-old male physician was seen in August because of a 1-week history of fever and night sweats

Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 55-year-old male physician was seen in August because of a 1-week history of fever and night sweats. The night sweats required at least one nightly change of his pajamas...

IMAGES IN CLINICAL MEDICINE: Pulmonary and Peritoneal Ossification

Phillip H. Kuo, M.D., Ph.D. and Myung Soo Shin, M.D., D.Sc. — Thu, 26Â AprÂ 2007 00:00:00 -05:00

A 20-year-old man, who had long-standing end-stage renal disease and was receiving peritoneal dialysis, presented with fever and abdominal pain. The patient began peritoneal dialysis at the age of 4...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2007 â A 46-Year-Old Woman with Gynecologic and Intestinal Cancers

Thu, 26Â AprÂ 2007 00:00:00 -05:00

A 46-year-old woman came to the Center for Cancer Risk Analysis at the Cancer Center of this hospital because of recent diagnoses of endometrial, ovarian, and colonic cancers.

Fifteen weeks earlier,...

IMAGES IN CLINICAL MEDICINE: Intestinal Obstruction Due to Inspissated Barium

Mohamed A. Kurer, M.Sc. and Srinivas Chintapatla, F.R.C.S. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

A 64-year-old woman with ulcerative colitis presented with abdominal pain. Plain radiography of the abdomen showed dilatation of the large bowel with a plug of barium (Panel A, arrow) and...

CLINICAL PRACTICE: Fecal Incontinence in Adults

Arnold Wald, M.D. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

A 53-year-old otherwise healthy woman presents with a 2-year history of intermittent fecal incontinence. Because of embarrassment, she has curtailed her social and professional activities. Physical activity often precipitates an...

ORIGINAL ARTICLE: Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding

Thu, 19Â AprÂ 2007 00:00:00 -05:00

Background: A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2007 â A 55-Year-Old Man Impaled in a Rowing Accident

Thu, 29Â MarÂ 2007 00:00:00 -05:00

A 55-year-old man was admitted to this hospital after being impaled by the prow of a racing shell in a rowing accident.

The patient, who was in excellent health, was sculling...

IMAGES IN CLINICAL MEDICINE: Small-Bowel Obstruction Due to an Internal Hernia

Kao-Lang Liu, M.D. and Been-Ren Lin, M.D. — Thu, 15Â MarÂ 2007 00:00:00 -05:00

A 48-year-old healthy woman presented with anorexia of 2 days' duration and abdominal pain in the right lower quadrant. Since appendicitis was suspected, she underwent a laparoscopic examination. An inflamed...

IMAGES IN CLINICAL MEDICINE: Floating Kidneys

Patrick O. Myers, M.D. and Gilles Chassot, M.D. — Thu, 08Â MarÂ 2007 00:00:00 -05:00

A 48-year-old man with multiple myeloma and a history of a repaired umbilical hernia and four thromboembolic events was admitted for cramping abdominal pain associated with back pain and a...

IMAGES IN CLINICAL MEDICINE: Gastric-Outlet Obstruction

Luis M. Franco, M.D. and Natalie J. Dryden, M.D. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

A 51-year-old woman with a history of hypertension and chronic constipation presented with abdominal pain of 2 weeks' duration. The pain was continuous, worsened with eating, was associated with nausea,...

CLINICAL PRACTICE: Diabetic Gastroparesis

Michael Camilleri, M.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

A 36-year-old man with a 20-year history of type 1 diabetes mellitus, background retinopathy, peripheral sensory neuropathy, and nephropathy presents with a history of several months of nausea and vomiting...

EDITORIAL: Is There a Role for the Endoscopic Treatment of Pain from Chronic Pancreatitis?

Grace H. Elta, M.D. — Thu, 15Â FebÂ 2007 00:00:00 -05:00

The treatment of the pain of chronic pancreatitis continues to be problematic. Although severe calcific pancreatitis can be asymptomatic, it can cause disabling pain daily. Medical management with abstinence from...

ORIGINAL ARTICLE: Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis

Thu, 15Â FebÂ 2007 00:00:00 -05:00

Background: For patients with chronic pancreatitis and a dilated pancreatic duct, ductal decompression is recommended. We conducted a randomized trial to compare endoscopic and surgical drainage of the pancreatic duct.

Methods:...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery: Dilated Bowel

Jason Handwerker, M.D. and Vassilios D. Raptopoulos, M.D. — Thu, 01Â FebÂ 2007 00:00:00 -05:00

A 70-year-old man presented with a history of increasing abdominal distention. On physical examination, the patient was afebrile and his abdomen was soft and nontender. An abdominal radiograph raised concern...

IMAGES IN CLINICAL MEDICINE: Complication of Central Venous Catheterization

Hangyuan Guo, M.D. — Thu, 11Â JanÂ 2007 00:00:00 -05:00

A 40-year-old man with Crohn's disease underwent an uncomplicated operation involving lysis of adhesions that were causing intestinal obstruction. After surgery, a cardiologist inserted a central venous catheter through the...

CLINICAL PROBLEM-SOLVING: A Stain in Time

Thu, 04Â JanÂ 2007 00:00:00 -05:00

A 45-year-old woman from northern Ontario presented to her local hospital with a 2-year history of asymmetric migratory arthralgias involving the left knee, ankles, elbows, and fingers. She also had...

REVIEW ARTICLE: Whipple's Disease

Thu, 04Â JanÂ 2007 00:00:00 -05:00

The discovery of Whipple's disease and its causative bacterium, Tropheryma whipplei, is a prime example of how modern technologies have contributed to medical knowledge. Although Whipple's disease was first described...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2006 â A 64-Year-Old Man with Anemia and a Low Level of HDL Cholesterol

Thu, 28Â DecÂ 2006 00:00:00 -05:00

A 64-year-old man was seen as an outpatient in the hematology division of this hospital because of anemia and a low serum level of high-density lipoprotein (HDL) cholesterol. A mild...

EDITORIAL: Carbapenems for Surgical Prophylaxis?

Daniel J. Sexton, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

In this issue of the Journal, Itani and colleagues1 describe a study in which 1002 patients were randomly assigned to receive either ertapenem or cefotetan in a single dose before...

REVIEW ARTICLE: Autoimmune Pancreatitis

Thu, 21Â DecÂ 2006 00:00:00 -05:00

The term âautoimmune pancreatitisâ (or âautoimmune-related pancreatitisâ) was introduced by Yoshida et al. in 1995 to describe the form of chronic pancreatitis that is associated with autoimmune manifestations revealed on...

ORIGINAL ARTICLE: Ertapenem versus Cefotetan Prophylaxis in Elective Colorectal Surgery

Thu, 21Â DecÂ 2006 00:00:00 -05:00

Background: Ertapenem, a long-acting carbapenem, may be an alternative to the recommended prophylactic antibiotic cefotetan.

Methods: In this randomized, double-blind trial, we assessed the efficacy and safety of antibiotic prophylaxis with...

EDITORIAL: A Call to Action â Measuring the Quality of Colonoscopy

David Lieberman, M.D. — Thu, 14Â DecÂ 2006 00:00:00 -05:00

Several years ago I visited the Ming Tombs near Beijing. The Ming emperors were buried in elaborate structures, hidden away in the hills to prevent looting. Bricks were embedded with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2006 â A 5-Year-Old Boy with Headache and Abdominal Pain

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Dr. Kerstin Zanger (Pediatrics): A 5-year-old boy was admitted to the hospital because of headache, abdominal pain that had increased in severity and frequency, increasing abdominal girth, and a rash.

The...

CLINICAL PRACTICE: Adenomatous Polyps of the Colon

Joel S. Levine, M.D., and Dennis J. Ahnen, M.D. — Thu, 14Â DecÂ 2006 00:00:00 -05:00

A 52-year-old man with no personal or family history of colon cancer, colonic polyps, or inflammatory bowel disease underwent a screening colonoscopy that showed no abnormalities except for a 1.5-cm...

ORIGINAL ARTICLE: Colonoscopic Withdrawal Times and Adenoma Detection during Screening Colonoscopy

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Background: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas...

IMAGES IN CLINICAL MEDICINE: Medical Mystery â Abnormal Abdominal Radiograph

Kumiko Tajima, M.D., Ph.D. and Masahiko Kurabayashi, M.D., Ph.D. — Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 50-year-old woman presented to the emergency department with obtundation and hypotension. She had a 1-month history of slight fever, before which she had been well. On abdominal examination, an...

ORIGINAL ARTICLE: as a Causative Organism of Antibiotic-Associated Hemorrhagic Colitis

Thu, 07Â DecÂ 2006 00:00:00 -05:00

Background: Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated colitis in which Clostridium difficile is absent. Although the cause is not known, previous reports have suggested a role of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2006 â A 19-Year-Old Woman with Thyroid Cancer and Lower Gastrointestinal Bleeding

Thu, 30Â NovÂ 2006 00:00:00 -05:00

A 19-year-old woman was seen in the outpatient gastroenterology division because of painless rectal bleeding.

The patient had been well until 8 months earlier, when a diagnosis of papillary carcinoma was...

IMAGES IN CLINICAL MEDICINE: Crohn's Disease and an Olive

Susan Shedda, F.R.A.C.S. and Frank Frizelle, F.R.A.C.S. — Thu, 09Â NovÂ 2006 00:00:00 -05:00

An otherwise healthy 45-year-old man presented with a 3-day history of colicky central abdominal pain associated with nausea and vomiting. His bowel habits had not changed, and he had no...

VIDEOS IN CLINICAL MEDICINE: Paracentesis

Thu, 09Â NovÂ 2006 00:00:00 -05:00

...

CLINICAL PROBLEM-SOLVING: The Missing Piece

Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 21-year-old man presented to the emergency department after a 2-day history of increasing pain in the right lower quadrant. The pain was dull and nonradiating, was not exacerbated by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2006 â A 43-Year-Old Man with Diabetes, Hypogonadism, Cirrhosis, Arthralgias, and Fatigue

Raymond T. Chung, M.D., Joseph Misdraji, M.D., and Dushyant V. Sahani, M.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

A 43-year-old white man was seen at this hospital because of hypogonadism.

The patient had felt well until 6 months earlier, when he noted the gradual onset of fatigue, decreased libido,...

IMAGES IN CLINICAL MEDICINE: Obturator Hernia

Daniel Kam Yin Chan, M.D., M.B., B.S. — Thu, 19Â OctÂ 2006 00:00:00 -05:00

A previously healthy 102-year-old woman was admitted with abdominal pain and a 3-day history of vomiting. She lived with relatives, but cared for herself, and was able to garden. There...

IMAGES IN CLINICAL MEDICINE: Radiographic Appearance of Lanthanum

Simon Cerny, M.D. and Ulrich Kunzendorf, M.D. — Thu, 14Â SepÂ 2006 00:00:00 -05:00

An 82-year-old man with hypertension, coronary artery disease, congestive heart failure, chronic constipation, degenerative joint disease of the hips, and a 5-year history of hemodialysis for end-stage renal disease presented...

ORIGINAL ARTICLE: Chemotherapy with Preoperative Radiotherapy in Rectal Cancer

Thu, 14Â SepÂ 2006 00:00:00 -05:00

Background: Preoperative radiotherapy is recommended for selected patients with rectal cancer. We evaluated the addition of chemotherapy to preoperative radiotherapy and the use of postoperative chemotherapy in the treatment of...

EDITORIAL: Risks and Benefits of Celecoxib to Prevent Recurrent Adenomas

Bruce M. Psaty, M.D., Ph.D., and John D. Potter, M.B., B.S., Ph.D. — Thu, 31Â AugÂ 2006 00:00:00 -05:00

In late September 2004, the cardiovascular risks identified in a placebo-controlled adenoma-prevention trial that was terminated early precipitated the voluntary withdrawal from the market of the cyclooxygenase-2 (COX-2) inhibitor rofecoxib.1...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2006 â A 17-Year-Old Boy with Fever and Lesions in the Liver and Spleen

Stephen I. Pelton, M.D., John Y. Kim, M.D., and Richard L. Kradin, M.D. — Thu, 31Â AugÂ 2006 00:00:00 -05:00

Dr. Melissa Sue Lee (Pediatrics): A 17-year-old boy was admitted to this hospital because of fever and nodules in the liver and spleen. The patient had been well until two...

IMAGES IN CLINICAL MEDICINE: Anthrax of the Cecum

Antoine Ghossain, M.D. — Thu, 31Â AugÂ 2006 00:00:00 -05:00

A 25-year-old man was admitted for pain and distention of the abdomen. He had a three-day history of dizziness, fatigue, myalgia, and mild fever. On physical examination, he was in...

ORIGINAL ARTICLE: Celecoxib for the Prevention of Colorectal Adenomatous Polyps

Thu, 31Â AugÂ 2006 00:00:00 -05:00

Background: Overexpression of cyclooxygenase 2 (COX-2) has been associated with colorectal adenomatous polyps and cancer, prompting researchers to propose its inhibition as a chemopreventive intervention.

Methods: The Prevention of Colorectal Sporadic...

ORIGINAL ARTICLE: Celecoxib for the Prevention of Sporadic Colorectal Adenomas

Thu, 31Â AugÂ 2006 00:00:00 -05:00

Background: Studies showing that drugs that inhibit cyclooxygenase-2 (COX-2) reduce the number of colorectal adenomas in animals and patients with familial adenomatous polyposis suggest that COX-2 inhibitors may also prevent...

IMAGES IN CLINICAL MEDICINE: Inguinal Hernia

David Rosmarin, M.D. and Chen S. Tan, M.D. — Thu, 10Â AugÂ 2006 00:00:00 -05:00

A 68-year-old man with chronic dysuria and increased urinary frequency presented with three weeks of weakness and fever. Physical examination revealed a man with cachexia who had a large, right-sided...

CLINICAL PROBLEM-SOLVING: A Sharp Right Turn

Thu, 03Â AugÂ 2006 00:00:00 -05:00

A 60-year-old man presented to the emergency department for evaluation of rectal bleeding, syncope, and pain in the right leg. Five days earlier, diffuse abdominal pain that worsened with movement...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2006 â A 36-Year-Old Man with Numbness in the Right Hand and Hypertension

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Dr. Joanna J. Wykrzykowska (Medicine): A 36-year-old man was admitted to the hospital because of a mass in the right adrenal gland. The patient had been well until seven months...

ORIGINAL ARTICLE: Mutant Neurogenin-3 in Congenital Malabsorptive Diarrhea

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Background: Neurogenin-3 (NEUROG3) is expressed in endocrine progenitor cells and is required for endocrine-cell development in the pancreas and intestine. The NEUROG3 gene (NEUROG3) is therefore a candidate for the...

PERSPECTIVE: Causes of Chronic Diarrhea

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Diarrhea can be classified in several ways. It is both a symptom and a sign. As a symptom, it is whatever the patient says it is: a decrease in consistency,...

REVIEW ARTICLE: Intensive Care of Patients with HIV Infection

Thu, 13Â JulÂ 2006 00:00:00 -05:00

Antiretroviral therapy has increased the life expectancy of patients who are infected with the human immunodeficiency virus (HIV) and has reduced the incidence of illnesses associated with the acquired immunodeficiency...

EDITORIAL: Gastric Cancer â New Therapeutic Options

John S. Macdonald, M.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

Gastric and gastroesophageal adenocarcinomas are important health problems. A 2005 analysis1 of the worldwide incidence of and mortality from cancer showed that 934,000 cases of gastric cancer occurred in 2002...

ORIGINAL ARTICLE: Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

Thu, 06Â JulÂ 2006 00:00:00 -05:00

Background: A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative...

IMAGES IN CLINICAL MEDICINE: Zenker's Diverticulum

S. Alam Hannan, M.B., B.S., M.R.C.S. and Ghassan Alusi, M.B., B.S. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

A 68-year-old man was referred because of progressive dysphagia and regurgitation that had reached a stage at which he could no longer eat or drink without coughing and spluttering. He...

ORIGINAL ARTICLE: Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women

Thu, 01Â JunÂ 2006 00:00:00 -05:00

Background: Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI) â the weight in kilograms divided by the square of the...

EDITORIAL: Necrotizing Enterocolitis in Preterm Infants â Is Laparotomy Necessary?

Alan W. Flake, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

The occurrence of intestinal perforation is a catastrophic event at any age. Its occurrence in a very-low-birth-weight infant with necrotizing enterocolitis, however, is particularly hazardous. Unfortunately, the incidence of necrotizing...

ORIGINAL ARTICLE: Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and Perforation

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes...

IMAGES IN CLINICAL MEDICINE: Burton's Line

Santiago NoguÃ©, M.D. and Alex Culla, M.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

A 61-year-old man presented for evaluation of increasing abdominal pain of eight months' duration. The patient reported having worked in a lead-smelting company for the past 30 years. The physical...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2006 â A 46-Year-Old Woman with Sudden Onset of Abdominal Distention

Thu, 18Â MayÂ 2006 00:00:00 -05:00

Dr. Patrick S. Yachimski (Gastrointestinal Unit): A 46-year-old woman was admitted to this hospital because of rapidly increasing abdominal girth. She had been well until five weeks earlier, when increasing...

CLINICAL PRACTICE: Acute Pancreatitis

David C. Whitcomb, M.D., Ph.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

A 56-year-old woman presents with severe epigastric pain and vomiting of 14 hours' duration, symptoms that had developed shortly after dinner the previous night. She has no history of alcohol...

VIDEOS IN CLINICAL MEDICINE: Nasogastric Intubation

Todd W. Thomsen, M.D., Robert W. Shaffer, M.D., and Gary S. Setnik, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 13-2006 â A 50-Year-Old Man with a Painful Bone Mass and Lesions in the Liver

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Dr. Brian M. Wolpin (Hematology and Oncology): A 50-year-old man was referred to the cancer center of this hospital because of a painful lytic bone lesion of the right ulna...

ORIGINAL ARTICLE: Thyroxine in Goiter, Infection, and Chronic Gastritis

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Background: Malabsorption of thyroxine has been described in patients treated with drugs that modify an acidic environment. We determined whether there is an increased need for thyroxine in patients with...

ORIGINAL ARTICLE: Oral Ondansetron for Gastroenteritis in a Pediatric Emergency Department

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Background: Vomiting limits the success of oral rehydration in children with gastroenteritis. We conducted a double-blind trial to determine whether a single oral dose of ondansetron, an antiemetic, would improve...

IMAGES IN CLINICAL MEDICINE:

Michael D. Brown, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

A 55-year-old man presented with intermittent, crampy pain in the right lower quadrant of the abdomen. The pain had started two days after his return from a two-week trip to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 10-2006 â A 66-Year-Old Woman with Barrett's Esophagus with High-Grade Dysplasia

Norman S. Nishioka, M.D., and Gregory Y. Lauwers, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

A 66-year-old woman was referred to the gastroenterology clinic for evaluation and management of Barrett's esophagus with high-grade dysplasia.

Seven months earlier, she had been seen at another hospital because of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2006 â A 71-Year-Old Woman with Crohn's Disease and Altered Mental Status

Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 71-year-old woman was admitted to the hospital because of left-sided weakness and a mass in the brain. She had had Crohn's disease for many years but was in her...

