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SpecialtyGastroenterology
and V. Deshpande
A number of autoimmune diseases that affect diverse organ systems have recently been noted to be related to IgG4 autoantibodies. The authors review the spectrum of IgG4-related disease and the current status of diagnostic and management approaches.
general hospital
J.A. Scott, and A.S. Dighe
A 37-year-old man was admitted to this hospital because of 12 hours of muscle pain and weakness, resulting in the inability to rise from bed. Brief episodes of similar symptoms had occurred during the past month. He reported blurred vision, gynecomastia, and weight loss.
- CME
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This interactive feature presents the case of a 39-year-old woman at 32 weeks of gestation...
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A 72-year-old man presented to his physician for evaluation of fatigue and weight loss. Over the previous 8 months, the patient had lost 16 kg (35 lb) and had begun having up to 10 loose stools per day. There was no history of blood in the stool, fever, chills, or rash.
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The holy grail of gene therapy is the treatment of disease caused by genetic mutations. A recent study in mice provides proof of principle that alpha1-antitrypsin deficiency can be corrected, if not cured, by the infusion of autologous induced pluripotent stem cells.
According to Rachet, Küssmaul in 1868 was the first to practice gastroscopy, the subject of his experiment having been a professional sword-swallower. In 1933, a Wolf-Schindler flexible gastroscope was used in 75 patients without ill effect in any way, and was helpful in gastritis, gastric ulcer, and benign and malignant tumors of the stomach.
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Case Records of the Massachusetts General Hospital
Case 4-2012 — A 37-Year-Old Man with Muscle Pain, Weakness, and Weight Loss
Presentation of Case. Dr. Ian J. Barbash (Medicine): A 37-year-old man was admitted to this hospital because of muscle pain and weakness. The patient had been well until the evening before admission, when mild diffuse myalgias developed. He awoke in the morning with diffuse muscle cramps and…
- CME
Review Article
Mechanisms of Disease: IgG4-Related Disease
IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. The disease was not recognized as…
Clinical Implications of Basic Research
Gene Therapy Meets Stem Cells
Stem cell–based therapies have the potential to repair and even correct the defects related to human diseases. Although tantalizing niche applications have moved forward in the clinical setting, progress seems to be slow, and ethical challenges have yet to be definitively addressed. The goal of…
Clinical Problem-Solving
Worth a Second Look
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 72-year-old man presented to his…
Perspective
Assessing Supplement Safety — The FDA's Controversial Proposal
Recently, a well-respected dietary-supplement company in Utah announced the recall of Zotrex, a sexual enhancement supplement labeled as containing "Ophioglossum polyphyllous." The problem with Zotrex was twofold: not only is no species of ophioglossum (adder's tongue) an established dietary…
- Audio
Review Article
Mechanisms of Disease: Iron Overload in Human Disease
Iron-overload disorders are typically insidious, causing progressive and sometimes irreversible end-organ injury before clinical symptoms develop. With a high index of suspicion, however, the consequences of iron toxicity can be attenuated or prevented. Some iron-overload disorders are quite common…
- CME
Clinical Implications of Basic Research
Closing the Iron Gate
Genetic hemochromatosis is a prevalent iron-overload disease resulting from inadequate production of the iron-regulatory hormone hepcidin. Recently, Preza and colleagues developed an oral, biologically active hepcidin mimic that offers a new experimental approach to treating hemochromatosis and…
Case Records of the Massachusetts General Hospital
Case 3-2012 — A Newborn Boy with Vomiting, Diarrhea, and Abdominal Distention
Presentation of Case. Dr. Rebecca C. Bell (Pediatrics): A 6-day-old boy was admitted to this hospital because of vomiting, diarrhea, and abdominal distention. The patient was born at another hospital to a teenaged primigravida by vaginal delivery after a full-term, uncomplicated gestation. The…
Editorial
A Watershed Moment in the Treatment of Hepatitis C
More than 170 million persons harbor chronic infection with hepatitis C virus (HCV), the leading indication for liver transplantation worldwide. For more than 20 years, treatment of chronic hepatitis C infection has relied on the use of the nonspecific antiviral cytokine interferon alfa, which…
Original Article
Preliminary Study of Two Antiviral Agents for Hepatitis C Genotype 1
Approximately 180 million people worldwide are infected with hepatitis C virus (HCV), including 4.1 million in the United States. HCV infection is the most common cause of chronic liver disease in the United States and a leading cause of cirrhosis and hepatocellular carcinoma globally. HCV is…
- CME
In 21 patients with hepatitis C virus genotype 1 infection who had had no response to prior treatment, sustained virologic responses were achieved in 4 of 11 who were treated with two antiviral agents alone and in 9 of 10 who were treated with the antiviral agents plus peginterferon and ribavirin.
Images in Clinical Medicine
Jugular Venous C-V Wave in Severe Tricuspid Regurgitation
Figure 1.
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Clinical Implications of Basic Research
Diet and Intestinal Immunity
"You are what you eat." A couple of recent studies underscore the relevance of this adage to the immune system. New studies by Kiss et al. and Li et al. show how certain dietary components derived from vegetables interact with intestinal immune receptors and thereby regulate the organogenesis of…
Original Article
TFAP2E–DKK4 and Chemoresistance in Colorectal Cancer
The treatment options and prognosis for patients with advanced colorectal cancer have improved through the development of novel drugs. However, studies of the molecular biology of cancer initiation and progression have so far provided scant knowledge of the molecular mechanisms contributing to…
Case Records of the Massachusetts General Hospital
Case 38-2011 — A 34-Year-Old Man with Diarrhea and Weakness
Presentation of Case. Dr. Andrew Courtwright (Medicine): A 34-year-old man was admitted to this hospital because of diarrhea and weakness. Three days before admission, weakness developed in the patient's right hand, followed by increasing weakness in the left hand. During the next 2 days, weakness…
- CME
Original Article
Norovirus Vaccine against Experimental Human Norwalk Virus Illness
Noroviruses are a leading cause of epidemic acute gastroenteritis and are also an important cause of sporadic cases of acute gastroenteritis. Because human noroviruses have not been grown in cell culture and there are no convenient animal models in which to evaluate immunity and illness, much of…
Correspondence
Intussusception after Rotavirus Vaccination — Spontaneous Reports
To the Editor: Patel et al. report an increased risk of intussusception after rotavirus vaccination. We conducted a case-series analysis of 151 spontaneous reports of intussusception worldwide after administration of the rotavirus vaccine RV1 (Rotarix, GlaxoSmithKline Biologicals). On the basis of…
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Original Article
Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice
Obesity is an important and growing public health problem around the world. In the United States, approximately one third of adults are obese. Obesity adversely affects each of the major cardiovascular risk factors — blood pressure, lipid profile, and diabetes. As a consequence, obese persons…
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Editorial
Obesity Treatment in Primary Care — Are We There Yet?
The U.S. Preventive Services Task Force recommends that clinicians arrange for their obese patients to receive intensive, multicomponent behavioral weight-loss counseling. However, less than 50% of primary care physicians (PCPs) report that they consistently provide diet and weight-control advice…
