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By Topic: All Topics; Emergency Medicine General (293); Acute Coronary Syndromes (74); Shock (51); Trauma (30); Toxicology (24); Stroke (23)

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Images in Clinical Medicine
Meconium-like Ileus in Cystic Fibrosis
Figure 1.
- May 24, 2012
- Lin L.-Y. and Wong J.-U.
- N Engl J Med 2012; 366:2017
- Free Full Text
A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed a typical mechanical obstruction.
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Editorial
Septic Shock — Evaluating Another Failed Treatment
Sepsis, severe sepsis, and septic shock are progressively severe stages of the host's systemic inflammatory response to infection. The latter stages carry increasing rates of end-organ failure and death. The spectrum of the sepsis syndrome remains a leading cause of death in the United States, and…
- May 22, 2012
- Wenzel R.P. and Edmond M.B.
- 10.1056/NEJMe1203412
- Free Full Text
Sepsis, severe sepsis, and septic shock are progressively severe stages of the host's systemic inflammatory response to infection.¹ The latter stages carry increasing rates of end-organ failure and death. The spectrum of the sepsis syndrome remains a ...
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Original Article
Drotrecogin Alfa (Activated) in Adults with Septic Shock
Recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), was approved for the treatment of severe sepsis in 2001 on the basis of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study, a phase 3 international, randomized,…
- May 22, 2012
- Ranieri V.M., Thompson B.T., Barie P.S., et al.
- 10.1056/NEJMoa1202290
- Free Full Text
Recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), was approved for the treatment of severe sepsis in 2001 on the basis of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) ...
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Editorial
Warfarin in Heart Failure
Despite major advances in the management of heart failure with angiotensin-converting–enzyme inhibitors, beta-blockers, and resynchronization therapy, there are more than 1 million hospitalizations for heart failure in the United States each year, and mortality remains high. As compared with the…
- May 17, 2012
- Eikelboom J.W. and Connolly S.J.
- N Engl J Med 2012; 366:1936-1938
Despite major advances in the management of heart failure with angiotensin-converting–enzyme inhibitors, beta-blockers, and resynchronization therapy, there are more than 1 million hospitalizations for heart failure in the United States each year, and ...
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Original Article
Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm
Chronic heart failure is a major cause of illness and death. Heart failure is associated with a hypercoagulable state, formation of left ventricular thrombus, and cerebral embolism. It is also associated with both sudden death and death resulting from progressive heart failure that may be caused by…
- May 17, 2012
- Homma S., Thompson J.L.P., Pullicino P.M., et al.
- N Engl J Med 2012; 366:1859-1869
- CME
Patients with heart failure and sinus rhythm benefit from anticoagulation. This trial showed no overall difference between warfarin and aspirin; reduced risk of ischemic stroke with warfarin was offset by an increase in major bleeding.
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Clinical Practice
Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 62-year-old…
- May 17, 2012
- Davis S.M. and Donnan G.A.
- N Engl J Med 2012; 366:1914-1922
- CME
- Full Text Audio
This article reviews recommended strategies to reduce the risk of a subsequent stroke in patients with a history of transient ischemic attack (TIA) or stroke.
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Original Article
Azithromycin and the Risk of Cardiovascular Death
Azithromycin, a broad-spectrum macrolide antibiotic, has been reported to be relatively free of cardiotoxic effects. However, the closely related drugs erythromycin and clarithromycin can increase the risk of serious ventricular arrhythmias– and are associated with an increased risk of sudden…
- May 17, 2012
- Ray W.A., Murray K.T., Hall K., Arbogast P.G., Stein C.M.
- N Engl J Med 2012; 366:1881-1890
In a large cohort study, patients who took azithromycin had significantly increased risks of cardiovascular death and death from any cause during a 5-day course of therapy, as compared with persons who received no antibiotic treatment or who took reference antibiotics.
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Perspective
Emergency Departments, Medicaid Costs, and Access to Primary Care — Understanding the Link
In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries "when those visits are not necessary for that place of service." To identify unnecessary visits, the state proposed a list of…
- May 16, 2012
- Kellermann A.L. and Weinick R.M.
- 10.1056/NEJMp1203247
- Free Full Text
In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries “when those visits are not necessary for that place of service.”¹ To identify unnecessary ...
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Case Records of the Massachusetts General Hospital
Case 14-2012 — A 43-Year-Old Woman with Fever and a Generalized Rash
Presentation of Case. Dr. Sarah Gee (Dermatology): A 43-year-old woman was admitted to the hospital because of fever and a generalized rash. The patient had a history of atopic dermatitis and had been in her usual health until approximately 1 week before admission, when a painful, pruritic rash…
- May 10, 2012
- Mackool B.T., Goverman J., Nazarian R.M.
- N Engl J Med 2012; 366:1825-1834
- CME
A 43-year-old woman with a history of atopic dermatitis was admitted to the hospital because of fever and a generalized painful, pruritic rash involving the entire body. Examination revealed vesicles, pustules, and erosions with scalloped borders. A diagnostic test result was received.
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Images in Clinical Medicine
An Electrocardiographic Sine Wave in Hyperkalemia
Figure 1.
- May 10, 2012
- Petrov D.B.
- N Engl J Med 2012; 366:1824
- Free Full Text
A 62-year-old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished.
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Review Article
Current Concepts: Percutaneous Coronary Interventions without On-Site Cardiac Surgical Backup
Certification to perform catheter-based interventions for coronary artery disease was originally limited to hospitals that had the capability to perform cardiac surgery on site. However, there has been a progressive worldwide trend to allow percutaneous coronary intervention (PCI) to be performed…
- May 10, 2012
- Shahian D.M., Meyer G.S., Yeh R.W., Fifer M.A., Torchiana D.F.