IMAGES IN CLINICAL MEDICINE: Veiled Right Kidney Sign in a Patient with Valentino's Syndrome

Hsiu-Po Wang, M.D. and Wei-Chih Su, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

A 72-year-old man presented to the emergency department with severe abdominal pain of two days' duration in the right lower quadrant. He reported recent use of nonsteroidal antiinflammatory drugs for...

ORIGINAL ARTICLE: A Placebo-Controlled Trial of Itopride in Functional Dyspepsia

Thu, 23Â FebÂ 2006 00:00:00 -05:00

Background: The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy of itopride, a dopamine D2 antagonist with acetylcholinesterase effects, in patients with functional dyspepsia.

Methods: Patients with...

PERSPECTIVE: Functional Dyspepsia â Managing the Conundrum

Thu, 23Â FebÂ 2006 00:00:00 -05:00

Every day, in countless examination rooms around the world, patients are consulting their doctors about chronic stomach pain. In industrialized countries, medical evaluation usually uncovers no structural cause for chronic...

IMAGES IN CLINICAL MEDICINE: Colonic Ileus

Senator Hazelwood, M.D. and Denise Burton, Ph.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

A 77-year-old man with a history of hypertension, diabetes mellitus, and seizure disorder presented to the emergency room with abdominal pain and distention of approximately two to three days' duration....

CLINICAL PROBLEM-SOLVING: Empirically Incorrect

Thu, 02Â FebÂ 2006 00:00:00 -05:00

A 46-year-old Mexican immigrant presented to the hospital because of epigastric pain and the vomiting of coffee-grounds material. He had had fatigue, malaise, jaundice, and a 20-lb (9.1 kg) weight...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2006 â A 63-Year-Old Woman with Jaundice and a Pancreatic Mass

Robert H. Schapiro, M.D., Michael M. Maher, M.D., and Joseph Misdraji, M.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

A 63-year-old woman was admitted to the hospital for evaluation of a pancreatic mass.

Four months before admission, the patient noticed dysuria and dark urine. The results of urinalysis showed 3+...

IMAGES IN CLINICAL MEDICINE: Heavy-Metal Meals of Mercury

Jon K.C. Yoong, M.R.C.P. — Thu, 19Â JanÂ 2006 00:00:00 -05:00

A 28-year-old flight engineer from Singapore presented with nausea, lethargy, and tremor. He had been defecating an increasingly large quantity of silver droplets, which were identified on laboratory analysis as...

IMAGES IN CLINICAL MEDICINE: Bleeding Angiodysplasia in the Duodenum

Kuang-I Fu, M.D. and Takahiro Fujimori, M.D., Ph.D. — Thu, 19Â JanÂ 2006 00:00:00 -05:00

An 86-year-old woman with cirrhosis and esophageal varices due to chronic hepatitis C infection was referred for evaluation of anemia and fatigue. Esophagogastroduodenoscopy revealed active bleeding in the third part...

EDITORIAL: The Promise of New Rotavirus Vaccines

Roger I. Glass, M.D., Ph.D. and Umesh D. Parashar, M.B., B.S., M.P.H. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

Rotavirus disease kills approximately half a million children annually in developing countries and accounts for one third of hospitalizations for diarrhea worldwide.1 In 1999, global efforts to control the tremendous...

IMAGES IN CLINICAL MEDICINE: Black Hairy Tongue

Andreas Korber, M.D. and Joachim Dissemond, M.D. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

An 85-year-old male cigar smoker with no notable medical history presented with black discoloration and hairy appearance of the tongue, which had lasted for several years. He said he did...

ORIGINAL ARTICLE: Safety and Efficacy of a Pentavalent HumanâBovine (WC3) Reassortant Rotavirus Vaccine

Thu, 05Â JanÂ 2006 00:00:00 -05:00

Background: Rotavirus is a leading cause of childhood gastroenteritis and death worldwide.

Methods: We studied healthy infants approximately 6 to 12 weeks old who were randomly assigned to receive three oral...

ORIGINAL ARTICLE: Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis

Thu, 05Â JanÂ 2006 00:00:00 -05:00

Background: The safety and efficacy of an attenuated G1P[8] human rotavirus (HRV) vaccine were tested in a randomized, double-blind, phase 3 trial.

Methods: We studied 63,225 healthy infants from 11 Latin...

IMAGES IN CLINICAL MEDICINE: Buckshot Ingestion

William M. Cox, M.D. and Gene R. Pesola, M.D., M.P.H. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

A 73-year-old Inuit woman was referred for a barium enema after an incomplete colonoscopy. A preliminary abdominal radiograph showed that the appendix was completely full of lead shot, with the...

EDITORIAL: Expression of Concern: Bombardier et al., âComparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis,â N Engl J Med 2000;343:1520-8.

Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D. — Thu, 29Â DecÂ 2005 00:00:00 -05:00

We have recently obtained information regarding inaccuracies in data in the report of the VIGOR (Vioxx Gastrointestinal Outcomes Research) study by Bombardier et al.1 that raise concern about certain conclusions...

IMAGES IN CLINICAL MEDICINE: Gastric Dilatation Secondary to Diabetic Autonomic Neuropathy

Peter J. Featherstone, M.B., B.Ch. and Lindsay D. George, M.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

A 75-year-old woman was admitted to the hospital due to severe nausea and vomiting. she had a 12-year history of type 2 diabetes with erratic glucose control complicated by severe...

EDITORIAL: The New â What Does It Mean?

John G. Bartlett, M.D., and Trish M. Perl, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

Recent experience with influenza, the severe acute respiratory syndrome (also known as SARS), avian influenza, and community-acquired methicillin-resistant Staphylococcus aureus has demonstrated how old pathogens can emerge with increased virulence...

IMAGES IN CLINICAL MEDICINE: Pseudomembranous Colitis Associated with

Paul L. Wolf, M.D. and Armen Kasyan, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

A 75-year-old man with peripheral vascular disease, chronic obstructive pulmonary disease, and diabetes mellitus presented with gangrene of the right fourth toe and underwent tarsalâmetatarsal amputation to manage the progression...

ORIGINAL ARTICLE: Infliximab for Induction and Maintenance Therapy for Ulcerative Colitis

Thu, 08Â DecÂ 2005 00:00:00 -05:00

Background: Infliximab, a chimeric monoclonal antibody directed against tumor necrosis factor Î±, is an established treatment for Crohn's disease but not ulcerative colitis.

Methods: Two randomized, double-blind, placebo-controlled studies â the...

ORIGINAL ARTICLE: A Predominantly Clonal Multi-Institutional Outbreak of âAssociated Diarrhea with High Morbidity and Mortality

Thu, 08Â DecÂ 2005 00:00:00 -05:00

Background: In March 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficileâassociated diarrhea.

Methods: In 2004 we conducted a prospective study at 12 Quebec...

PERSPECTIVE: Clinician-Discoverers â Marshall, Warren, and

Julie Parsonnet, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

In 2002, Barry Marshall â the cowinner with Robin Warren of this year's Nobel Prize in Physiology or Medicine for their discovery of Helicobacter pylori â edited a book entitled...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inducing Intestinal Growth

Thu, 24Â NovÂ 2005 00:00:00 -05:00

The small-intestinal epithelium is composed of proliferative-crypt and differentiating-villus compartments. Pluripotent stem cells (believed to reside near crypt bases) give rise to progenitors that proliferate and migrate either toward the...

IMAGES IN CLINICAL MEDICINE: Unfortunate Ingestion

M.C. Ruiz, M.D. and J. Soler-Gonzalez, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

A 37-year-old woman had an eating disorder characterized by frequent episodes of self-induced vomiting. She presented after accidentally swallowing a kitchen fork while attempting to induce emesis. Radiographs of the...

EDITORIAL: Selective Adhesion-Molecule Therapy and Inflammatory Bowel Disease â A Tale of Janus?

Daniel K. Podolsky, M.D. — Thu, 03Â NovÂ 2005 00:00:00 -05:00

Although our understanding of the pathogenesis of the chief forms of inflammatory bowel disease, Crohn's disease, and ulcerative colitis remains incomplete, progress is being made in identifying essential components.1 The...

ORIGINAL ARTICLE: Natalizumab Induction and Maintenance Therapy for Crohn's Disease

Thu, 03Â NovÂ 2005 00:00:00 -05:00

Background: Natalizumab, a humanized monoclonal antibody against Î±4 integrin, inhibits leukocyte adhesion and migration into inflamed tissue.

Methods: We conducted two controlled trials to evaluate natalizumab as induction and maintenance therapy...

IMAGES IN CLINICAL MEDICINE: Angioedema of the Arytenoids

Joseph R. Shiber, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

A 42-year-old woman reported feeling as if something were stuck in her throat (pointing to her thyroid cartilage) since eating a steak dinner two hours earlier. She had a hoarse,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2005 â A 43-Year-Old Man with Lower Gastrointestinal Bleeding

Thu, 27Â OctÂ 2005 00:00:00 -05:00

Dr. Joshua D. Moss (Department of Medicine): A 43-year-old man was admitted to the hospital because of blood in his stool.

When the patient was a child of about three and...

IMAGES IN CLINICAL MEDICINE: Hemorrhagic Cellulitis after Consumption of Raw Oysters

Lara M. Falcon, M.D. and Lan Pham, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 52-year-old man from southern Louisiana with a history of nonalcoholic steatohepatitis presented to the emergency room with a report of severe bilateral lower-leg pain and swelling. He had ingested...

ORIGINAL ARTICLE: Outbreak of Gastroenteritis Associated with Alaskan Oysters

Thu, 06Â OctÂ 2005 00:00:00 -05:00

Background: Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis in the United States, typically is associated with the consumption of raw oysters gathered from warm-water estuaries. We describe a recognized...

IMAGES IN CLINICAL MEDICINE: Cullen's and Turner's Signs

Farouk Mookadam, M.D. and Maja Cikes, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

A 72-year-old man with unstable angina was admitted to the hospital. On the sixth day of heparin therapy, the hemoglobin level decreased from 11.7 to 9.4 g per deciliter. On...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2005 â A 40-Year-Old Man with Prolonged Fever and Weight Loss

Dennis L. Kasper, M.D., Dushyant Sahani, M.D., and Joseph Misdraji, M.D. — Thu, 18Â AugÂ 2005 00:00:00 -05:00

A 40-year-old man was admitted to this hospital because of persistent fever, night sweats, anorexia, and weight loss.

The patient had been in excellent health until eight and a half weeks...

IMAGES IN CLINICAL MEDICINE: Medical Mystery â Abdominal Pain

Karen M. Kim, M.D. and Richard I. Kopelman, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

A 40-year-old, previously healthy man presented with a four-day history of pain in the left upper quadrant of the abdomen, accompanied by fatigue, fever, sweating, and sore throat. Physical examination...

IMAGES IN CLINICAL MEDICINE: Transcatheter Treatment of Thromboembolism in the Superior Mesenteric Artery

Akifumi Nishida, M.D. and Kenichiro Fukui, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

An 88-year-old woman with a history of hypertension and atrial fibrillation presented with an acute onset of severe abdominal pain, vomiting, and diarrhea. She had been taking warfarin for the...

EDITORIAL: Patients at Risk

Jeffrey M. Drazen, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

In clinical trials, the term âpatients at riskâ refers to the altruistic people who volunteer to participate in studies of novel treatments. In this issue of the Journal, three reports123...

EDITORIAL: Progressive Multifocal Leukoencephalopathy and Natalizumab â Unforeseen Consequences

Joseph R. Berger, M.D., and Igor J. Koralnik, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

In this issue of the Journal, there are reports describing in detail three patients in whom progressive multifocal leukoencephalopathy (PML) developed during treatment with natalizumab, a humanized monoclonal antibody against...

ORIGINAL ARTICLE: Progressive Multifocal Leukoencephalopathy after Natalizumab Therapy for Crohn's Disease

Thu, 28Â JulÂ 2005 00:00:00 -05:00

The prior diagnosis of fatal astrocytoma in a 60-year-old man with Crohn's disease treated with natalizumab, a monoclonal antibody against Î±4 integrins, was reclassified as JC virusârelated progressive multifocal leukoencephalopathy...

EDITORIAL: Gastric Bypass and Nesidioblastosis â Too Much of a Good Thing for Islets?

David E. Cummings, M.D. — Thu, 21Â JulÂ 2005 00:00:00 -05:00

As the obesity pandemic continues to worsen and medical interventions remain only moderately effective, bariatric surgery is at present the only method that reliably results in major, long-term weight loss.12...

ORIGINAL ARTICLE: Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery

Thu, 21Â JulÂ 2005 00:00:00 -05:00

We describe six patients (five women and one man; median age, 47 years; range, 39 to 54) with postprandial symptoms of neuroglycopenia owing to endogenous hyperinsulinemic hypoglycemia after Roux-en-Y gastric...

ORIGINAL ARTICLE: Treatment of Ulcerative Colitis with a Humanized Antibody to the Î±Î² Integrin

Thu, 16Â JunÂ 2005 00:00:00 -05:00

Background: Selective blockade of interactions between leukocytes and vascular endothelium in the gut is a promising strategy for the treatment of inflammatory bowel diseases.

Methods: We conducted a multicenter, double-blind, placebo-controlled...

IMAGES IN CLINICAL MEDICINE: Crohn's Disease

Philippe de Saussure, M.D. and Claudio Soravia, M.D. — Thu, 26Â MayÂ 2005 00:00:00 -05:00

A 33-year-old woman who had had Crohn's disease for many years reported the development of dull pain in the left lower back, which was associated with sporadic episodes of fever...

ORIGINAL ARTICLE: Sargramostim for Active Crohn's Disease

Thu, 26Â MayÂ 2005 00:00:00 -05:00

Background: Sargramostim, granulocyteâmacrophage colony-stimulating factor, a hematopoietic growth factor, stimulates cells of the intestinal innate immune system. Preliminary studies suggest sargramostim may have activity in Crohn's disease. To evaluate this...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2005 â An 80-Year-Old Man with Shortness of Breath, Edema, and Proteinuria

Thu, 19Â MayÂ 2005 00:00:00 -05:00

An 80-year-old man was admitted to the hospital because of shortness of breath, pleural effusions, and edema of the legs.

Atrial fibrillation had developed seven years earlier, with bradycardia and syncope,...

IMAGES IN CLINICAL MEDICINE: Sister Mary Joseph's Nodule

Edythe A. Albano, M.D. and Julie Kanter, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 12-year-old girl presented with a one-month history of decreased appetite, vomiting, and weight loss. The patient had had no fevers or night sweats. Physical examination revealed a distended abdomen...

ORIGINAL ARTICLE: Screening for the Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)

Thu, 05Â MayÂ 2005 00:00:00 -05:00

Background: Germ-line mutations in the mismatch-repair genes MLH1, MSH2, MSH6, and PMS2 lead to the development of the Lynch syndrome (hereditary nonpolyposis colorectal cancer), conferring a strong susceptibility to cancer....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2005 â A 30-Year-Old Woman with a Mediastinal Mass

Margaret A. Shipp, M.D., Suzanne L. Aquino, M.D., and Nancy Lee Harris, M.D. — Thu, 21Â AprÂ 2005 00:00:00 -05:00

Dr. Rameen Beroukhim (Medical Oncology): A 30-year-old woman was admitted to the hospital because of a fever and a mediastinal mass.

The patient had been in her usual state of health...

CLINICAL PROBLEM-SOLVING: One Surprise after Another

Thu, 07Â AprÂ 2005 00:00:00 -05:00

A previously healthy 22-year-old man presented to an emergency department reporting that he had had three days of intermittent abdominal pain. Although the pain was initially mild and crampy and...

IMAGES IN CLINICAL MEDICINE: Severe Fecal Impaction

Yann LoubiÃ¨res, M.D. and Olivier Chereau, M.D. — Thu, 24Â MarÂ 2005 00:00:00 -05:00

A 49-year-old man with a history of paraplegia due to poliomyelitis, surgical treatment of a lumbar ependymoma, and chronic renal insufficiency due to a neuropathic bladder was admitted to the...

EDITORIAL: COX-2 Inhibitors â Lessons in Drug Safety

Bruce M. Psaty, M.D., Ph.D., and Curt D. Furberg, M.D., Ph.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

Approximately six years after the cyclooxygenase-2 (COX-2) inhibitors were approved for use in the United States, the results of three randomized, placebo-controlled trials provide new evidence about the cardiovascular risks...

EDITORIAL: COX-2 Inhibitors â A Lesson in Unexpected Problems

Jeffrey M. Drazen, M.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

This issue of the Journal contains three articles about the adverse cardiovascular effects of agents that selectively inhibit one form of prostaglandin endoperoxide synthase, commonly known as cyclooxygenase-2 (COX-2).123 This...

ORIGINAL ARTICLE: Cardiovascular Events Associated with Rofecoxib in a Colorectal Adenoma Chemoprevention Trial

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Background: Selective inhibition of cyclooxygenase-2 (COX-2) may be associated with an increased risk of thrombotic events, but only limited long-term data have been available for analysis. We report on the...

ORIGINAL ARTICLE: Cardiovascular Risk Associated with Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Background: Selective cyclooxygenase-2 (COX-2) inhibitors have come under scrutiny because of reports suggesting an increased cardiovascular risk associated with their use. Experimental research suggesting that these drugs may contribute to...

IMAGES IN CLINICAL MEDICINE: Malposition of a SengstakenâBlakemore Tube

Jung-Yien Chien, M.D. and Chong-Jen Yu, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

An 86-year-old woman had a history of cirrhosis associated with chronic hepatitis B infection lasting more than 16 years; she had had five episodes of esophageal variceal bleeding that had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2005 â A 58-Year-Old Man with Esophageal Cancer and Nausea, Vomiting, and Intractable Hiccups

Thu, 24Â FebÂ 2005 00:00:00 -05:00

Dr. Kevin R. McDonald: A 58-year-old man was transferred to this hospital for management of newly diagnosed adenocarcinoma of the esophagus.

Several months before admission, the patient initially had episodes of...

IMAGES IN CLINICAL MEDICINE: Corkscrew Esophagus

Giovanni Cammarota, M.D. and Maria Certo, M.D., Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

An 81-year-old man was admitted to the hospital because of a six-month history of intermittent dysphagia, regurgitation, and vomiting during meals. Upper gastrointestinal endoscopy revealed an abnormal appearance of the...

CLINICAL PROBLEM-SOLVING: The Unturned Stone

Thu, 03Â FebÂ 2005 00:00:00 -05:00

A 20-year-old man was transferred to an academic medical center in Salt Lake City for further evaluation of diarrhea, abdominal pain, and fever. Two months before admission, he presented to...

REVIEW ARTICLE: Systemic Therapy for Colorectal Cancer

Jeffrey A. Meyerhardt, M.D., M.P.H., and Robert J. Mayer, M.D. — Thu, 03Â FebÂ 2005 00:00:00 -05:00

Colorectal cancer is the third most common malignant disease and the second most frequent cause of cancer-related death in the United States, with 145,290 new cases and 56,290 deaths anticipated...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2005 â A 14-Year-Old Boy with Recent Slowing of Growth and Delayed Puberty

Thu, 27Â JanÂ 2005 00:00:00 -05:00

A 14-year-old boy was evaluated in the pediatric endocrinology clinic because of decreased endurance, slow growth, and delayed onset of puberty.

Ten weeks before his presentation at the clinic, he saw...

