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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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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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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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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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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
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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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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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Case Records of the Massachusetts General Hospital
Case 11-2012 — A 60-Year-Old Man with Weakness, Rash, and Renal Failure
Presentation of Case. Dr. Pritha Sen (Medicine): A 60-year-old man with a history of schizophrenia was admitted to this hospital in late spring because of weakness, rash, and renal failure. The patient was in his usual state of health until several days before admission, when fatigue and myalgias…
- April 12, 2012
- Channick R.N., Lorenzo M.E., Wu C.C., Hoang M.P.
- N Engl J Med 2012; 366:1434-1443
- CME
A 60-year-old man from coastal New England was admitted to this hospital because of fever, weakness, rash, and renal failure. An initial measurement of creatine kinase was 20,437 U per liter. A diagnostic test was performed.
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Original Article
Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism
Pulmonary embolism is a common disease, with an estimated annual incidence of 70 cases per 100,000 population. The condition usually leads to hospitalization and may recur; it can be fatal. For half a century, the standard therapy for most patients with pulmonary embolism has been the…
- April 5, 2012
- The EINSTEIN–PE Investigators
- N Engl J Med 2012; 366:1287-1297
In the treatment of patients with acute pulmonary embolism, the efficacy of rivaroxaban, a factor Xa inhibitor, was similar to that of traditional anticoagulation therapy. There was less bleeding in the group receiving rivaroxaban, which supports its use in the treatment of this condition.
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Videos in Clinical Medicine
Emergency Pericardiocentesis
- March 22, 2012
- Fitch M.T., Nicks B.A., Pariyadath M., McGinnis H.D., Manthey D.E.
- N Engl J Med 2012; 366:e17
The use of emergency pericardiocentesis to aspirate fluid in patients with cardiac tamponade can be a lifesaving procedure that restores normal cardiac function and peripheral perfusion. This video demonstrates the procedure.
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Images in Clinical Medicine
Barium Aspiration
Figure 1.
- March 15, 2012
- Albeldawi M. and Makkar R.
- N Engl J Med 2012; 366:1038
- Free Full Text
A 79-year-old man was evaluated for unintentional weight loss and dysphagia. He underwent a modified barium swallow.
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Images in Clinical Medicine
Westermark Sign in Pulmonary Embolism
Figure 1.
- March 15, 2012
- Krishnan A.S. and Barrett T.
- N Engl J Med 2012; 366:e16
- Free Full Text
A 47-year-old woman presented to the emergency department with acute shortness of breath and hypoxia. Her medical history included sex reassignment, for which she was taking estrogen, and a deep-vein thrombosis on the left side, for which she had required warfarin.
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Images in Clinical Medicine
Sigmoid Perforation in Association with Colonoscopy
Figure 1.
- February 23, 2012
- Lu A. and Aronowitz P.
- N Engl J Med 2012; 366:744
- Free Full Text
A 74-year-old woman was undergoing a screening colonoscopy when it became apparent that the rectosigmoid junction might have become perforated. The procedure was terminated, and radiographs were obtained.
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Correspondence
Percutaneous Injuries before and after the Needlestick Safety and Prevention Act
To the Editor: The Needlestick Safety and Prevention Act (NSPA) (HR.5178) was signed into law on November 6, 2000. It required employers to provide safety-engineered devices to employees who are at risk for exposure to bloodborne pathogens, to include frontline workers in selecting these devices,…
- February 16, 2012
- N Engl J Med 2012; 366:670-671
- Free Full Text
According to this analysis of needlestick injuries in a sample of U.S. hospitals before and after passage of the NSPA in 2000, the number of percutaneous injuries per 100 full-time hospital employees declined after enactment of the legislation.
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Editorial
Intramuscular versus Intravenous Benzodiazepines for Prehospital Treatment of Status Epilepticus
Acute seizures account for 1% of adult and 2% of pediatric emergency department visits, at an annual cost of $1 billion (in U.S. dollars). When seizures are prolonged or repetitive without recovery between episodes, the condition is termed status epilepticus, and it occurs in approximately 6% of…
- February 16, 2012
- Hirsch L.J.
- N Engl J Med 2012; 366:659-660
Acute seizures account for 1% of adult and 2% of pediatric emergency department visits, at an annual cost of $1 billion (in U.S. dollars).¹ When seizures are prolonged or repetitive without recovery between episodes, the condition is termed status ...
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Images in Clinical Medicine
Vernal Keratoconjunctivitis
Figure 1.
- February 16, 2012
- Homme J. and Wiswell J.
- N Engl J Med 2012; 366:647
- Free Full Text
An otherwise healthy 6-year-old boy presented to the ER with a 2-year history of what his mother referred to as “eye problems.” She reported noticing “whitish specks” surrounding both irises, which had been increasing in size.
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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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