- N Engl J Med 2012; 366:1814-1823
- CME
PCIs for acute coronary disease are increasingly being performed at centers without on-site surgical backup. This review summarizes the safety and the efficacy of this practice, along with the policy implications, including those for patients undergoing elective procedures.
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Original Article
Outcomes of PCI at Hospitals with or without On-Site Cardiac Surgery
The potential need for emergency cardiac surgery to treat complications related to percutaneous coronary intervention (PCI) suggests that performance of PCI may be best limited to hospitals with on-site cardiac surgery. Among Grüntzig's first 50 PCI procedures, 10% of patients required emergency…
- May 10, 2012
- Aversano T., Lemmon C.C., Liu L.
- N Engl J Med 2012; 366:1792-1802
In a randomized trial, performance of percutaneous coronary intervention (PCI) at hospitals without cardiac surgery on site was noninferior to PCI performed at hospitals with cardiac surgery on site with respect to mortality at 6 weeks and major adverse cardiac events at 9 months.
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Correspondence
A Noninvasive Test to Determine Paternity in Pregnancy
To the Editor: Five percent of women who are raped become pregnant, which results in an estimated 32,000 pregnancies annually in the United States. In many circumstances, it is unclear whether the pregnancy resulted from the rape or from consensual intercourse. The only options available for…
- May 3, 2012
- N Engl J Med 2012; 366:1743-1745
- Free Full Text
By comparing markers of circulating fetal DNA with markers of maternal DNA and those of DNA obtained from both the biologic father and an unrelated man, investigators were able to identify the biologic father in 30 out of 30 tests.
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Case Records of the Massachusetts General Hospital
Case 13-2012 — A 62-Year-Old Man with Paresthesias, Weight Loss, Jaundice, and Anemia
Presentation of Case. Dr. Norifumi Kamo (Medicine): A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. The patient had been well until approximately 2 months before admission, when numbness, tingling ("pins and needles"), and burning in his…
- April 26, 2012
- Puig A., Mino-Kenudson M., Dighe A.S.
- N Engl J Med 2012; 366:1626-1633
- CME
A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. Diagnostic test results were received.
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Images in Clinical Medicine
Pneumoperitoneum
Figure 1.
- April 26, 2012
- Ailon J.
- N Engl J Med 2012; 366:e26
- Free Full Text
A 69-year-old woman presented to the emergency department with a 3-day history of progressively worsening abdominal distention and pain. She was taking dexamethasone for cerebral edema associated with glioblastoma multiforme.
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Original Article
Low-Dose Abdominal CT for Evaluating Suspected Appendicitis
Owing to the many advantages that computed tomography (CT) has over other diagnostic tests, including ultrasonography,– CT has assumed a paramount position in the evaluation of adults with suspected appendicitis. Despite historical debate, the increased use of CT has been consistently found to…
- April 26, 2012
- Kim K., Kim Y.H., Kim S.Y., et al.
- N Engl J Med 2012; 366:1596-1605
- CME
In this randomized trial involving young adults with suspected appendicitis, low-dose abdominal computed tomography (CT) was noninferior to standard-dose abdominal CT, with similar rates of negative appendectomy and appendiceal perforation in the two study groups.
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Images in Clinical Medicine
Torsion of Undescended Testis
Figure 1.
- April 26, 2012
- Hajji F. and Janane A.
- N Engl J Med 2012; 366:1625
- Free Full Text
A 22-year-old man with a history of uncorrected left cryptorchidism presented after 7 days of left groin pain. A genitourinary examination was performed, which revealed that his left inguinal region was swollen because of a palpable, tender mass.
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Editorial
Why We Still Need Randomized Trials to Compare Effectiveness
Over the past 20 years, there have been 12 randomized trials in which the revascularization strategies of coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have been compared, against the background of advances in both fields. Percutaneous treatment of multiple…
- April 19, 2012
- Mauri L.
- N Engl J Med 2012; 366:1538-1540
Over the past 20 years, there have been 12 randomized trials in which the revascularization strategies of coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have been compared, against the background of advances in both ...
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Case Records of the Massachusetts General Hospital
Case 12-2012 — A 10-Month-Old Girl with Vomiting and Episodes of Unresponsiveness
Presentation of Case. Dr. Helen H. Yeung (Pediatrics): A 10-month-old girl was seen in the emergency department at this hospital because of vomiting and episodes of unresponsiveness. The patient had been well until 2 a.m. on the day of admission, when she awoke with vomiting that was associated…
- April 19, 2012
- Sassower K.C., Allister L.M., Westra S.J.
- N Engl J Med 2012; 366:1527-1536
- CME
A 10-month-old girl was seen in the emergency department because of vomiting and episodes of unresponsiveness, which had begun suddenly 7 hours earlier. She gradually became somnolent. Vital signs, a physical examination, and brain imaging were normal.
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Original Article
Comparative Effectiveness of Revascularization Strategies
The strategies of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) for revascularization have been compared in randomized clinical trials. Although the best way to control for treatment-selection bias is to conduct a randomized trial, such trials often have…
- April 19, 2012
- Weintraub W.S., Grau-Sepulveda M.V., Weiss J.M., et al.
- N Engl J Med 2012; 366:1467-1476
- CME
A large PCI registry and a large CABG registry were linked to claims records, with data adjusted for propensity score, to compare clinical outcomes. Patients selected for CABG had a long-term survival advantage over those selected for PCI.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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