EDITORIAL: Reducing the Risks of Gastrointestinal Bleeding with Antiplatelet Therapies

Byron Cryer, M.D. — Thu, 20Â JanÂ 2005 00:00:00 -05:00

In the treatment of cardiovascular disease, clinicians commonly are caught between the competing considerations of cardiovascular benefit and gastrointestinal risks. Low-dose aspirin (325 mg or less daily) lowers the risk...

ORIGINAL ARTICLE: Clopidogrel versus Aspirin and Esomeprazole to Prevent Recurrent Ulcer Bleeding

Thu, 20Â JanÂ 2005 00:00:00 -05:00

Background: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who...

IMAGES IN CLINICAL MEDICINE: Laterally Spreading Colon Cancer

Satoru Tamura, M.D., Ph.D. and Saburo Onishi, M.D., Ph.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

A 74-year-old man was referred for evaluation after a positive fecal occult-blood test. He had no history of cancer and no family history of colorectal cancer. A colonoscopy was performed...

EDITORIAL: A Smarter Strategy? â Reflections on Fecal DNA Screening for Colorectal Cancer

Steven H. Woolf, M.D., M.P.H. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

Colorectal cancer, the second leading cause of death from cancer in the United States, will claim approximately 56,730 lives in 2004.1 Screening for colorectal cancer lowers both the mortality and...

ORIGINAL ARTICLE: Fecal DNA versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population

Thu, 23Â DecÂ 2004 00:00:00 -05:00

Background: Although fecal occult-blood testing is the only available noninvasive screening method that reduces the risk of death from colorectal cancer, it has limited sensitivity. We compared an approach that...

IMAGES IN CLINICAL MEDICINE: Diaphragmatic Hernia

Reiko Fukamizu, M.D. and Seiji Hayashi, M.D., Ph.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

A 76-year-old man was referred to our hospital because of hemoptysis. He had had pulmonary tuberculosis six years before his current admission, and he had had an abnormal chest radiograph...

REVIEW ARTICLE: Contagious Acute Gastrointestinal Infections

Daniel M. Musher, M.D., and Benjamin L. Musher, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

In our ever-shrinking world, widespread media coverage of infections, ranging from the severe acute respiratory syndrome (also known as SARS) and influenza in Asia to acute gastroenteritis on cruise ships...

IMAGES IN CLINICAL MEDICINE: Cholelithiasis

Ensar Yekeler, M.D. and Yakup Akyol, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

A previously healthy 34-year-old woman who had back pain was referred for radiography of the lumbar spine. The patient's laboratory data were normal. The radiograph showed multiple faceted stones outlining...

ORIGINAL ARTICLE: AntiâInterleukin-12 Antibody for Active Crohn's Disease

Thu, 11Â NovÂ 2004 00:00:00 -05:00

Background: Crohn's disease is associated with excess cytokine activity mediated by type 1 helper T (Th1) cells. Interleukin-12 is a key cytokine that initiates Th1-mediated inflammatory responses.

Methods: This double-blind trial...

PERSPECTIVE: Cytokine-Based Therapies for Crohn's Disease â New Paradigms

Fabio Cominelli, M.D., Ph.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

Crohn's disease is one of two idiopathic inflammatory bowel diseases that affect approximately 1 million people in North America. Despite important advances in diagnosis and treatment in recent years, the...

CLINICAL PROBLEM-SOLVING: Special Cure

Thu, 04Â NovÂ 2004 00:00:00 -05:00

A 42-year-old white man presented with a history of eight months of pain in his low back, hips, ankles, and feet. He had begun experiencing progressively severe pain during a...

IMAGES IN CLINICAL MEDICINE: Falciform-Ligament Sign of Pneumoperitoneum

Jiun-Nong Lin, M.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

An 87-year-old woman with iatrogenic Cushing's syndrome presented with fever and shock. She had had diarrhea for several days, but after the use of antidiarrheal agents, she had become constipated....

EDITORIAL: Chemoradiotherapy for Rectal Cancer â When, Why, and How?

Robert D. Madoff, M.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

Although colon cancer and rectal cancer share many features, clinicians should be aware of important differences in the clinical behavior and treatment of these two distinct diseases. Prominent among these...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2004 â A 68-Year-Old Man with a Large Retroperitoneal Mass

Thu, 21Â OctÂ 2004 00:00:00 -05:00

Dr. David P. Ryan: A 68-year-old man was admitted to the hospital because of a large retroperitoneal tumor.

The patient had been in excellent health. A few days before admission,...

ORIGINAL ARTICLE: Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer

Thu, 21Â OctÂ 2004 00:00:00 -05:00

Background: Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative chemoradiotherapy...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Building an Intestine â Architectural Contributions of Commensal Bacteria

James Madara, M.D. — Thu, 14Â OctÂ 2004 00:00:00 -05:00

Bacterial cells within the intestine (commensal microflora) vastly outnumber the epithelial cells lining this organ. Like all bacteria, they release chemical signals with conserved patterns recognized by specific receptors â...

IMAGES IN CLINICAL MEDICINE: Morgagni's Hernia

Henning Schubert, M.D. and Patrick Haage, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

A 64-year-old woman without symptoms underwent routine chest radiography, which revealed a well-circumscribed, low-density mass that measured 8 cm in diameter and rendered the right cardiophrenic angle opaque (Panel A,...

IMAGES IN CLINICAL MEDICINE: Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm

W. Anthony Lee, M.D. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

A 62-year-old man presented with an acute onset of severe lower back pain, hypotension, and nausea and vomiting. He had a history of hypertension and hypertriglyceridemia. On arrival, the patient...

REVIEW ARTICLE: Cystic Neoplasms of the Pancreas

Thu, 16Â SepÂ 2004 00:00:00 -05:00

Physicians from a wide range of disciplines are being confronted with questions regarding the management of cystic lesions of the pancreas. Owing to recent improvements in pancreatic imaging, an increasing...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2004 â Newborn Twins with Thrombocytopenia, Coagulation Defects, and Hepatosplenomegaly

Thu, 09Â SepÂ 2004 00:00:00 -05:00

Newborn identical twin male infants were admitted to the neonatal intensive care unit. They were delivered at 32 weeks of gestation by a healthy 27-year-old primipara. The parents were of...

IMAGES IN CLINICAL MEDICINE: Gallstone Ileus

John S. Graham, M.D. and Bruce C. Rothwell, M.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

An 83-year-old woman was hospitalized with nausea, vomiting, and obstipation. She had been losing weight for six months and had had similar, though less severe, symptoms during that time. She...

IMAGES IN CLINICAL MEDICINE: VIPoma

Stuart M. Lubinski, M.D. and Thomas Hendrix, M.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

A 50-year-old woman presented with a five-month history of fatigue, weakness, and diarrhea. Her electrocardiogram disclosed prominent U waves and ST-segment depression. The serum potassium level was 1.6 mmol per...

IMAGES IN CLINICAL MEDICINE: Gastrothorax Simulating Acute Tension Pneumothorax

Cornelis P.C. de Jager, M.D. and Ronald J. Trof, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 27-year-old man was admitted to the emergency department because of respiratory failure. Three years earlier, he had undergone surgery to repair a traumatic rupture of the left side of...

CLINICAL PROBLEM-SOLVING: A Bitter Tale

Lori S. Newman, M.D., Ph.D., Mark W. Feinberg, M.D., and Howard E. LeWine, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 53-year-old woman presented to an outpatient urgent care clinic with persistent nausea and vomiting. On the previous evening, she had had an acute onset of nausea that was followed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2004 â A 48-Year-Old Man with Recurrent Gastrointestinal Bleeding

Thu, 29Â JulÂ 2004 00:00:00 -05:00

A 48-year-old man was admitted to the hospital for evaluation of recurrent gastrointestinal bleeding.

He had been well until 33 months earlier, when he had midepigastric pain and passed black stools...

EDITORIAL: New Treatment Options for Colorectal Cancer

Charles Erlichman, M.D., and Daniel J. Sargent, Ph.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

Epidermal growth factor receptor (EGFR) is a member of the HER family of tyrosine kinase cell-surface receptors that are dysregulated in many types of tumor; its expression has been associated...

IMAGES IN CLINICAL MEDICINE: Intussusception of the Small Bowel

Lawrence E. Harrison, M.D. and Steve H. Kim, M.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

A 37-year-old man presented to the emergency department with a two-day history of crampy abdominal pain, nausea, and vomiting. On physical examination, his temperature was 37.2Â°C, and his pulse was...

PERSPECTIVE: The Price Tag on Progress â Chemotherapy for Colorectal Cancer

Deborah Schrag, M.D., M.P.H. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

From the 1960s until the mid-1990s, fluorouracil was the primary chemotherapeutic agent available for the treatment of colorectal cancer. During the past decade, the Food and Drug Administration (FDA) has...

EDITORIAL: Prevention of Postoperative Nausea and Vomiting â A Multimodal Solution to a Persistent Problem

Paul F. White, Ph.D., M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Despite the introduction of new antiemetic agents, short-acting anesthetics, and minimally invasive surgical techniques, the incidence of postoperative nausea and vomiting has remained largely unchanged over the past two decades.1...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2004 â A 61-Year-Old Man with Rectal Bleeding and a 2-cm Mass in the Rectum

Thu, 10Â JunÂ 2004 00:00:00 -05:00

A 61-year-old man was referred to this hospital for treatment of a low rectal adenocarcinoma. He had been well until five months previously, when he occasionally began to note blood...

ORIGINAL ARTICLE: A Factorial Trial of Six Interventions for the Prevention of Postoperative Nausea and Vomiting

Thu, 10Â JunÂ 2004 00:00:00 -05:00

Background: Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone...

EDITORIAL: Two Steps Forward in the Treatment of Colorectal Cancer

Robert J. Mayer, M.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

Until recently, fluorouracil was the only effective systemic treatment for colorectal cancer. It acts primarily by inhibiting thymidylate synthase, a key enzyme in DNA synthesis, and because leucovorin (folinic acid)...

IMAGES IN CLINICAL MEDICINE: Paraesophageal Hernia

Robert J. Canter, M.D. and James P. Greelish, M.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

A 34-year-old woman with a nine-month history of postprandial dyspnea and substernal fullness had severe pain in her epigastrium, without emesis, shortly after the ingestion of an evening meal. On...

CLINICAL PRACTICE: Surveillance Strategies after Curative Treatment of Colorectal Cancer

David G. Pfister, M.D., Al B. Benson III, M.D., and Mark R. Somerfield, Ph.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

A 63-year-old man underwent complete resection of a T3N0M0, stage II adenocarcinoma of the ascending colon. No adjuvant therapy is planned. There is no family history of colorectal cancer. How...

ORIGINAL ARTICLE: Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer

Thu, 03Â JunÂ 2004 00:00:00 -05:00

Background: The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin (FL). Oxaliplatin improves the efficacy of this combination in patients with metastatic colorectal cancer. We evaluated the efficacy...

ORIGINAL ARTICLE: Bevacizumab plus Irinotecan, Fluorouracil, and Leucovorin for Metastatic Colorectal Cancer

Thu, 03Â JunÂ 2004 00:00:00 -05:00

Background: Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, has shown promising preclinical and clinical activity against metastatic colorectal cancer, particularly in combination with chemotherapy.

Methods: Of 813 patients with...

IMAGES IN CLINICAL MEDICINE: Unusual Cystitis

Keyvan Ravakhah, M.D., M.B.A. and Ramona Simionescu, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

A 68-year-old woman with diabetes mellitus that was treated with insulin was hospitalized because of abdominal pain and vomiting. She had been treated empirically for a urinary tract infection with...

EDITORIAL: Laparoscopic Resection for Colon Cancer â The End of the Beginning?

Theodore N. Pappas, M.D., and Danny O. Jacobs, M.D., M.P.H. — Thu, 13Â MayÂ 2004 00:00:00 -05:00

Technological advances, which are followed by long periods of catch-up while clinicians learn how to use the new techniques appropriately, often precede true medical progress. Such certainly appears to be...

ORIGINAL ARTICLE: A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer

The Clinical Outcomes of Surgical Therapy Study Group — Thu, 13Â MayÂ 2004 00:00:00 -05:00

Background: Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper...

IMAGES IN CLINICAL MEDICINE: Intraabdominal Abscess after Acupuncture

Rodney C. Studd, M.B., Ch.B. and Peter J. Stewart, F.R.A.C.S. — Thu, 22Â AprÂ 2004 00:00:00 -05:00

A 64-year-old Korean woman had a four-week history of dull pain in the lower abdomen that was worse on movement; she had no gastrointestinal or urogenital symptoms. The previous year,...

REVIEW ARTICLE: Management of Cirrhosis and Ascites

Thu, 15Â AprÂ 2004 00:00:00 -05:00

Cirrhosis, most frequently caused by hepatitis C or alcoholism, was the 12th leading cause of death in the United States in 2000, accounting for more than 25,000 deaths.1 Ascites is...

IMAGES IN CLINICAL MEDICINE: Pseudomyxoma Peritonei

Sanford H. Barsky, M.D. and Kathryn McGonigle, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 55-year-old man presented with a five-month history of increasing abdominal girth, a weight loss of 4.5 kg (10 lb), and occasional episodes of anorexia and nausea. Physical examination revealed...

IMAGES IN CLINICAL MEDICINE: Diffuse Subcutaneous Air Due to a Perforated Colonic Diverticulum

Wen Lai, M.D. and Jonathan Dowell, M.D. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

An 80-year-old man with multiple medical problems underwent a colonoscopy, which was performed to determine the cause of anemia. During the colonoscopy, he reported abdominal discomfort, and profound abdominal distention...

EDITORIAL: Adjuvant Therapy for Pancreatic Cancer â The Debate Continues

Michael A. Choti, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

Surgical therapy currently offers the only potential cure for pancreatic adenocarcinoma. Surgical morbidity and mortality have decreased dramatically in recent years; the perioperative mortality associated with pancreaticoduodenectomy in major centers...

ORIGINAL ARTICLE: A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic Cancer

Thu, 18Â MarÂ 2004 00:00:00 -05:00

Background: The effect of adjuvant treatment on survival in pancreatic cancer is unclear. We report the final results of the European Study Group for Pancreatic Cancer 1 Trial and update...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2004 â A 28-Year-Old Man with Abdominal Pain, Fever, and a Mass in the Region of the Pancreas

William R. Brugge, M.D., Peter R. Mueller, M.D., and Joseph Misdraji, M.D. — Thu, 11Â MarÂ 2004 00:00:00 -05:00

A 28-year-old man was admitted to the hospital because of abdominal pain and fever.

The patient had been well until 10 days earlier, when mild epigastric pain developed. Two days before...

IMAGES IN CLINICAL MEDICINE: Nodular Colitis

Faheem Younus, M.D. and Roy T. Steigbigel, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

A 29-year-old man infected with the human immunodeficiency virus (HIV) presented with right-sided abdominal pain and diarrhea. His CD4 cell count was 24 per cubic millimeter, and his HIV viral...

ORIGINAL ARTICLE: Estrogen plus Progestin and Colorectal Cancer in Postmenopausal Women

Thu, 04Â MarÂ 2004 00:00:00 -05:00

Background: Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use...

EDITORIAL: Closing Fistulas in Crohn's Disease â Should the Accent Be on Maintenance or Safety?

Claudio Fiocchi, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

Among the many complications of Crohn's disease, the development of fistulas is one of the most distressing to patients because it decreases their quality of life and one of the...

IMAGES IN CLINICAL MEDICINE: Inflammatory Pseudopolyposis in Crohn's Disease

Glen M. Arluk, M.D. and Perry J. Pickhardt, M.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

A 63-year-old woman with a history of Crohn's disease presented with abdominal pain and diarrhea, findings consistent with a flare of her disease. One week after treatment with infliximab, she...

ORIGINAL ARTICLE: Infliximab Maintenance Therapy for Fistulizing Crohn's Disease

Thu, 26Â FebÂ 2004 00:00:00 -05:00

Background: Infliximab, a monoclonal antibody against tumor necrosis factor, is an effective maintenance therapy for patients with Crohn's disease without fistulas. It is not known whether infliximab is an effective...

IMAGES IN CLINICAL MEDICINE: Meckel's Diverticulum in Action

See-Ching Chan, M.D. and Chung-Yau Lo, F.R.C.S., F.A.C.S. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

A 26-year-old man presented with massive gastrointestinal hemorrhage and hypovolemic shock. His hemoglobin level dropped by 4 g per deciliter over a six-hour period. Emergency upper endoscopy to the second...

IMAGES IN CLINICAL MEDICINE: A Message from the Gut

Ellen Haig, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

An endoscopic photograph taken during colonoscopy sent a greeting from the gut....

IMAGES IN CLINICAL MEDICINE: Pneumatosis Intestinalis and Portal Venous Gas

Craig See, M.D. and David Elliott, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

A 53-year-old woman who had recently been treated for ulcerative colitis with high-dose prednisone and mercaptopurine was admitted with severe abdominal pain and signs of peritoneal irritation. Colonoscopy, radiography of...

IMAGES IN CLINICAL MEDICINE: Intussusception

Duyen Dang, M.D. and David Cromwell, M.D. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

An 80-year-old woman presented with a three-day history of passage of bright red blood from the rectum. She was afebrile and had a blood pressure of 70/52 mm Hg. The...

ORIGINAL ARTICLE: Immunoproliferative Small Intestinal Disease Associated with

Thu, 15Â JanÂ 2004 00:00:00 -05:00

Background: Immunoproliferative small intestinal disease (also known as alpha chain disease) is a form of lymphoma that arises in small intestinal mucosa-associated lymphoid tissue (MALT) and is associated with the...

PERSPECTIVE: Bacterial Infection and MALT Lymphoma

Julie Parsonnet, M.D., and Peter G. Isaacson, F.R.C.Path. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

Fifty years ago, the idea that infectious agents caused lymphoma would have seemed heretical. Although viruses were known to cause tumors in animals, they were not considered a cause of...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Bruno FranÃ§ois, M.D. and Olivier Brenet, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

A 62-year-old man presented with an ileus, marked abdominal distention, hypotension, and oliguria. He had a 15-year history of chronic psychosis. Laboratory findings included renal dysfunction, abnormal liver-function values, and...

CLINICAL PRACTICE: Acute Infectious Diarrhea

Nathan M. Thielman, M.D., M.P.H., and Richard L. Guerrant, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

An otherwise healthy 23-year-old man presents after the acute onset of watery diarrhea that has persisted for two days. He reports associated nausea and cramping but no emesis and is...

IMAGES IN CLINICAL MEDICINE: Emphysematous Pancreatitis

Hernan A. Bazan, M.D. and Unsup Kim, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

A 78-year-old man had fever, intermittent nausea and vomiting, and increasing abdominal pain for one week. He said he did not use alcohol. On examination, he had a distended abdomen...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Putting the Brakes on Insulin Signaling

Alan R. Saltiel, Ph.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

The dramatic increase in the incidence of type 2 diabetes mellitus and obesity in the Western world signals the beginning of an epidemic that is expected to become a major...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2003 â A 14-Month-Old Boy with Recurrent Abdominal Distention and Diarrhea

Benjamin D. Gold, M.D., Sjirk J. Westra, M.D., and Fiona M. Graeme-Cook, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

A 14-month-old boy was admitted to the hospital because of recurrent abdominal distention, vomiting, and diarrhea.

The boy had been born at another hospital at 34 weeks' gestation and weighed 2.56...

REVIEW ARTICLE: Body Packing â The Internal Concealment of Illicit Drugs

Stephen J. Traub, M.D., Robert S. Hoffman, M.D., and Lewis S. Nelson, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

In 1973, two physicians from Toronto admitted a patient in whom a small-bowel obstruction developed 13 days after he had swallowed a condom filled with hashish.1 The condom was surgically...

IMAGES IN CLINICAL MEDICINE: Bleeding Colonic Diverticulum

Sripathi R. Kethu, M.D. and Harlan G. Rich, M.D. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

A 73-year-old man presented with acute lower gastrointestinal bleeding. He was hemodynamically stable, and nasogastric-tube lavage revealed bile with no blood, suggesting a lower gastrointestinal source for the bleeding. Urgent...

IMAGES IN CLINICAL MEDICINE: Cecal Kaposi's Sarcoma

Tamer Atassi, M.D. and Elizabeth Montgomery, M.D. — Thu, 11Â DecÂ 2003 00:00:00 -05:00

A 35-year-old man with human immunodeficiency virus infection was admitted because of weight loss, fatigue, anorexia, and chronic, watery, nonbloody diarrhea. The workup for diarrhea revealed steatorrhea (110 g of...

EDITORIAL: Screening Virtual Colonoscopy â Ready for Prime Time?

Martina M. Morrin, M.B., and J. Thomas LaMont, M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

Many professional societies in the United States recommend screening for colorectal cancer in asymptomatic, average-risk adults, beginning at 50 years of age. Screening achieves two goals: the detection of early-stage...

REVIEW ARTICLE: Esophageal Cancer

Peter C. Enzinger, M.D., and Robert J. Mayer, M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

Esophageal cancer is one of the least studied and deadliest cancers worldwide. During the past three decades, important changes have occurred in the epidemiologic patterns associated with this disease. Recent...

ORIGINAL ARTICLE: Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults

Thu, 04Â DecÂ 2003 00:00:00 -05:00

Background: We evaluated the performance characteristics of computed tomographic (CT) virtual colonoscopy for the detection of colorectal neoplasia in an average-risk screening population.

Methods: A total of 1233 asymptomatic adults (mean...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2003 â A 79-Year-Old Man with Coronary Artery Disease, Peripheral Vascular Disease, End-Stage Renal Disease, and Abdominal Pain and Distention

Peter B. Kelsey, M.D., Steven Chen, M.D., and Gregory Y. Lauwers, M.D. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A 79-year-old man was admitted to the hospital because of occlusion at a vascular access site in the right forearm for hemodialysis and worsening intermittent claudication.

There was a history of...

REVIEW ARTICLE: Irritable Bowel Syndrome

Howard R. Mertz, M.D. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

Irritable bowel syndrome, a common disorder in which bowel habits are altered in association with abdominal pain or discomfort, has a prevalence of 12 percent among adults in the United...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2003 â A 75-Year-Old Man with a Cystic Lesion of the Pancreas

Thu, 13Â NovÂ 2003 00:00:00 -05:00

A 75-year-old man was evaluated in the clinic because of a cystic lesion of the pancreas.

For several years he had had gastroesophageal reflux, which was alleviated by pantoprazole. He continued...

CLINICAL PROBLEM-SOLVING: A Window of Opportunity

Thu, 06Â NovÂ 2003 00:00:00 -05:00

A 62-year-old woman presented to her local emergency department because of pain in the epigastrium and right upper quadrant. The pain had begun insidiously five days earlier and was constant,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 34-2003 â A 45-Year-Old Woman with a Family History of Colonic Polyps and Cancer

Daniel C. Chung, M.D., Mari Mino, M.D., and Kristen M. Shannon, M.S., C.G.C. — Thu, 30Â OctÂ 2003 00:00:00 -05:00

A 45-year-old woman came to the outpatient clinic for counseling because of concern about a family history of colonic polyps and cancer.

The patient felt well and had had no abdominal...

IMAGES IN CLINICAL MEDICINE: Splenic Sarcoidosis

Christophe Penna, M.D. and GrÃ©goire A. Deroide, M.D. — Thu, 23Â OctÂ 2003 00:00:00 -05:00

A 45-year-old woman with a history of mediastinal sarcoidosis, who had been treated with oral corticosteroids six years previously, presented with pain in the left upper quadrant of her abdomen....

REVIEW ARTICLE: Chronic Constipation

Anthony Lembo, M.D., and Michael Camilleri, M.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

Constipation is a common symptom affecting between 2 percent12 and 27 percent3 of the population in Western countries. In the United States, it results in more than 2.5 million visits...

IMAGES IN CLINICAL MEDICINE: Melanosis Coli

Shazia Ahmed, M.D. and Naresh T. Gunaratnam, M.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

A 60-year-old woman with a family history of colon cancer and a history of adenomatous colorectal polyps underwent surveillance colonoscopy. Her last endoscopy, three years previously, had revealed two polyps...

IMAGES IN CLINICAL MEDICINE: A Bleeding Meckel's Diverticulum

Christian Zellner, M.D. and Andrew K. Roorda, B.A. — Thu, 28Â AugÂ 2003 00:00:00 -05:00

A 29-year-old man presented to the emergency department after two days of hematochezia. He had a hemoglobin level of 7.2 g per deciliter. Esophagogastroduodenoscopy showed no identifiable source of bleeding....

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2003 â A 36-Year-Old Man with Recurrent Epigastric Pain and Elevated Amylase Levels

Thu, 28Â AugÂ 2003 00:00:00 -05:00

A 36-year-old man was referred to the hospital because of recurrent epigastric pain and persistently elevated amylase levels.

The patient had been well until five months earlier, when he began to...

CLINICAL PRACTICE: Bulimia Nervosa

Philip S. Mehler, M.D. — Thu, 28Â AugÂ 2003 00:00:00 -05:00

A 20-year-old woman presents with fatigue; laboratory tests reveal a serum potassium level of 2.3 mmol per liter and a serum bicarbonate level of 36 mmol per liter. She is...

IMAGES IN CLINICAL MEDICINE: Calcified Splenic Cyst

Ton-Ho Young, M.D. and Hung-Shang Tang, M.D. — Thu, 21Â AugÂ 2003 00:00:00 -05:00

A 45-year-old man presented with a two-month history of discomfort in the left upper quadrant. Twenty years earlier, he had been involved in a motor vehicle accident. Physical examination confirmed...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2003 â A 10-Year-Old Girl with Recurrent Bouts of Abdominal Pain

Dawn M. McGee, M.D., Susan A. Connolly, M.D., and Robert H. Young, M.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

A 10-year-old girl was admitted to the hospital because of abdominal pain, vomiting, and fever.

She had been in excellent health until about 18 months earlier, when she had the first...

EDITORIAL: Epidermal Growth Factor for Ulcerative Colitis

Richard J. Farrell, M.D. — Thu, 24Â JulÂ 2003 00:00:00 -05:00

The treatment of active ulcerative colitis largely relies on the nonspecific antiinflammatory effects of aminosalicylates (mesalamine and sulfasalazine) and the broad immunosuppressive actions of corticosteroids and other potent immunomodulators.1 Data...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2003 â A 79-Year-Old Woman with Gastric Lymphoma and Erosive Mucosal and Cutaneous Lesions

A. Razzaque Ahmed, M.D., Mathew M. Avram, M.D., J.D., and Lyn M. Duncan, M.D. — Thu, 24Â JulÂ 2003 00:00:00 -05:00

A 79-year-old woman with a gastric B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type was admitted to the hospital because of erosive mucosal and cutaneous lesions.

The patient had been...

IMAGES IN CLINICAL MEDICINE: Chronic Ulcerative Colitis with Megacolon

Andreas M. Kaiser, M.D. and Robert W. Beart, M.D. — Thu, 24Â JulÂ 2003 00:00:00 -05:00

A 53-year-old woman with a history of ulcerative colitis presented with abdominal pain and bloody diarrhea. The abdominal examination revealed a distended and mildly tender abdomen with hypoactive bowel sounds....

ORIGINAL ARTICLE: Epidermal Growth Factor Enemas with Oral Mesalamine for Mild-to-Moderate Left-Sided Ulcerative Colitis or Proctitis

Thu, 24Â JulÂ 2003 00:00:00 -05:00

Background: Epidermal growth factor (EGF) is a potent mitogenic peptide produced by salivary glands. We examined whether EGF enemas are an effective treatment for active left-sided ulcerative colitis and ulceration...

CLINICAL PROBLEM-SOLVING: A Gut Feeling

Thu, 03Â JulÂ 2003 00:00:00 -05:00

A 79-year-old man was referred to our hospital because of an 18-kg weight loss over the previous six months. Seven months before admission, his house burned down, and insomnia, anorexia,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Celiac Disease â The Villain Unmasked?

Ross McManus, Ph.D., and Dermot Kelleher, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

Celiac disease (also known as celiac sprue and gluten-sensitive enteropathy) is a common autoimmune condition triggered by ingesting one of several related proteins found in wheat, barley, and rye: the...

EDITORIAL: Celiac Disease â How to Handle a Clinical Chameleon

Alessio Fasano, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

Celiac disease is an immune-mediated enteropathy triggered by the ingestion of gluten-containing grains (including wheat, rye, and barley) in genetically susceptible persons. The disease is associated with HLA-DQ2 in 90...

ORIGINAL ARTICLE: Prevalence of Celiac Disease among Children in Finland

Thu, 19Â JunÂ 2003 00:00:00 -05:00

Background: Wheat, rye, and barley proteins induce celiac disease, an autoimmune type of gastrointestinal disorder, in genetically susceptible persons. Because the disease may be underdiagnosed, we estimated the prevalence of...

IMAGES IN CLINICAL MEDICINE: Emphysematous Cholecystitis

Yasuyoshi Sakai, M.D., Ph.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

An 83-year-old man was being treated for diabetes mellitus, hypertension, and ischemic heart disease. Cholelithiasis had previously been detected by abdominal ultrasonography. After drinking alcohol at home, the patient had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2003 â A 47-Year-Old Man with Waxing and Waning Pulmonary Nodules Five Years after Treatment for Testicular Seminoma

Carolyn M. Fleming, M.D., Jo-Anne O. Shepard, M.D., and Eugene J. Mark, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

A 47-year-old man was evaluated in the pulmonary clinic because of waxing and waning pulmonary lesions several years after treatment for seminoma.

The patient had been well until five years earlier,...

IMAGES IN CLINICAL MEDICINE: âCorkscrewâ Esophagus

Sachin Dheer, M.D. and Raymond Chang, M.D. — Thu, 24Â AprÂ 2003 00:00:00 -05:00

An 89-year-old woman was referred for an upper gastrointestinal examination because of dysphagia, epigastric pain, and frequent belching. A single-contrast barium examination of the patient's esophagus showed a constricted, twisted...

REVIEW ARTICLE: Amebiasis

Thu, 17Â AprÂ 2003 00:00:00 -05:00

Diarrheal diseases continue to be major causes of morbidity and mortality in children in developing countries. For example, in Bangladesh 1 in 30 children dies of diarrhea or dysentery by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2003 â A 14-Year-Old Boy with Ulcerative Colitis, Primary Sclerosing Cholangitis, and Partial Duodenal Obstruction

Albert M. Ross IV, M.D., Sudha A. Anupindi, M.D., and Ulysses J. Balis, M.D. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

A 14-year-old boy with a history of ulcerative colitis was admitted to the hospital because of vomiting and abdominal pain.

Ulcerative colitis had been diagnosed at the age of three years...

IMAGES IN CLINICAL MEDICINE: Hematoma of the Rectus Sheath

David R. Gutknecht, M.D. — Thu, 10Â AprÂ 2003 00:00:00 -05:00

A 79-year-old woman who was taking warfarin and enoxaparin because of deep venous thrombosis reported abdominal pain after coughing. On physical examination, a mass was felt in the left side...

IMAGES IN CLINICAL MEDICINE: Trichobezoar in a Four-Year-Old Girl

John L. Lanoue, M.D. and Marc S. Arkovitz, M.D. — Thu, 27Â MarÂ 2003 00:00:00 -05:00

A four-year-old girl was brought to her pediatrician by her parents because of intermittent bilious emesis, which had started two weeks earlier. There were no other changes in her bowel...

IMAGES IN CLINICAL MEDICINE: A Deadly Examination

Oren Fruchter, M.D. and Robert Dragu, M.D. — Thu, 13Â MarÂ 2003 00:00:00 -05:00

An 80-year-old man underwent esophagogastroduodenography with barium contrast medium to investigate long-standing dysphagia. During the examination, the patient aspirated contrast material into his lungs. Forty-eight hours later, he presented with...

ORIGINAL ARTICLE: Influence of Immunogenicity on the Long-Term Efficacy of Infliximab in Crohn's Disease

Thu, 13Â FebÂ 2003 00:00:00 -05:00

Background: Treatment with infliximab, a chimeric monoclonal IgG1 antibody against tumor necrosis factor, can result in the formation of antibodies against infliximab. We evaluated the clinical significance of these antibodies...

CLINICAL PRACTICE: Suspected Appendicitis

Erik K. Paulson, M.D., Matthew F. Kalady, M.D., and Theodore N. Pappas, M.D. — Thu, 16Â JanÂ 2003 00:00:00 -05:00

An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours' duration in the right lower quadrant. On physical examination, she is afebrile, with...

IMAGES IN CLINICAL MEDICINE: Retained Surgical Instrument

Anne Dembitzer, M.D. and Edwin J. Lai, M.D. — Thu, 16Â JanÂ 2003 00:00:00 -05:00

A 59-year-old man with a history of diverticulosis came to the clinic with abdominal pain in the right upper quadrant of two weeks' duration. His surgical history included a subtotal...

EDITORIAL: Î± Integrins as Therapeutic Targets in Autoimmune Disease

Ulrich H. von Andrian, M.D., Ph.D., and Britta Engelhardt, Ph.D. — Thu, 02Â JanÂ 2003 00:00:00 -05:00

In this issue of the Journal, two groups of investigators report on clinical trials of natalizumab, a recombinant monoclonal antibody against Î±4 integrins, for the treatment of multiple sclerosis1 and...

ORIGINAL ARTICLE: Natalizumab for Active Crohn's Disease

Thu, 02Â JanÂ 2003 00:00:00 -05:00

Background: In chronic inflammatory conditions such as Crohn's disease, the migration of leukocytes from the circulation into the parenchyma and their activation within inflammatory sites are mediated in part by...

EDITORIAL: NSAIDs, and Pandora's Box

Thu, 26Â DecÂ 2002 00:00:00 -05:00

Widespread use of nonsteroidal antiinflammatory drugs (NSAIDs) among the elderly has resulted in a large population of persons at risk for ulcer complications. Selective cyclooxygenase-2 (COX-2) inhibitors were introduced with...

ORIGINAL ARTICLE: Celecoxib versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis

Thu, 26Â DecÂ 2002 00:00:00 -05:00

Background: Current guidelines recommend that patients at risk for ulcer disease who require treatment for arthritis receive nonsteroidal antiinflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 or the combination of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2002 â A 69-Year-Old Man with Painful Cutaneous Nodules, Elevated Lipase Levels, and Abnormal Results on Abdominal Scanning

Stanley W. Ashley and Gregory Y. Lauwers — Thu, 28Â NovÂ 2002 00:00:00 -05:00

A 69-year-old man was admitted to the hospital because of painful cutaneous nodules, elevated lipase levels, and abnormal results on abdominal scanning.

The patient had been in stable health until 15...

EDITORIAL: Surgical Treatment of Esophageal Cancer â The Advent of the Era of Individualization

Thu, 21Â NovÂ 2002 00:00:00 -05:00

Although esophageal carcinoma is a relatively uncommon cancer in Western countries, there has been a rising incidence of adenocarcinoma of the esophagus and increasing mortality due to that disease in...

ORIGINAL ARTICLE: Extended Transthoracic Resection Compared with Limited Transhiatal Resection for Adenocarcinoma of the Esophagus

Thu, 21Â NovÂ 2002 00:00:00 -05:00

Background: Controversy exists about the best surgical treatment for esophageal carcinoma.

Methods: We randomly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the...

REVIEW ARTICLE: Infection

Sebastian Suerbaum, M.D., and Pierre Michetti, M.D. — Thu, 10Â OctÂ 2002 00:00:00 -05:00

Since the first culture of Helicobacter pylori 20 years ago, the diagnosis and treatment of upper gastroduodenal disease have changed dramatically. Peptic ulcer disease is now approached as an infectious...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2002 â An 87-Year-Old Woman with Abdominal Pain, Vomiting, Bloody Diarrhea, and an Abdominal Mass

David L. Berger and Maryam Mohammadkhani — Thu, 22Â AugÂ 2002 00:00:00 -05:00

An 87-year-old woman was admitted to the hospital because of abdominal pain, vomiting, bloody diarrhea, and an abdominal mass.

The patient had been in stable health until two days before admission,...

ORIGINAL ARTICLE: Efficacy and Safety of Imatinib Mesylate in Advanced Gastrointestinal Stromal Tumors

Thu, 15Â AugÂ 2002 00:00:00 -05:00

Background: Constitutive activation of KIT receptor tyrosine kinase is critical in the pathogenesis of gastrointestinal stromal tumors. Imatinib mesylate, a selective tyrosine kinase inhibitor, has been shown in preclinical models...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2002 â A 48-Year-Old Man with Persistent Erosive Oral Lesions

George T. Gallagher and Stephen Lyle — Thu, 08Â AugÂ 2002 00:00:00 -05:00

A 48-year-old man was admitted to the Ambulatory Disease Service of the Massachusetts Eye and Ear Infirmary because of severe chronic oral lesions.

For several years, the patient had taken ibuprofen...

REVIEW ARTICLE: Inflammatory Bowel Disease

Daniel K. Podolsky, M.D. — Thu, 08Â AugÂ 2002 00:00:00 -05:00

In the decades since the major forms of idiopathic inflammatory bowel disease were defined on the basis of clinical manifestations, investigators have been challenged to identify the fundamental pathophysiologic processes...

IMAGES IN CLINICAL MEDICINE: Fistulizing Crohn's Disease

William Sanchez, M.D. and Edward V. Loftus, M.D. — Thu, 08Â AugÂ 2002 00:00:00 -05:00

Figure 1. A 54-year-old man with a long history of Crohn's disease presented with abdominal pain, low-grade fevers, fatigue, and pneumaturia. Several enterocutaneous fistulas as well as worsening of perianal...

ORIGINAL ARTICLE: Lansoprazole for the Prevention of Recurrences of Ulcer Complications from Long-Term Low-Dose Aspirin Use

Thu, 27Â JunÂ 2002 00:00:00 -05:00

Background: The role of gastric acid suppression in preventing the recurrence of ulcer complications after the eradication of Helicobacter pylori infection in patients taking long-term low-dose aspirin is uncertain.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Aberrant Right Subclavian Artery and Dysphagia Lusoria

Peter D. Kent, M.D. and Thomas H. Poterucha, M.D. — Thu, 23Â MayÂ 2002 00:00:00 -05:00

Figure 1. A 45-year-old woman had had intermittent dysphagia for two years. Physical examination revealed a blood pressure of 104/72 mm Hg in the right arm and 120/80 mm Hg...

IMAGES IN CLINICAL MEDICINE: Porcelain Gallbladder

Steffen Rickes, M.D. and Kenneth Ocran, M.D. — Thu, 04Â AprÂ 2002 00:00:00 -05:00

Figure 1. A 45-year-old woman was hospitalized with a seven-day history of fever and pain in the right upper abdomen. Ultrasonography (Panel A) showed gallstones (large arrows), including one in...

CLINICAL PRACTICE: Barrett's Esophagus

Stuart Jon Spechler, M.D. — Thu, 14Â MarÂ 2002 00:00:00 -05:00

A 55-year-old obese white man has had frequent heartburn for more than 10 years. He has treated himself with a histamine H2-receptor antagonist, which provides only partial relief. He decided...

REVIEW ARTICLE: Imatinib Mesylate â A New Oral Targeted Therapy

David G. Savage, M.D., and Karen H. Antman, M.D. — Thu, 28Â FebÂ 2002 00:00:00 -05:00

Imatinib (Gleevec, Novartis, Basel, Switzerland), formerly referred to as STI571, is an inhibitor of specific protein tyrosine kinases that was targeted to the platelet-derived growth factor (PDGF) receptor (Figure 1)....

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Genes, Microbes, and T Cells â New Therapeutic Targets in Crohn's Disease

Thu, 21Â FebÂ 2002 00:00:00 -05:00

Crohn's disease and ulcerative colitis, collectively known as inflammatory bowel disease, affect up to 1 million people in the United States. These related but distinct diseases are complex disorders with...

CLINICAL PRACTICE: Antibiotic-Associated Diarrhea

John G. Bartlett, M.D. — Thu, 31Â JanÂ 2002 00:00:00 -05:00

A 53-year-old woman reports severe watery diarrhea with cramps. She is in her 7th day of a 10-day course of cefixime, prescribed for bronchitis. How should she be evaluated and...

IMAGES IN CLINICAL MEDICINE: Colitis

George Triadafilopoulos, M.D. — Thu, 31Â JanÂ 2002 00:00:00 -05:00

Figure 1. A 62-year-old man presented with abdominal pain and a sigmoid-colostomy output of more than 1 liter of stool per day while receiving cefazolin for aspiration pneumonia. The colostomy...

ORIGINAL ARTICLE: Gastropericardial Fistula after Laparoscopic Surgery for Reflux Disease

Sudish Murthy, M.D., Ph.D., John Looney, M.D., and Michael T. Jaklitsch, M.D. — Thu, 31Â JanÂ 2002 00:00:00 -05:00

Laparoscopic approaches are now commonly used to treat gastroesophageal reflux disease.12 Many studies have demonstrated the safety, efficacy, and durability of these minimal-access procedures.3 However, the learning curve for performing...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2002 â A 17-Year-Old Boy with Biliary Obstruction

M. Susan Moyer and Fiona M. Graeme-Cook — Thu, 24Â JanÂ 2002 00:00:00 -05:00

A 17-year-old boy was admitted to the hospital because of evidence of biliary obstruction.

Seventeen months before admission, the patient was admitted to another hospital because of bloody diarrhea. The serum...

REVIEW ARTICLE: Celiac Sprue

Richard J. Farrell, M.D., and CiarÃ¡n P. Kelly, M.D. — Thu, 17Â JanÂ 2002 00:00:00 -05:00

Celiac sprue, also known as celiac disease and gluten-sensitive enteropathy, is characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine after the ingestion of wheat...

IMAGES IN CLINICAL MEDICINE: A Retained Pharmacy

Janus P. Ong, M.D. and Edgar A. Achkar, M.D. — Thu, 27Â DecÂ 2001 00:00:00 -05:00

Figure 1. A 37-year-old man with Crohn's disease was referred because of an enterocutaneous fistula. He had been taking six tablets of mesalamine and 20 mg of prednisone a day...

REVIEW ARTICLE: Hereditary Periodic Fever

Joost P.H. Drenth, M.D., Ph.D., and Jos W.M. van der Meer, M.D., Ph.D. — Thu, 13Â DecÂ 2001 00:00:00 -05:00

Periodic fever is defined as recurrences of fever that last from a few days to a few weeks, separated by symptom-free intervals of variable duration. This pattern of fever can...

EDITORIAL: An Opioid Antagonist for Postoperative Ileus

Thu, 27Â SepÂ 2001 00:00:00 -05:00

Postoperative ileus, a temporary impairment of gastrointestinal motility, occurs universally after major abdominal surgery. This condition exacerbates nausea and vomiting, delays oral feeding, increases postoperative pain, and prolongs hospitalization. Nearly...

IMAGES IN CLINICAL MEDICINE: Pneumatosis Coli and Colonic Intussusception

Mark A. Stern, M.D. and William D. Chey, M.D. — Thu, 27Â SepÂ 2001 00:00:00 -05:00

Figure 1. A 32-year-old man with no clinically significant medical history presented to the emergency room with fever and a 12-hour history of pain in the right upper quadrant. Before...

ORIGINAL ARTICLE: Selective Postoperative Inhibition of Gastrointestinal Opioid Receptors

Thu, 27Â SepÂ 2001 00:00:00 -05:00

Background: Postoperative recovery of gastrointestinal function and resumption of oral intake are critical determinants of the length of hospital stay. Although opioids are effective treatments for postoperative pain, they contribute...

EDITORIAL: â Not a Good Bug after All

Thu, 13Â SepÂ 2001 00:00:00 -05:00

Worldwide, gastric cancer is the second most frequent cancer and the second leading cause of death from cancer. Since the discovery of Helicobacter pylori in 1982 by Marshall and Warren,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2001 â A 44-Year-Old Woman with Chills, Fever, Jaundice, and Hepatic Abscesses

Raymond T. Chung, M.D., and Eric C. Sheffer, M.D> — Thu, 13Â SepÂ 2001 00:00:00 -05:00

A 44-year-old woman was admitted to this hospital because of abdominal pain, chills, fever, and jaundice.

The patient, a native of southern China, had been treated for intrahepatic stones by lithotripsy...

ORIGINAL ARTICLE: Infection and the Development of Gastric Cancer

Thu, 13Â SepÂ 2001 00:00:00 -05:00

Background: Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer, many aspects of this relation remain uncertain.

Methods: We prospectively studied 1526 Japanese...

IMAGES IN CLINICAL MEDICINE: Gallbladder Sludge

Eric Y. Chen, M.D., Ph.D. and Toan D. Nguyen, M.D. — Thu, 06Â SepÂ 2001 00:00:00 -05:00

Figure 1. A 54-year-old man underwent autologous peripheral stem-cell transplantation for acute myelogenous leukemia in second remission. Fifteen days later, right-upper-quadrant pain and jaundice occurred with the resumption of oral...

REVIEW ARTICLE: Gastroesophageal Variceal Hemorrhage

Ala I. Sharara, M.D., and Don C. Rockey, M.D. — Thu, 30Â AugÂ 2001 00:00:00 -05:00

Gastroesophageal variceal hemorrhage, a major complication of portal hypertension resulting from cirrhosis, accounts for 10 to 30 percent of all cases of bleeding from the upper gastrointestinal tract.1 Variceal hemorrhage...

ORIGINAL ARTICLE: Endoscopic Ligation Compared with Combined Treatment with Nadolol and Isosorbide Mononitrate to Prevent Recurrent Variceal Bleeding

Thu, 30Â AugÂ 2001 00:00:00 -05:00

Background: After an episode of acute bleeding from esophageal varices, patients are at high risk for recurrent bleeding and death. We compared two treatments to prevent recurrent bleeding â endoscopic...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2001 â A 71-Year-Old Man with Gastric Ulcers and Ileocecal Thickening Eight Years after Renal Transplantation

Nezam H. Afdhal, M.D., and Rhonda K. Yantiss, M.D. — Thu, 16Â AugÂ 2001 00:00:00 -05:00

A 71-year-old man was admitted to the hospital because of diarrhea and abdominal pain.

The patient had a history of polycystic renal disease with hypertension and end-stage renal failure, for which...

REVIEW ARTICLE: The Coxibs, Selective Inhibitors of Cyclooxygenase-2

Garret A. FitzGerald, M.D., and Carlo Patrono, M.D. — Thu, 09Â AugÂ 2001 00:00:00 -05:00

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used to treat arthritis, menstrual pain, and headache. Although they are effective, their long-term use is limited by gastrointestinal effects such as dyspepsia and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2001 â An 18-Month-Old Girl with Persistent Diarrhea and Malnutrition

Christopher P. Duggan, M.D., M.P.H., and Joseph Misdraji, M.D. — Thu, 26Â JulÂ 2001 00:00:00 -05:00

An 18-month-old girl was admitted to the hospital because of diarrhea with intermittent constipation and vomiting.

The child had been born by cesarean section, performed because of a breech presentation, at...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2001 â A 25-Year-Old Woman with Fever and Abnormal Liver Function

Eric J. Rubin, M.D., Ph.D., and Fiona M. Graeme-Cook, M.B.B.C. — Thu, 19Â JulÂ 2001 00:00:00 -05:00

A 25-year-old woman was admitted to the hospital because of persistent fever.

The patient was a resident of the Philippines who had flown to the United States 11 days before admission...

IMAGES IN CLINICAL MEDICINE: Tension Pneumoperitoneum

John F. Devine, D.O. and Thomas G. McCarter, Jr., M.D. — Thu, 28Â JunÂ 2001 00:00:00 -05:00

Figure 1. A 69-year-old woman with a permanent pacemaker became nauseated at a luncheon, vomited, and collapsed. Paramedics arrived within three minutes and found her pulseless, in ventricular fibrillation, and...

EDITORIAL: The Power of Genetics to Target Surgical Prevention

Thu, 21Â JunÂ 2001 00:00:00 -05:00

Dramatic advances in our understanding of the genetic basis of cancer have led to new forms of technology and new tools for assessing the genetic risk of cancer. In this...

ORIGINAL ARTICLE: Early Gastric Cancer in Young, Asymptomatic Carriers of Germ-Line E-Cadherin Mutations

Thu, 21Â JunÂ 2001 00:00:00 -05:00

Background: Germ-line truncating mutations in the E-cadherin (CDH1) gene have been found in families with hereditary diffuse gastric cancer. These families are characterized by a highly penetrant susceptibility to diffuse...

REVIEW ARTICLE: The Irritable Bowel Syndrome

Brenda J. Horwitz, M.D., and Robert S. Fisher, M.D. — Thu, 14Â JunÂ 2001 00:00:00 -05:00

In 1849, Cumming1 said of the irritable bowel syndrome, âThe bowels are at one time constipated, another lax, in the same person. How the disease has two such different symptoms...

REVIEW ARTICLE: Expandable Metal Stents for the Treatment of Cancerous Obstruction of the Gastrointestinal Tract

Todd H. Baron, M.D. — Thu, 31Â MayÂ 2001 00:00:00 -05:00

Expandable metal stents have been approved by the Food and Drug Administration for the treatment of gastrointestinal obstruction due to cancer. Although they have not been approved for use in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2001 â A 17-Year-Old Girl with Worsening Abdominal Pain, Fever, and Diarrhea after a Recent Cesarean Section

J. Thomas LaMont, Fiona M. Graeme-Cook — Thu, 24Â MayÂ 2001 00:00:00 -05:00

A 17-year-old girl (gravida 1, para 1) was admitted to the hospital because of abdominal pain, fever, and diarrhea.

The patient had been in good health before admission. Three weeks earlier,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2001 â A 47-Year-Old Woman with Diabetes, Crohn's Colitis, and a Painful Swelling of the Foot

Harley A. Haynes, Fiona M. Graeme-Cook, Lisa H. Lerner — Thu, 10Â MayÂ 2001 00:00:00 -05:00

A 47-year-old woman was admitted to the hospital for the third time because of a painful, red swelling of the right foot.

Nine months before the third admission, the patient had...

ORIGINAL ARTICLE: Effect of the Tyrosine Kinase Inhibitor STI571 in a Patient with a Metastatic Gastrointestinal Stromal Tumor

Thu, 05Â AprÂ 2001 00:00:00 -05:00

Gastrointestinal stromal tumors are a group of mesenchymal neoplasms that arise from precursors of the connective-tissue cells of the gastrointestinal tract.1 They occur predominantly in middle-aged and older persons, and...

IMAGES IN CLINICAL MEDICINE: Complication of Cantor-Tube Insertion

Frederic E. Wien, M.D. and Joel Cooperman, M.D. — Thu, 29Â MarÂ 2001 00:00:00 -05:00

Figure 1. A 61-year-old man with metastatic colon carcinoma was hospitalized with small-bowel obstruction. A Cantor tube was placed in the stomach with instructions to the nurse to advance the...

ORIGINAL ARTICLE: Preventing Recurrent Upper Gastrointestinal Bleeding in Patients with Infection Who Are Taking Low-Dose Aspirin or Naproxen

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Background: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other nonsteroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether...

ORIGINAL ARTICLE: Appendectomy and Protection against Ulcerative Colitis

Thu, 15Â MarÂ 2001 00:00:00 -05:00

Background: A history of appendectomy is rare in patients with ulcerative colitis. This suggests a protective effect of appendectomy or that appendicitis and ulcerative colitis are alternative inflammatory responses. We...

ORIGINAL ARTICLE: High Serum IgG4 Concentrations in Patients with Sclerosing Pancreatitis

Thu, 08Â MarÂ 2001 00:00:00 -05:00

Background: Sclerosing pancreatitis is a unique form of pancreatitis that is characterized by irregular narrowing of the main pancreatic duct, lymphoplasmacytic inflammation of the pancreas, and hypergammaglobulinemia and that responds...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2001 â A 17-Year-Old Girl with Marked Jaundice and Weight Loss

Maureen M. Jonas, Fiona M. Graeme-Cook — Thu, 22Â FebÂ 2001 00:00:00 -05:00

A 17-year-old girl was admitted to the hospital because of progressive jaundice and weight loss.

The patient had been well until four months earlier, when she experienced the onset of malaise,...

ORIGINAL ARTICLE: Intussusception among Infants Given an Oral Rotavirus Vaccine

Thu, 22Â FebÂ 2001 00:00:00 -05:00

Background: Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Our investigation began on May 27, 1999, after nine...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2001 â A 52-Year-Old Man with Chronic Anemia and Sudden Severe Abdominal Pain

Farhad Navab, Rhonda K. Yantiss — Thu, 15Â FebÂ 2001 00:00:00 -05:00

A 52-year-old man was admitted to the hospital because of an attack of severe abdominal pain.

During the preceding four years, the patient had been evaluated repeatedly for chronic iron-deficiency anemia,...

ORIGINAL ARTICLE: Regression of Liver Fibrosis after Biliary Drainage in Patients with Chronic Pancreatitis and Stenosis of the Common Bile Duct

Thu, 08Â FebÂ 2001 00:00:00 -05:00

Background: Chronic obstruction of the common bile duct may cause hepatic fibrosis and secondary biliary cirrhosis.

Methods: We studied liver-biopsy specimens from 11 patients with chronic stenosis of the common bile...

ORIGINAL ARTICLE: Hepatitis B Vaccination and the Risk of Multiple Sclerosis

Thu, 01Â FebÂ 2001 00:00:00 -05:00

Background: Reports of multiple sclerosis developing after hepatitis B vaccination have led to the concern that this vaccine might be a cause of multiple sclerosis in previously healthy subjects.

Methods: We...

ORIGINAL ARTICLE: Use of Molecular Subtyping in Surveillance for Serotype Typhimurium

Thu, 18Â JanÂ 2001 00:00:00 -05:00

Background: Because Salmonella enterica serotype typhimurium is the most common serotype isolated from persons with salmonellosis in the United States, it is difficult to detect unusual clusters or outbreaks. To...

IMAGES IN CLINICAL MEDICINE: Rectal Varices

J. Barry O'Connor, M.D. and Khaled Issa, M.D. — Thu, 04Â JanÂ 2001 00:00:00 -05:00

Figure 1. A 71-year-old woman with primary biliary cirrhosis had recurrent lower gastrointestinal bleeding requiring transfusions. At colonoscopic examination, large rectal varices were the only apparent source of bleeding (Panel...

ORIGINAL ARTICLE: Effect of Antibiotic Therapy on the Density of Vancomycin-Resistant Enterococci in the Stool of Colonized Patients

Thu, 28Â DecÂ 2000 00:00:00 -05:00

Background: Colonization and infection with vancomycin-resistant enterococci have been associated with exposure to antibiotics that are active against anaerobes. In mice that have intestinal colonization with vancomycin-resistant enterococci, these agents...

ORIGINAL ARTICLE: Treatment of MÃ©nÃ©trier's Disease with a Monoclonal Antibody against the Epidermal Growth Factor Receptor

Thu, 07Â DecÂ 2000 00:00:00 -05:00

MÃnÃtrier's disease (hypoproteinemic hypertrophic gastropathy) is a rare, acquired, premalignant disorder of the stomach.1234 It is characterized by giant hypertrophic folds that most often involve the fundus, excess mucus secretion,...

ORIGINAL ARTICLE: Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Each year, clinical upper gastrointestinal events occur in 2 to 4 percent of patients who are taking nonselective nonsteroidal antiinflammatory drugs (NSAIDs). We assessed whether rofecoxib, a selective inhibitor...

ORIGINAL ARTICLE: Transmission of Norwalk Virus during a Football Game

Thu, 26Â OctÂ 2000 00:00:00 -05:00

Background: During a college football game in Florida, diarrhea and vomiting developed in many of the members of a North Carolina team. The next day, similar symptoms developed in some...

IMAGES IN CLINICAL MEDICINE: Mesenteric Ischemia

Azam Ansari, M.D. and Ronald Decesare, M.D. — Thu, 28Â SepÂ 2000 00:00:00 -05:00

Figure 1. An 81-year-old woman with long-standing hypertension and diabetes mellitus was evaluated for increasingly frequent and longer episodes of epigastric pain soon after eating. She grew progressively more fearful...

IMAGES IN CLINICAL MEDICINE: An Aspirin Tablet and a Gastric Ulcer

David J. Levy, M.D. — Thu, 21Â SepÂ 2000 00:00:00 -05:00

Figure 1. A 76-year-old woman had iron-deficiency anemia, a hematocrit of 24 percent, and a positive test for occult blood in stool. For several years, she had been taking 400...

ORIGINAL ARTICLE: Nitrovasodilators, Low-Dose Aspirin, Other Nonsteroidal Antiinflammatory Drugs, and the Risk of Upper Gastrointestinal Bleeding

Thu, 21Â SepÂ 2000 00:00:00 -05:00

Background: The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced...

IMAGES IN CLINICAL MEDICINE: Hepatodiaphragmatic Interposition of the Colon

Jun Nakagawa, M.D., Ph.D. — Thu, 31Â AugÂ 2000 00:00:00 -05:00

Figure 1. A 30-year-old man with a mild respiratory tract infection reported having had intermittent abdominal bloating for more than 15 years. He had no other symptoms, he took no...

IMAGES IN CLINICAL MEDICINE: Pseudomembranous Colitis

Andrew T. Marshall, M.D. and Andrew Bedford, M.D. — Thu, 24Â AugÂ 2000 00:00:00 -05:00

Figure 1. A 94-year-old woman presented with a five-day history of progressive abdominal pain, fever, and diarrhea. Approximately 4 weeks earlier, she had started a 10-day course of a second-generation...

ORIGINAL ARTICLE: Treatment of Type II Gastric Carcinoid Tumors with Somatostatin Analogues

Thu, 24Â AugÂ 2000 00:00:00 -05:00

Gastric carcinoid tumors are rare tumors that originate from gastric enterochromaffin-like cells in the oxyntic mucosa.1 There are three types of gastric carcinoid tumors: type I is associated with chronic...

IMAGES IN CLINICAL MEDICINE: Spontaneous Duodenal Hematoma during Oral Anticoagulation

Pierre HÃ¶sli, M.D. and Marc Schapira, M.D. — Thu, 17Â AugÂ 2000 00:00:00 -05:00

Figure 1. A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender. He had been receiving oral anticoagulants for more than two...

ORIGINAL ARTICLE: Racecadotril in the Treatment of Acute Watery Diarrhea in Children

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Background: Racecadotril (acetorphan), an enkephalinase inhibitor with antisecretory and antidiarrheal actions, is an effective and safe treatment for acute diarrhea in adults and children. Whether treatment with racecadotril and oral...

EDITORIAL: Omeprazole to Prevent Recurrent Bleeding after Endoscopic Treatment of Ulcers

Thu, 03Â AugÂ 2000 00:00:00 -05:00

The management of peptic ulcer disease has changed greatly during the past three decades. Infection with Helicobacter pylori is now recognized as the cause of most ulcers, the use of...

ORIGINAL ARTICLE: Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

Thu, 03Â AugÂ 2000 00:00:00 -05:00

Background: After endoscopic treatment of bleeding peptic ulcers, bleeding recurs in 15 to 20 percent of patients.

Methods: We assessed whether the use of a high dose of a proton-pump inhibitor...

IMAGES IN CLINICAL MEDICINE: Boerhaave's Syndrome

Ramana Gopalan, M.D., M.P.H. and Colleen G. Cooke, M.D. — Thu, 20Â JulÂ 2000 00:00:00 -05:00

Figure 1. A 71-year-old man began to have burning substernal pain while he was eating a sandwich. The pain became excruciating, worsened with breathing, and was accompanied by dyspnea. On...

IMAGES IN CLINICAL MEDICINE: Severe Malaria

Yves Chalandon, M.D. and Alain Kocher, M.D. — Thu, 08Â JunÂ 2000 00:00:00 -05:00

Figure 1. Fever and diarrhea developed in a 34-year-old Swiss man two weeks after his return from Madagascar. Before his visit he had not taken any prophylactic antimalarial drugs. Despite...

EDITORIAL: New Therapeutic Approaches to Crohn's Disease

Thu, 01Â JunÂ 2000 00:00:00 -05:00

Crohn's disease is an idiopathic, immunologically mediated disorder in which medically or surgically induced remissions are followed by relapses. The goals of treatment are to induce and then maintain remission...

IMAGES IN CLINICAL MEDICINE: Oral Manifestations of Crohn's Disease

Tamar Stricker, M.D. and Christian P. Braegger, M.D. — Thu, 01Â JunÂ 2000 00:00:00 -05:00

Figure 1. An eight-year-old girl had a four-month history of painful mouth lesions, resulting in decreased oral intake and weight loss, and a one-year history of intermittent abdominal pain and...

ORIGINAL ARTICLE: A Preliminary Study of Growth Hormone Therapy for Crohn's Disease

Thu, 01Â JunÂ 2000 00:00:00 -05:00

Background: Crohn's disease is a chronic inflammatory disorder of the bowel. In a preliminary study, we evaluated whether the administration of growth hormone (somatropin) as well as a high-protein diet...

ORIGINAL ARTICLE: A Comparison of Methotrexate with Placebo for the Maintenance of Remission in Crohn's Disease

Thu, 01Â JunÂ 2000 00:00:00 -05:00

Background: Patients with Crohn's disease often have relapses. Better treatments are needed for the maintenance of remission. Although methotrexate is an effective short-term treatment for Crohn's disease, its role in...

ORIGINAL ARTICLE: Dexamethasone Alone or in Combination with Ondansetron for the Prevention of Delayed Nausea and Vomiting Induced by Chemotherapy

The Italian Group for Antiemetic Research — Thu, 25Â MayÂ 2000 00:00:00 -05:00

Background: The prevention of delayed nausea and vomiting caused by moderately emetogenic chemotherapy for cancer has not been studied systematically.

Methods: We enrolled patients who were scheduled to receive chemotherapy for...

ORIGINAL ARTICLE: Enteritis Necroticans (Pigbel) in a Diabetic Child

Thu, 27Â AprÂ 2000 00:00:00 -05:00

Background: Enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its...

ORIGINAL ARTICLE: An Outbreak of Febrile Gastroenteritis Associated with Corn Contaminated by

Thu, 27Â AprÂ 2000 00:00:00 -05:00

Background: On May 21, 1997, numerous cases of febrile gastrointestinal illness were reported among the students and staff of two primary schools in northern Italy, all of whom had eaten...

REVIEW ARTICLE: Carcinoma of the Anal Canal

David P. Ryan, M.D., Carolyn C. Compton, M.D., and Robert J. Mayer, M.D. — Thu, 16Â MarÂ 2000 00:00:00 -05:00

Carcinoma of the anal canal accounts for 1.5 percent of digestive-system cancers in the United States, with an estimated 3400 new cases in 2000.1 Thirty years ago, anal cancer was...

IMAGES IN CLINICAL MEDICINE: Retroperitoneal Hemorrhage

David J. Kastan, M.D. and Thomas H. Burke, R.T. — Thu, 09Â MarÂ 2000 00:00:00 -05:00

Figure 1. Left flank pain and hypotension developed in a 62-year-old woman during treatment with intravenous heparin (900 U per hour) and warfarin (7.5 mg per day) for deep venous...

IMAGES IN CLINICAL MEDICINE: Cytomegalovirus Esophageal Ulcers

J. Michael Kilby, M.D. and Swarnjit Singh, M.D. — Thu, 17Â FebÂ 2000 00:00:00 -05:00

Figure 1. A 48-year-old man infected with the human immunodeficiency virus had had recurrent painful ulcers in his mouth and esophagus for several years. Biopsies of the lesions were nondiagnostic....

EDITORIAL: The Search for a Better Oral Rehydration Solution for Cholera

Thu, 03Â FebÂ 2000 00:00:00 -05:00

Oral rehydration therapy was developed in the 1960s. During the past three decades it has been used widely and successfully in the treatment of cholera and other diarrheal diseases. The...

IMAGES IN CLINICAL MEDICINE: Gingival Hyperplasia Induced by Phenytoin

Sanjay Sharma, M.D., D.M. and S.K. Dasroy, B.D.S. — Thu, 03Â FebÂ 2000 00:00:00 -05:00

Figure 1. A 17-year-old boy had generalized tonicâclonic seizures for four years. When the seizures began, a computed tomographic scan of his brain and an electroencephalogram were normal. Treatment with...

ORIGINAL ARTICLE: Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera

Thu, 03Â FebÂ 2000 00:00:00 -05:00

Background: Although standard glucose-based oral rehydration therapy corrects the dehydration caused by cholera, it does not reduce the diarrhea. Short-chain fatty acids, which are produced in the colon from nonabsorbed...

ORIGINAL ARTICLE: Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular Hemorrhage

Thu, 13Â JanÂ 2000 00:00:00 -05:00

Background: Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain.

Methods: We studied the...

EDITORIAL: The Role of Endoscopy in Managing Acute Lower Gastrointestinal Bleeding

Thu, 13Â JanÂ 2000 00:00:00 -05:00

In this issue of the Journal, Jensen et al. report their experience with the use of colonoscopy performed on an urgent basis for the diagnosis and treatment of acute hemorrhage...

REVIEW ARTICLE: Pancreatic and Biliary Endoscopy

William R. Brugge, M.D., and Jacques Van Dam, M.D., Ph.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

Dramatic improvements in the quality of instrumentation have established endoscopy as the primary method for diagnosing and treating many pancreatic and biliary diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the most...

REVIEW ARTICLE: Pancreatic and Biliary Endoscopy

William R. Brugge, M.D., and Jacques Van Dam, M.D., Ph.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

REVIEW ARTICLE: Endoscopy of the Upper Gastrointestinal Tract

Jacques Van Dam, M.D., Ph.D., and William R. Brugge, M.D. — Thu, 02Â DecÂ 1999 00:00:00 -05:00

The rapid development of high-technology procedures has come at a time when the ability of the U.S. health care system to provide expensive services to all patients is increasingly constrained....

IMAGES IN CLINICAL MEDICINE:

Claude Matuchansky, M.D. and Yves Lenormand, M.D. — Thu, 02Â DecÂ 1999 00:00:00 -05:00

Figure 1. A 22-year-old man presented with a six-month history of severe epigastric and periumbilical hunger pangs, diarrhea, and a weight loss of 8 kg. Ultrasonographic abdominal examination showed normal...

ORIGINAL ARTICLE: Epidemics of Diarrhea Caused by a Clindamycin-Resistant Strain of in Four Hospitals

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: Large outbreaks of diarrhea caused by a newly recognized strain of Clostridium difficile occurred in four hospitals located in different parts of the United States between 1989 and 1992....

IMAGES IN CLINICAL MEDICINE: Inverted Colonic Diverticulum

George Triadafilopoulos, M.D. — Thu, 11Â NovÂ 1999 00:00:00 -05:00

Figure 1. A 42-year-old man with a history of mild, intermittent pain on the lower left side of the abdomen presented with an episode of painless hematochezia. The physical examination...

IMAGES IN CLINICAL MEDICINE: Barrett's Esophagus with High-Grade Dysplasia

Uri Ladabaum, M.D. and W. Michael McDonnell, M.D. — Thu, 04Â NovÂ 1999 00:00:00 -05:00

Figure 1. A 73-year-old man underwent endoscopy after presenting with melena. A duodenal ulcer was seen, and Barrett's esophagus was found incidentally. One year later, esophageal-biopsy specimens obtained during surveillance...

ORIGINAL ARTICLE: An Outbreak of Multidrug-Resistant, Quinolone-Resistant Serotype Typhimurium DT104

Thu, 04Â NovÂ 1999 00:00:00 -05:00

Background: Food-borne salmonella infections have become a major problem in industrialized countries. The strain of Salmonella enterica serotype typhimurium known as definitive phage type 104 (DT104) is usually resistant to...

REVIEW ARTICLE: Biliary Tract Cancers

Thu, 28Â OctÂ 1999 00:00:00 -05:00

In the United States, an estimated 20,000 new cases of liver and biliary tract cancer are diagnosed annually.1 Biliary tract cancer is the second most common primary hepatobiliary cancer, after...

IMAGES IN CLINICAL MEDICINE: An Endoscopic Jack-o'-Lantern

Michael E. Humphrey, M.D. — Thu, 28Â OctÂ 1999 00:00:00 -05:00

Figure 1. A 72-year-old man underwent follow-up colonoscopy after the removal of multiple tubulovillous polyps. Severe diverticulosis was the only finding. Three diverticula were seen adjacent to the larger lumen...

IMAGES IN CLINICAL MEDICINE: Emphysematous Cholecystitis

Etienne M. Danse, M.D. and Pierre-FranÃ§ois Laterre, M.D. — Thu, 07Â OctÂ 1999 00:00:00 -05:00

Figure 1. A 67-year-old patient with type 2 diabetes who had no history of biliary disease was admitted to the emergency department for acute pain in the right upper quadrant....

ORIGINAL ARTICLE: Absence of Benefit of Eradicating in Patients with Nonulcer Dyspepsia

Thu, 07Â OctÂ 1999 00:00:00 -05:00

Background: The relation between Helicobacter pylori infection and nonulcer dyspepsia is uncertain. We tested the hypothesis that curing the infection will relieve symptoms of dyspepsia.

Methods: We randomly assigned 170 H....

ORIGINAL ARTICLE: Neurologic Complications in Children with Enterovirus 71 Infection

Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: Enterovirus 71 infection causes hand-foot-and-mouth disease in young children, which is characterized by several days of fever and vomiting, ulcerative lesions in the oral mucosa, and vesicles on the...

ORIGINAL ARTICLE: An Epidemic of Enterovirus 71 Infection in Taiwan

Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: Enteroviruses can cause outbreaks of hand-foot-and-mouth disease (characterized by vesicular lesions on the hands, feet, and oral mucosa) or herpangina, usually without life-threatening manifestations. In 1998 an epidemic of...

EDITORIAL: Exercise and the Gallbladder

Thu, 09Â SepÂ 1999 00:00:00 -05:00

Gallstones are an important cause of disease and a common reason for surgery. Women, particularly those who have had multiple pregnancies or have certain ethnic backgrounds, such as Native American...

ORIGINAL ARTICLE: Recreational Physical Activity and the Risk of Cholecystectomy in Women

Thu, 09Â SepÂ 1999 00:00:00 -05:00

Background: Physical activity may be an important determinant of the risk of gallstone disease in women, both independently and as a result of its role in maintaining body weight.

Methods: We...

EDITORIAL: Surgery for the ZollingerâEllison Syndrome

Thu, 26Â AugÂ 1999 00:00:00 -05:00

In 1955, Zollinger and Ellison described the clinical syndrome of virulent peptic ulcer disease associated with marked gastric hyperacidity and pancreatic islet-cell tumors.1 A year earlier, Wermer had reported a...

IMAGES IN CLINICAL MEDICINE: Mesenteric Cyst

Diane M. Simeone, M.D. and Thomas Pranikoff, M.D. — Thu, 26Â AugÂ 1999 00:00:00 -05:00

Figure 1. Abdominal examination of a 37-year-old woman with a week-long history of nausea and vomiting revealed only midabdominal fullness. An upper gastrointestinal series revealed proximal dilatation of the duodenum,...

ORIGINAL ARTICLE: Surgery to Cure the ZollingerâEllison Syndrome

Thu, 26Â AugÂ 1999 00:00:00 -05:00

Background: and Methods: The role of surgery in patients with the ZollingerâEllison syndrome is controversial. To determine the efficacy of surgery in patients with this syndrome, we followed 151 consecutive...

REVIEW ARTICLE: Magnetic Resonance Cholangiopancreatography

Matthew A. Barish, M.D., E. Kent Yucel, M.D., and Joseph T. Ferrucci, M.D. — Thu, 22Â JulÂ 1999 00:00:00 -05:00

Magnetic resonance cholangiopancratography (MRCP) is a radiologic technique that produces images of the pancreaticobiliary tree that are similar in appearance to those obtained by invasive radiographic methods, such as endoscopic...

EDITORIAL: Management of Acute Colonic Pseudo-Obstruction

Thu, 15Â JulÂ 1999 00:00:00 -05:00

Acute colonic pseudo-obstruction, also called Ogilvie's syndrome, refers to marked dilation of the colon in the absence of mechanical obstruction. It generally develops in hospitalized patients over a period of...

ORIGINAL ARTICLE: Neostigmine for the Treatment of Acute Colonic Pseudo-Obstruction

Robert J. Ponec, M.D., Michael D. Saunders, M.D., and Michael B. Kimmey, M.D. — Thu, 15Â JulÂ 1999 00:00:00 -05:00

Background: Acute colonic pseudo-obstruction â that is, massive dilation of the colon without mechanical obstruction â may develop after surgery or severe illness. Although it may resolve with conservative therapy,...

ORIGINAL ARTICLE: A Comparison of Injections of Botulinum Toxin and Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure

Thu, 08Â JulÂ 1999 00:00:00 -05:00

Background: and Methods: Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared...

REVIEW ARTICLE: Occult Gastrointestinal Bleeding

Don C. Rockey, M.D. — Thu, 01Â JulÂ 1999 00:00:00 -05:00

Occult gastrointestinal bleeding typically refers to bleeding that is not apparent to the patient. The potential for occult bleeding is emphasized by the finding that for melena to be produced...

REVIEW ARTICLE: Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs

M. Michael Wolfe, M.D., David R. Lichtenstein, M.D., and Gurkirpal Singh, M.D. — Thu, 17Â JunÂ 1999 00:00:00 -05:00

One hundred years have passed since Felix Hoffman, working at Bayer Industries, reported the successful synthesis of acetylsalicylic acid as the first nonsteroidal antiinflammatory drug (NSAID).12 At the suggestion of...

IMAGES IN CLINICAL MEDICINE: Hereditary Hemorrhagic Telangiectasia (OslerâWeberâRendu Disease)

Aryel Nicoleau, M.D. and Carl A. Nicoleau, M.D., Ph.D. — Thu, 10Â JunÂ 1999 00:00:00 -05:00

Figure 1. A 67-year-old woman has multiple telangiectasias on her hands, as well as on her arms, legs, ears, lips, and nasal mucosa. She has had numerous episodes of epistaxis...

REVIEW ARTICLE: Acute Necrotizing Pancreatitis

Todd H. Baron, M.D., and Desiree E. Morgan, M.D. — Thu, 06Â MayÂ 1999 00:00:00 -05:00

Acute pancreatitis may be clinically mild or severe. Severe acute pancreatitis is usually a result of pancreatic glandular necrosis. The morbidity and mortality associated with acute pancreatitis are substantially higher...

IMAGES IN CLINICAL MEDICINE: Rupture of a Pancreatic Pseudocyst into the Duodenum

Hideyuki Hiraishi, M.D. and Akira Terano, M.D. — Thu, 06Â MayÂ 1999 00:00:00 -05:00

Figure 1. A 42-year-old man who had consumed approximately 180 g of alcohol per day for 22 years was admitted to the hospital with acute pancreatitis complicated by a pseudocyst....

ORIGINAL ARTICLE: Infliximab for the Treatment of Fistulas in Patients with Crohn's Disease

Thu, 06Â MayÂ 1999 00:00:00 -05:00

Background: Enterocutaneous fistulas are a serious complication of Crohn's disease and are difficult to treat. Infliximab, a chimeric monoclonal antibody to tumor necrosis factor Î±, has recently been developed as...

IMAGES IN CLINICAL MEDICINE: Herpes Simplex Esophagitis

Frank L. Urbano, M.D. and Minhhuyen T. Nguyen, M.D. — Thu, 22Â AprÂ 1999 00:00:00 -05:00

Figure 1. A 47-year-old woman with a history of hypertension and alcohol abuse had had fatigue, nausea, vomiting, and abdominal pain for two days. On admission, she vomited coffee-grounds material....

ORIGINAL ARTICLE: Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Background: and Methods: We compared propranolol therapy and endoscopic ligation for the primary prevention of bleeding from esophageal varices. This prospective, controlled trial included consecutive eligible patients who had large...

EDITORIAL: Primary Prevention of Bleeding from Esophageal Varices

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Most patients with portal hypertension in North America and Europe have cirrhosis. Of those with compensated cirrhosis (i.e., cirrhosis with no ascites, encephalopathy, or severe jaundice), 30 percent have esophageal...

EDITORIAL: Lymph-Node Dissection for Gastric Cancer

Thu, 25Â MarÂ 1999 00:00:00 -05:00

In this issue of the Journal, Bonenkamp et al.1 report the results of a Dutch trial in which 711 patients with gastric cancer were randomly assigned to gastrectomy with either...

IMAGES IN CLINICAL MEDICINE: Gastric Tumor Discovered by Chest Radiography

Arthur H. Zalev, M.D. and Peter A. Kopplin, M.D. — Thu, 25Â MarÂ 1999 00:00:00 -05:00

Figure 1. An 88-year-old Japanese woman had a six-week history of black stools and fatigue. Her hemoglobin level was 6.7 g per deciliter, and a fecal occult-blood test (Hemoccult) was...

ORIGINAL ARTICLE: Extended Lymph-Node Dissection for Gastric Cancer

Thu, 25Â MarÂ 1999 00:00:00 -05:00

Background: Curative resection is the treatment of choice for gastric cancer, but it is unclear whether this operation should include an extended (D2) lymph-node dissection, as recommended by the Japanese...

EDITORIAL: Heartburn â A Serious Symptom

Thu, 18Â MarÂ 1999 00:00:00 -05:00

Heartburn is a serious symptom that merits more attention from patients and physicians. It is the hallmark of gastroesophageal reflux, a disorder that may lead to esophagitis, progressing in some...

REVIEW ARTICLE: Carcinoid Tumors

Matthew H. Kulke, M.D., and Robert J. Mayer, M.D. — Thu, 18Â MarÂ 1999 00:00:00 -05:00

Carcinoid tumors were first described over 100 years ago by Lubarsch, who found multiple tumors in the distal ileum of two patients at autopsy.1 The term karzinoide was used by...

ORIGINAL ARTICLE: Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma

Thu, 18Â MarÂ 1999 00:00:00 -05:00

Background: The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors.

Methods: We...

EDITORIAL: Management of Severe Ulcer Rebleeding

Thu, 11Â MarÂ 1999 00:00:00 -05:00

The number of patients hospitalized for upper gastrointestinal bleeding from ulcers has decreased substantially in recent years. The decrease reflects a variety of factors: the widespread use of histamine H2âreceptor...

SPECIAL ARTICLE: The Cost Effectiveness of Strategies for the Treatment of Intestinal Parasites in Immigrants

Thu, 11Â MarÂ 1999 00:00:00 -05:00

Background: Currently, more than 600,000 immigrants enter the United States each year from countries where intestinal parasites are endemic. At entry persons with parasitic infections may be asymptomatic, and stool...

IMAGES IN CLINICAL MEDICINE: Endoscopy in Its Infancy

L. Fred Ayvazian, M.D. — Thu, 11Â MarÂ 1999 00:00:00 -05:00

Figure 1. While still a teenager, Chevalier Jackson (1865â1958) concocted a tool that enabled him to recover an expensive drill bit lost underground during oil-well drilling on his father's Pennsylvania...

ORIGINAL ARTICLE: Endoscopic Retreatment Compared with Surgery in Patients with Recurrent Bleeding after Initial Endoscopic Control of Bleeding Ulcers

Thu, 11Â MarÂ 1999 00:00:00 -05:00

Background: and Methods: After endoscopic treatment to control bleeding of peptic ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective, randomized study, we compared endoscopic retreatment...

ORIGINAL ARTICLE: Reduction of Cisplatin-Induced Emesis by a Selective Neurokinin-1âReceptor Antagonist

Thu, 21Â JanÂ 1999 00:00:00 -05:00

Background: The localization of substance P in brain-stem regions associated with vomiting, and the results of studies in ferrets, led us to postulate that a neurokinin-1âreceptor antagonist would be an...

IMAGES IN CLINICAL MEDICINE: Meckel's Diverticulum

Ernesto P. Molmenti, M.D. and Robert W. Thompson, M.D. — Thu, 07Â JanÂ 1999 00:00:00 -05:00

Figure 1. A 50-year-old obese man who sustained a closed traumatic injury to the abdomen in a motor vehicle accident was taken to the operating room, where a splenectomy was...

ORIGINAL ARTICLE: Chemotherapy Followed by Surgery Compared with Surgery Alone for Localized Esophageal Cancer

Thu, 31Â DecÂ 1998 00:00:00 -05:00

Background: We performed a multi-institutional randomized trial comparing preoperative chemotherapy followed by surgery with surgery alone for patients with local and operable esophageal cancer.

Methods: Preoperative chemotherapy for patients randomly assigned...

EDITORIAL: and Nonulcer Dyspepsia

Thu, 24Â DecÂ 1998 00:00:00 -05:00

Dyspepsia encompasses a variety of upper abdominal symptoms â pain and discomfort, bloating, fullness, early satiety, nausea, anorexia, heartburn, regurgitation, and belching â that are experienced regularly by 25 to...

ORIGINAL ARTICLE: Lack of Effect of Treating Infection in Patients with Nonulcer Dyspepsia

Thu, 24Â DecÂ 1998 00:00:00 -05:00

Background: It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer, or functional, dyspepsia.

Methods: We conducted a double-blind, multicenter trial of patients with H. pylori...

ORIGINAL ARTICLE: Symptomatic Benefit from Eradicating Infection in Patients with Nonulcer Dyspepsia

Thu, 24Â DecÂ 1998 00:00:00 -05:00

Background: The eradication of Helicobacter pylori infection is beneficial in patients with gastric or duodenal ulcers. The value of eradicating the infection in patients with dyspepsia and no evidence of...

REVIEW ARTICLE: Management of Nonulcer Dyspepsia

Robert S. Fisher, M.D., and Henry P. Parkman, M.D. — Thu, 05Â NovÂ 1998 00:00:00 -05:00

The term âdyspepsia,â derived from the Greek words dys (bad) and pepsis (digestion), refers to symptoms thought to originate in the upper gastrointestinal tract.12 Dyspepsia is often used to refer...

EDITORIAL: Constipation in Children

Thu, 15Â OctÂ 1998 00:00:00 -05:00

Constipation is a frequent problem among infants and children. For example, in a U.S. study, 16 percent of parents of 22-month-olds reported that their children had constipation.1 In the United...

ORIGINAL ARTICLE: Intolerance of Cow's Milk and Chronic Constipation in Children

Thu, 15Â OctÂ 1998 00:00:00 -05:00

Background: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Michael S. Mahoney, M.D. and Marc Kahn, M.D. — Thu, 10Â SepÂ 1998 00:00:00 -05:00

Figure 1. A 20-year-old college student, newly arrived in the United States, was evaluated for severe abdominal pain. What is the diagnosis?...

EDITORIAL: Pancreatitis and Mutations of the Cystic Fibrosis Gene

Thu, 03Â SepÂ 1998 00:00:00 -05:00

In patients with cystic fibrosis, the inability to maintain the luminal hydration of ducts that contain or secrete large molecules may affect multiple organs. The protein product of the gene...

ORIGINAL ARTICLE: Relation between Mutations of the Cystic Fibrosis Gene and Idiopathic Pancreatitis

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: It is unknown whether genetic factors predispose patients to idiopathic pancreatitis. In patients with cystic fibrosis, mutations of the cystic fibrosis transmembrane conductance regulator (CFTR ) gene typically cause...

ORIGINAL ARTICLE: Mutations of the Cystic Fibrosis Gene in Patients with Chronic Pancreatitis

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: The pancreatic lesions of cystic fibrosis develop in utero and closely resemble those of chronic pancreatitis. Therefore, we hypothesized that mutations of the cystic fibrosis transmembrane conductance regulator (CF...

EDITORIAL: Treatment of Crohn's Disease at the Turn of the Century

Thu, 06Â AugÂ 1998 00:00:00 -05:00

Inflammatory bowel diseases are the second most common chronic inflammatory disorder after rheumatoid arthritis. Of these, Crohn's disease afflicts hundreds of thousands of patients, particularly in developed countries, and its...

ORIGINAL ARTICLE: A Comparison of Budesonide and Mesalamine for Active Crohn's Disease

Thu, 06Â AugÂ 1998 00:00:00 -05:00

Background: Crohn's disease is often treated with glucocorticoids or mesalamine. We compared the efficacy and safety of controlled-ileal-release budesonide capsules and slow-release mesalamine tablets in patients with active Crohn's disease...

IMAGES IN CLINICAL MEDICINE: Vascular Ectasia of the Gastric Antrum

Jeffrey L. Barnett, M.D. — Thu, 16Â JulÂ 1998 00:00:00 -05:00

Figure 1. A 76-year-old woman presented with a two-month history of intermittent melena, weakness, and anemia that required the transfusion of six units of packed red cells. In the past...

ORIGINAL ARTICLE: Relative Frequency of Upper Gastrointestinal and Colonic Lesions in Patients with Positive Fecal Occult-Blood Tests

Thu, 16Â JulÂ 1998 00:00:00 -05:00

Background: Although bleeding lesions anywhere in the gastrointestinal tract can cause a positive reaction on guaiac-based fecal occult-blood tests, the relative frequency of upper gastrointestinal and colonic lesions is unknown.

Methods:...

REVIEW ARTICLE: Acute Diverticulitis

L.B. Ferzoco, M.D., V. Raptopoulos, M.D., and W. Silen, M.D. — Thu, 21Â MayÂ 1998 00:00:00 -05:00

The acquired form of diverticular disease is extremely common in Western society, affecting approximately 5 to 10 percent of the population over 45 years old and almost 80 percent of...

CLINICAL DEBATE: Should All People over the Age of 50 Have Regular Fecal Occult-Blood Tests?

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Recent controlled clinical trials have demonstrated that periodic fecal occult-blood testing can reduce deaths from colorectal cancer.123 As a result, the U.S. Preventive Services Task Force, the American Cancer Society,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Genome â New Insights into Pathogenesis and Therapeutics

Thu, 19Â MarÂ 1998 00:00:00 -05:00

The ability of robotic analyzers to sequence long lengths of DNA automatically and the rapidity with which computers can scan gene data banks have spawned a new discipline in the...

IMAGES IN CLINICAL MEDICINE: Briskly Bleeding Gastric Ulcer

Pankaj Vashi, M.D. — Thu, 19Â MarÂ 1998 00:00:00 -05:00

Figure 1. A 67-year-old woman was evaluated for a one-week history of mild epigastric pain and black stools. On the day of admission she had two episodes of hematemesis. Physical...

ORIGINAL ARTICLE: Molecular Analysis of the Progression from âAssociated Chronic Gastritis to Mucosa-Associated Lymphoid-Tissue Lymphoma of the Stomach

Thu, 19Â MarÂ 1998 00:00:00 -05:00

Several lines of evidence suggest a link between chronic gastritis due to Helicobacter pylori and mucosa-associated lymphoid-tissue (MALT) lymphoma of the stomach.12 A close epidemiologic association has been reported.345 The...

ORIGINAL ARTICLE: A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation

Thu, 19Â MarÂ 1998 00:00:00 -05:00

Background: Critically ill patients who require mechanical ventilation are at increased risk for gastrointestinal bleeding from stress ulcers. There are conflicting data on the effect of histamine H2-receptor antagonists and...

ORIGINAL ARTICLE: Omeprazole Compared with Misoprostol for Ulcers Associated with Nonsteroidal Antiinflammatory Drugs

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Background: Misoprostol is effective for ulcers associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs) but is often poorly tolerated because of diarrhea and abdominal pain. We compared the efficacy...

ORIGINAL ARTICLE: A Comparison of Omeprazole with Ranitidine for Ulcers Associated with Nonsteroidal Antiinflammatory Drugs

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Background: Suppressing acid secretion is thought to reduce the risk of ulcers associated with regular use of nonsteroidal antiinflammatory drugs (NSAIDs), but the best means of accomplishing this is uncertain.

Methods:...

IMAGES IN CLINICAL MEDICINE: Cellular Aggregation in the Pancreas

Domenico Bosco, Ph.D. and Paolo Meda, M.D. — Thu, 12Â FebÂ 1998 00:00:00 -05:00

Figure 1. Immunofluorescence staining with antiglucagon antibody reveals glucagon cells at the periphery of a heart-shaped islet of Langerhans in the pancreas (Ã800)....

ORIGINAL ARTICLE: Infection in an Asymptomatic 74-Year-Old Greek Woman with Splenomegaly

Thu, 05Â FebÂ 1998 00:00:00 -05:00

Malaria most commonly presents as an acute systemic, febrile illness but may manifest more indolently as chronic anemia, glomerulonephritis, or tropical splenomegaly syndrome (or hyperreactive malarial splenomegaly) due to Plasmodium...

EDITORIAL: Pharmacologic Therapy for Anal Fissure

Thu, 22Â JanÂ 1998 00:00:00 -05:00

It has been said that all patients with anorectal symptoms come to the doctor reporting hemorrhoids or worrying about cancer. Among the myriad other diagnostic possibilities, one of the most...

ORIGINAL ARTICLE: A Comparison of Botulinum Toxin and Saline for the Treatment of Chronic Anal Fissure

Thu, 22Â JanÂ 1998 00:00:00 -05:00

Background: Chronic anal fissure is a tear in the lower half of the anal canal that is maintained by contraction of the internal anal sphincter. Sphincterotomy, the most widely used...

EDITORIAL: More Precision in Diagnosing Appendicitis

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Despite the advances in surgery over the past century, the diagnosis of acute appendicitis continues to present clinicians with problems. As Rao et al. report in this issue of the...

ORIGINAL ARTICLE: Effect of Computed Tomography of the Appendix on Treatment of Patients and Use of Hospital Resources

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Background: In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the...

EDITORIAL: Human Papillomaviruses and Anogenital Cancers

Thu, 06Â NovÂ 1997 00:00:00 -05:00

Squamous-cell carcinoma of the cervix (cervical cancer) has long been known to have all the epidemiologic characteristics of a sexually transmitted infectious disease. Annually, there are about 500,000 new cases...

ORIGINAL ARTICLE: Sexually Transmitted Infection as a Cause of Anal Cancer

Thu, 06Â NovÂ 1997 00:00:00 -05:00

Background: The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based caseâcontrol study in Denmark and Sweden.

Methods: We...

IMAGES IN CLINICAL MEDICINE: Barium Impaction in the Sigmoid Colon

W. Michael McDonnell, M.D. and Frank Jung, M.D. — Thu, 30Â OctÂ 1997 00:00:00 -05:00

Figure 1. A 54-year-old woman with lung cancer presented with severe abdominal pain and bilious vomiting. She had had a diagnostic barium small-bowel follow-through 10 days earlier for nausea and...

ORIGINAL ARTICLE: Anaphylaxis from the Carboxymethylcellulose Component of Barium Sulfate Suspension

Thu, 30Â OctÂ 1997 00:00:00 -05:00

Although allergic reactions to barium sulfate suspensions are estimated to occur at a rate of less than 2 per million,12 the frequency has been reported to be increasing.34 The cause...

ORIGINAL ARTICLE: Prognostic Value of Immunohistochemically Identifiable Tumor Cells in Lymph Nodes of Patients with Completely Resected Esophageal Cancer

Thu, 23Â OctÂ 1997 00:00:00 -05:00

Background: Current methods of disease staging often fail to detect small numbers of tumor cells in lymph nodes. Metastatic relapse may arise from these few cells.

Methods: We studied 1308 lymph...

ORIGINAL ARTICLE: A Short-Term Study of Chimeric Monoclonal Antibody cA2 to Tumor Necrosis Factor Î± for Crohn's Disease

Thu, 09Â OctÂ 1997 00:00:00 -05:00

Background: Studies in animals and an open-label trial have suggested a role for antibodies to tumor necrosis factor Î±, specifically chimeric monoclonal antibody cA2, in the treatment of Crohn's disease.

Methods:...

ORIGINAL ARTICLE: Patient-to-Patient Transmission of Hepatitis C Virus during Colonoscopy

Thu, 24Â JulÂ 1997 00:00:00 -05:00

Invasive diagnostic or therapeutic procedures may be a route for the transmission of the hepatitis C virus (HCV).12345 In a study of patients in a gastrointestinal-disease unit, endoscopic biopsies were...

IMAGES IN CLINICAL MEDICINE: Annular Pancreas

Aslam Godil, M.D. and John D. McCracken, M.D. — Thu, 19Â JunÂ 1997 00:00:00 -05:00

Figure 1. A 79-year-old man had a five-month history of dull, aching epigastric pain radiating to the back and a 16-kg (35-lb) weight loss. The pain was made worse by...

ORIGINAL ARTICLE: Rapid Measurement of Urinary Trypsinogen-2 as a Screening Test for Acute Pancreatitis

Thu, 19Â JunÂ 1997 00:00:00 -05:00

Background: Acute pancreatitis can be difficult to diagnose. We developed a rapid dipstick screening test for pancreatitis, based on the immunochromatographic measurement of urinary trypsinogen-2.

Methods: We prospectively compared the urinary...

IMAGES IN CLINICAL MEDICINE: Trichobezoars

Farhad Navab, M.D. and Jennifer Sabol, M.D. — Thu, 12Â JunÂ 1997 00:00:00 -05:00

Figure 1. A 27-year-old woman was admitted because of a three-day history of constant epigastric pain radiating to the back, associated with nausea and vomiting. For several years, as a...

IMAGES IN CLINICAL MEDICINE: Perforated Duodenal Ulcer

Ernesto P. Molmenti, M.D. — Thu, 22Â MayÂ 1997 00:00:00 -05:00

Figure 1. A 48-year-old man who was receiving medical treatment for peptic ulcer disease experienced intense epigastric pain, sudden in onset and without emesis, four hours before admission. On examination,...

ORIGINAL ARTICLE: High-Dose Pancreatic-Enzyme Supplements and Fibrosing Colonopathy in Children with Cystic Fibrosis

Thu, 01Â MayÂ 1997 00:00:00 -05:00

Background: Fibrosing colonopathy has been reported in young children with cystic fibrosis, the majority of whom take high-strength pancreatic-enzyme supplements to control intestinal malabsorption. We conducted a caseâcontrol study in...

IMAGES IN CLINICAL MEDICINE: Spigelian Hernia

Susana M. Campos, M.D. and Thomas Walden, M.D. — Thu, 17Â AprÂ 1997 00:00:00 -05:00

Figure 1. Abdominal computed tomography, with the administration of oral and intravenous contrast material, was performed in a 40-year-old woman with long-standing pain in the right lower quadrant and a...

EDITORIAL: Therapy for Bleeding Peptic Ulcers

Thu, 10Â AprÂ 1997 00:00:00 -05:00

During the past 50 years, mortality from acute bleeding in the upper gastrointestinal tract has remained at 6 to 10 percent, despite improved medical and surgical treatments, the development of...

ORIGINAL ARTICLE: A Comparison of Omeprazole and Placebo for Bleeding Peptic Ulcer

Thu, 10Â AprÂ 1997 00:00:00 -05:00

Background: The role of medical treatment for patients with bleeding peptic ulcers is uncertain.

Methods: We conducted a double-blind, placebo-controlled trial in 220 patients with duodenal, gastric, or stomal ulcers and...

REVIEW ARTICLE: The Esophagogastric Junction

Ravinder K. Mittal, M.D., and David H. Balaban, M.D. — Thu, 27Â MarÂ 1997 00:00:00 -05:00

The lower esophageal sphincter regulates the flow of food between the esophagus and the stomach. It is now clear that both the intrinsic smooth muscle of the distal esophagus and...

ORIGINAL ARTICLE: The Use and Interpretation of Commercial Gene Testing for Familial Adenomatous Polyposis

Thu, 20Â MarÂ 1997 00:00:00 -05:00

Background: The use of commercially available tests for genes linked to familial cancer has aroused concern about the impact of these tests on patients. Familial adenomatous polyposis is an autosomal...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Trefoil Peptides in the Defense of the Gastrointestinal Tract

Thu, 13Â FebÂ 1997 00:00:00 -05:00

Microorganisms and other agents continually threaten the intestinal mucosa, calling for the gut to prevent damage, restore epithelium in regions in which cells are lost, and suppress inflammation. How does...

IMAGES IN CLINICAL MEDICINE: Intussusception

Jeff L. Young, M.D. and Allan R. Cooke, M.D. — Thu, 13Â FebÂ 1997 00:00:00 -05:00

Figure 1. A 63-year-old woman in whom two hamartomatous polyps had been removed by colonoscopic polypectomy 18 years earlier presented with intermittent abdominal pain in the right lower quadrant and...

EDITORIAL: Treatment of Acute Biliary Pancreatitis

Thu, 23Â JanÂ 1997 00:00:00 -05:00

Almost 100 years ago, Opie postulated that a gallstone transiently obstructing the ampulla of Vater â the channel where the bile duct and pancreatic duct meet â could precipitate pancreatitis.1...

IMAGES IN CLINICAL MEDICINE: Cholecystoduodenal Fistula

Nina Singh, M.D. and Kevin Stempel, M.D. — Thu, 23Â JanÂ 1997 00:00:00 -05:00

Figure 1. A 69-year-old man with no prior biliary surgery had intermittent, self-limited episodes of fever and chills for three months and a cholestatic pattern of liver-enzyme elevations. A diagnosis...

ORIGINAL ARTICLE: Early ERCP and Papillotomy Compared with Conservative Treatment for Acute Biliary Pancreatitis

Thu, 23Â JanÂ 1997 00:00:00 -05:00

Background: The role of early endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy in the treatment of patients who have acute biliary pancreatitis without obstructive jaundice is uncertain.

Methods: We conducted a prospective,...

EDITORIAL: Listeria Gastroenteritis â Old Syndrome, New Pathogen

Thu, 09Â JanÂ 1997 00:00:00 -05:00

The evidence that Listeria monocytogenes can be a dangerous food-borne pathogen continues to accumulate. In this issue of the Journal, Dalton et al.1 provide evidence that this uncommon organism can...

ORIGINAL ARTICLE: Proton-Pump Inhibition of Gastric Chloride Secretion in Congenital Chloridorrhea

Thu, 09Â JanÂ 1997 00:00:00 -05:00

In 1945 Gamble et al.1 and Darrow2 reported on two infants with severe congenital diarrhea, in back-to-back articles with identical titles. Both infants had very high stool chloride concentrations, low...

ORIGINAL ARTICLE: An Outbreak of Gastroenteritis and Fever Due to in Milk

Thu, 09Â JanÂ 1997 00:00:00 -05:00

Background: After an outbreak of gastroenteritis and fever among persons who attended a picnic in Illinois, chocolate milk served at the picnic was found to be contaminated with Listeria monocytogenes.

Methods:...

IMAGES IN CLINICAL MEDICINE: Aortoenteric Fistula

William Abernethy, M.D. and John H. Sekijima, M.D. — Thu, 02Â JanÂ 1997 00:00:00 -05:00

Figure 1. A 76-year-old man with a three-day history of crampy abdominal pain presented to the hospital with melena and a near-syncopal episode. Sixteen years earlier he had undergone successful...

EDITORIAL: âPill Esophagitisâ â The Case of Alendronate

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Esophageal mucosal injury from the noxious effect of gastric contents refluxing up the esophagus is a common condition. Much less common is esophagitis from injurious agents passing down the esophagus,...

ORIGINAL ARTICLE: Rotavirus Infection in Infants as Protection against Subsequent Infections

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Background: Rotavirus is the leading cause of severe diarrhea in infants. To provide a base line for assessing the efficacy of rotavirus vaccines, we evaluated the protection that is conferred...

ORIGINAL ARTICLE: Esophagitis Associated with the Use of Alendronate

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Background: Alendronate, an aminobisphosphonate and a selective inhibitor of osteoclast-mediated bone resorption, is used to treat osteoporosis in postmenopausal women and Paget's disease of bone. Aminobisphosphonates can irritate the upper...

EDITORIAL: Complications of Endoscopic Sphincterotomy and Their Prevention

Thu, 26Â SepÂ 1996 00:00:00 -05:00

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy for gallstone removal and the insertion of biliary and pancreatic stents is the most difficult gastrointestinal endoscopic procedure. Success rates depend on the...

ORIGINAL ARTICLE: Gabexate for the Prevention of Pancreatic Damage Related to Endoscopic Retrograde Cholangiopancreatography

Thu, 26Â SepÂ 1996 00:00:00 -05:00

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with elevated levels of pancreatic enzymes and pancreatitis. Gabexate, a protease inhibitor, has been used to prevent pancreatic damage related to ERCP.

Methods: We...

ORIGINAL ARTICLE: Complications of Endoscopic Biliary Sphincterotomy

Thu, 26Â SepÂ 1996 00:00:00 -05:00

Background: Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes.

Methods: We studied...

EDITORIAL: Multimodal Therapy for Adenocarcinoma of the Esophagus and Esophagogastric Junction

Thu, 15Â AugÂ 1996 00:00:00 -05:00

In the Western world the incidence of adenocarcinoma of the esophagus has risen markedly in the past three decades. Barrett's specialized columnar-cell metaplasia (Barrett's esophagus), which is the most important...

ORIGINAL ARTICLE: A Comparison of Multimodal Therapy and Surgery for Esophageal Adenocarcinoma

Thu, 15Â AugÂ 1996 00:00:00 -05:00

Background: Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma. We conducted a prospective, randomized trial comparing surgery alone with combined...

EDITORIAL: in the Stomach â A Paradox Unmasked

Thu, 25Â JulÂ 1996 00:00:00 -05:00

In 1993, a National Institutes of Health Consensus Conference declared infection with Helicobacter pylori to be an important cause of duodenal and gastric ulcers.1 Soon thereafter, the International Agency for...

ORIGINAL ARTICLE: The Risk of Stomach Cancer in Patients with Gastric or Duodenal Ulcer Disease

Thu, 25Â JulÂ 1996 00:00:00 -05:00

Background: Helicobacter pylori infection, now considered to be a cause of gastric cancer, is also strongly associated with gastric and duodenal ulcer disease. The discovery of these relations has brought...

ORIGINAL ARTICLE: Nadolol plus Isosorbide Mononitrate Compared with Sclerotherapy for the Prevention of Variceal Rebleeding

Thu, 20Â JunÂ 1996 00:00:00 -05:00

Background: Patients who have bleeding from esophageal varices are at high risk for rebleeding and death. We compared the efficacy and safety of endoscopic sclerotherapy with the efficacy and safety...

EDITORIAL: Keeping Crohn's Disease Quiet

Thu, 13Â JunÂ 1996 00:00:00 -05:00

Fifteen years ago, after the National Cooperative Crohn's Disease Study (NCCDS)1 had found that patients in remission who were given placebo fared better than those given corticosteroids, azathioprine, or a...

ORIGINAL ARTICLE: Effect of an Enteric-Coated Fish-Oil Preparation on Relapses in Crohn's Disease

Thu, 13Â JunÂ 1996 00:00:00 -05:00

Background: Patients with Crohn's disease may have periods of remission, interrupted by relapses. Because fish oil has antiinflammatory actions, it could reduce the frequency of relapses, but it is often...

ORIGINAL ARTICLE: Famotidine for the Prevention of Gastric and Duodenal Ulcers Caused by Nonsteroidal Antiinflammatory Drugs

Thu, 30Â MayÂ 1996 00:00:00 -05:00

Background: Acid suppression with famotidine, a histamine H2âreceptor antagonist, provides protection against gastric injury in normal subjects receiving short courses of aspirin or naproxen. The efficacy of famotidine in preventing...

EDITORIAL: The Many Faces of Celiac Disease

Thu, 02Â MayÂ 1996 00:00:00 -05:00

The report by Fine in this issue of the Journal,1 which describes frequent positive tests for occult intestinal bleeding among patients with celiac disease, adds a new dimension to our...

ORIGINAL ARTICLE: The Prevalence of Occult Gastrointestinal Bleeding in Celiac Sprue

Kenneth D. Fine, M.D. — Thu, 02Â MayÂ 1996 00:00:00 -05:00

Background: Iron deficiency complicating celiac sprue is usually attributed to the malabsorption of dietary iron or the loss of iron from the intestinal mucosa. There has been little investigation of...

REVIEW ARTICLE: The Enteric Nervous System

Raj K. Goyal, M.D., and Ikuo Hirano, M.D. — Thu, 25Â AprÂ 1996 00:00:00 -05:00

The enteric nervous system is a collection of neurons in the gastrointestinal tract1 that constitutes the âbrain of the gutâ and can function independently of the central nervous system.2 This...

ORIGINAL ARTICLE: Atrophic Gastritis and Infection in Patients with Reflux Esophagitis Treated with Omeprazole or Fundoplication

Thu, 18Â AprÂ 1996 00:00:00 -05:00

Background: Helicobacter pylori infection plays an important part in the development of atrophic gastritis and intestinal metaplasia, conditions that predispose patients to gastric cancer. Profound suppression of gastric acid is...

SOUNDING BOARD: Olestra and the FDA

Thu, 11Â AprÂ 1996 00:00:00 -05:00

Olestra, a polyester of sucrose and six or more triglycerides, was approved by the Food and Drug Administration (FDA) on January 24 as a nondigestible substitute for fat in snack...

REVIEW ARTICLE: Inflammatory Bowel Disease

Stephen B. Hanauer, M.D. — Thu, 28Â MarÂ 1996 00:00:00 -05:00

In recent years there has been a series of advances in the treatment of inflammatory bowel disease (ulcerative colitis and Crohn's disease).123456 Notwithstanding these advances, our understanding of inflammatory bowel...

ORIGINAL ARTICLE: Recombinant Erythropoietin for the Treatment of Anemia in Inflammatory Bowel Disease

Thu, 07Â MarÂ 1996 00:00:00 -05:00

Background: Some patients with inflammatory bowel disease have anemia that is refractory to treatment with iron and vitamins. We examined whether administering iron and recombinant erythropoietin could raise hemoglobin levels...

REVIEW ARTICLE: Octreotide

Thu, 25Â JanÂ 1996 00:00:00 -05:00

A peptide inhibiting the release of growth hormone was originally detected accidentally during studies of the distribution of growth hormoneâreleasing factor in the hypothalamus of rats.1 This peptide, called somatostatin,...

NEJM â Collection Updates for Gastroenterology

IMAGES IN CLINICAL MEDICINE: Bleeding Esophageal Varices

EDITORIAL: Rotavirus Vaccine â A Powerful Tool to Combat Deaths from Diarrhea

IMAGES IN CLINICAL MEDICINE: Gallstone Ileus

ORIGINAL ARTICLE: Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency

ORIGINAL ARTICLE: Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico

ORIGINAL ARTICLE: Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants

EDITORIAL: â Beyond Antibiotics

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

ORIGINAL ARTICLE: Treatment with Monoclonal Antibodies against Toxins

EDITORIAL: Preoperative Biliary Stents in Pancreatic Cancer â Proceed with Caution

ORIGINAL ARTICLE: Preoperative Biliary Drainage for Cancer of the Head of the Pancreas

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

CLINICAL PROBLEM-SOLVING: Painful Purple Toes

CLINICAL PRACTICE: Barrett's Esophagus

INTERACTIVE MEDICAL CASE: Painful Purple Toes

IMAGES IN CLINICAL MEDICINE: Hernia through the Foramen Omentale

IMAGES IN CLINICAL MEDICINE: Ileocecal Intussusception

ORIGINAL ARTICLE: Identification of a Novel Antibody Associated with Autoimmune Pancreatitis

CLINICAL IMPLICATIONS OF BASIC RESEARCH: The Hedgehog Pathway and Pancreatic Cancer

EDITORIAL: Interleukin-10 in Inflammatory Bowel Disease

IMAGES IN CLINICAL MEDICINE: Air in the Portal and Mesenteric Veins

REVIEW ARTICLE: Inflammatory Bowel Disease

ORIGINAL ARTICLE: Inflammatory Bowel Disease and Mutations Affecting the Interleukin-10 Receptor

IMAGES IN CLINICAL MEDICINE: Extensive Bowel Infarction

REVIEW ARTICLE: Norovirus Gastroenteritis

CLINICAL PRACTICE: Bacterial Diarrhea

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

CLINICAL PROBLEM-SOLVING: The Writing on the Wall

IMAGES IN CLINICAL MEDICINE: Pelvic Spleen

IMAGES IN CLINICAL MEDICINE: Uvular Necrosis after Endoscopy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

INTERACTIVE MEDICAL CASE: The Writing on the Wall

IMAGES IN CLINICAL MEDICINE: De Garengeot's Hernia

CLINICAL THERAPEUTICS: Parenteral Nutrition in the Critically Ill Patient

REVIEW ARTICLE: Intestinal Transplantation

IMAGES IN CLINICAL MEDICINE: Sigmoid Volvulus

IMAGES IN CLINICAL MEDICINE: Pneumatosis Cystoides Coli

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2009 â A 34-Year-Old Man with Cystic Fibrosis with Abdominal Pain and Distention

IMAGES IN CLINICAL MEDICINE: Rectovesical Fistula

IMAGES IN CLINICAL MEDICINE: Esophageal Foreign Body

IMAGES IN CLINICAL MEDICINE: Tortuous Varicosities in Chronic Schistosomiasis

EDITORIAL: Surgical Treatment of Obesity â Weighing the Facts

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

ORIGINAL ARTICLE: Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

IMAGES IN CLINICAL MEDICINE: Lupus-Associated Intestinal Vasculitis

EDITORIAL: The Capsule and Colorectal-Cancer Screening â The Crux of the Matter

IMAGES IN CLINICAL MEDICINE: Segmental Diverticulitis

ORIGINAL ARTICLE: Capsule Endoscopy versus Colonoscopy for the Detection of Polyps and Cancer

IMAGES IN CLINICAL MEDICINE: Telltale Triangle of Pneumoperitoneum

IMAGES IN CLINICAL MEDICINE: Ingested Magnets

IMAGES IN CLINICAL MEDICINE: Perforated Umbilical Hernia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2009 â A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

EDITORIAL: Radiofrequency Ablation â Great for Some or Justified for Many?

ORIGINAL ARTICLE: Radiofrequency Ablation in Barrett's Esophagus with Dysplasia

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

IMAGES IN CLINICAL MEDICINE: Fecaliths in Crohn's Disease

BOOK REVIEW:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2009 â A 36-Year-Old Man with Chest Pain, Dysphagia, and Pleural and Mediastinal Calcifications

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Crohn's Disease, Autophagy, and the Paneth Cell

EDITORIAL: Silent Acid Reflux and Asthma Control

ORIGINAL ARTICLE: Efficacy of Esomeprazole for Treatment of Poorly Controlled Asthma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2009 â An 81-Year-Old Man with Massive Rectal Bleeding

BOOK REVIEW:

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

PERSPECTIVE: Serotonin Rising â The Bone, Brain, Bowel Connection

IMAGES IN CLINICAL MEDICINE: Achalasia

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inflammatory Bowel Disease, Stress, and the Endoplasmic Reticulum

IMAGES IN CLINICAL MEDICINE: A Smooth, Shiny Tongue

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis

BOOK REVIEW:

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

CORRESPONDENCE: Reports of Esophageal Cancer with Oral Bisphosphonate Use

ORIGINAL ARTICLE: Decontamination of the Digestive Tract and Oropharynx in ICU Patients

EDITORIAL: Shared Genetic Risk Factors for Type 1 Diabetes and Celiac Disease

ORIGINAL ARTICLE: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease

BOOK REVIEW:

REVIEW ARTICLE: â More Difficult Than Ever

CORRESPONDENCE: Antiemetic Properties of the Antiepileptic Drug Levetiracetam

NEJM â Collection Updates for Gastroenterology

EDITORIAL: Rotavirus Vaccine â A Powerful Tool to Combat Deaths from Diarrhea

EDITORIAL: â Beyond Antibiotics

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

EDITORIAL: Preoperative Biliary Stents in Pancreatic Cancer â Proceed with Caution

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2009 â An 81-Year-Old Man with Weight Loss, Odynophagia, and Failure to Thrive

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2009 â A 34-Year-Old Man with Cystic Fibrosis with Abdominal Pain and Distention

EDITORIAL: Surgical Treatment of Obesity â Weighing the Facts

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2009 â A 26-Year-Old Woman with Painful Swelling of the Neck

EDITORIAL: The Capsule and Colorectal-Cancer Screening â The Crux of the Matter

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 19-2009 â A 63-Year-Old Woman with Carcinoma of the Gastroesophageal Junction

EDITORIAL: Radiofrequency Ablation â Great for Some or Justified for Many?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2009 â A 25-Year-Old Man with Coma after Cardiac Arrest

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2009 â A 36-Year-Old Man with Chest Pain, Dysphagia, and Pleural and Mediastinal Calcifications

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2009 â An 81-Year-Old Man with Massive Rectal Bleeding

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

PERSPECTIVE: Serotonin Rising â The Bone, Brain, Bowel Connection

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Constipation

REVIEW ARTICLE: â More Difficult Than Ever

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2008 â A 63-Year-Old Woman with Dyspnea on Exertion

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 â A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

CORRESPONDENCE: Glucagon-like Peptide 1âReceptor Scans to Localize Occult Insulinomas

PERSPECTIVE: Gastric Cancer in Japan â Honing Treatment, Seeking Causes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2008 â A 57-Year-Old Woman with Abdominal Pain and Weakness after Gastric Bypass Surgery

EDITORIAL: Opioid Side Effects â Mechanism-Based Therapy

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Inflammatory Bowel Disease â Live Transmission

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 1-2008 â A 45-Year-Old Man with Sudden Onset of Abdominal Pain and Hypotension

IMAGES IN CLINICAL MEDICINE: Chronic BuddâChiari Syndrome and Abdominal Varices

CLINICAL PROBLEM-SOLVING: The Leading Diagnosis â A 23-year-old black woman presented to the emergency department with diffuse, colicky abdominal pain of 1 hour's duration

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2007 â A 30-Year-Old Man with Inflammatory Bowel Disease and Recent Onset of Fever and Bloody Diarrhea

IMAGES IN CLINICAL MEDICINE: Medical Mystery â An Unusual Complication of Colonoscopy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2007 â A 51-Year-Old Man with Gastric Cancer and Lung Nodules

IMAGES IN CLINICAL MEDICINE: EhlersâDanlos Syndrome

CLINICAL PROBLEM-SOLVING: A Stitch in Time â A 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue

IMAGES IN CLINICAL MEDICINE: PeutzâJeghers Syndrome

EDITORIAL: Anti-TNF Antibodies for Crohn's Disease â In Pursuit of the Perfect Clinical Trial

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2007 â A Woman with a Family History of Gastric and Breast Cancer