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Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Presentation of Case. Dr. Steven Jay Isakoff (Hematology–Oncology): A 32-year-old woman was seen in the outpatient cancer center at this hospital because of infiltrating ductal carcinoma of the right breast. The patient had been well until 2 months before admission, when she became aware of a…
- May 24, 2012
- Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
- N Engl J Med 2012; 366:2018-2026
- CME
A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.
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Perspective
HIV–HBV Coinfection — A Global Challenge
Human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Antiviral drug resistance often develops after patients have received treatment…
- May 10, 2012
- Kourtis A.P., Bulterys M., Hu D.J., Jamieson D.J.
- N Engl J Med 2012; 366:1749-1752
- Free Full Text
Human immunodeficiency virus and hepatitis B virus exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Coinfection with the two viruses represents a major global health problem.
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Images in Clinical Medicine
Kayser–Fleischer Rings in Wilson's Disease
Figure 1.
- March 22, 2012
- Schrag A. and Schott J.M.
- N Engl J Med 2012; 366:e18
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An 18-year-old woman presented with color and temperature changes in her hands, as well as intermittent tremor of the hands for 3 years. She also reported involuntary right arm movements and difficulties with concentration.
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Images in Clinical Medicine
Spider Angioma
Figure 1.
- February 23, 2012
- Caseiro M.M. and Pinto da Costa S.O.
- N Engl J Med 2012; 366:e13
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- Video
A 62-year-old man was referred to the hepatology clinic for evaluation of elevated levels of aspartate and alanine aminotransferase, detected on routine laboratory examination. The patient reported no symptoms except for a reddish lesion on his forehead.
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Case Records of the Massachusetts General Hospital
Case 6-2012 — A 45-Year-Old Man with a History of Alcohol Abuse and Rapid Cognitive Decline
Presentation of Case. Dr. Clayton Knox (Medicine): A 45-year-old man with a history of alcoholism was admitted to this hospital because of rapid cognitive decline and worsening jaundice. During the previous 3 months, increasing fatigue and cough productive of yellow sputum and flecks of blood had…
- February 23, 2012
- Cho T.A., Larvie M., Tian D., Mino-Kenudson M.
- N Engl J Med 2012; 366:745-755
- CME
A 45-year-old man with a history of alcoholism was admitted to the hospital because of cognitive decline and jaundice. He had a 3-month history of cough, blood-tinged sputum, and vomiting. Imaging showed a peripherally enhancing brain lesion. A diagnostic procedure was performed.
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Case Records of the Massachusetts General Hospital
Case 5-2012 — A 39-Year-Old Man with a Recent Diagnosis of HIV Infection and Acute Psychosis
Presentation of Case. Dr. Carlos Fernandez-Robles: A 39-year-old man with a recent diagnosis of human immunodeficiency virus (HIV) infection was transferred to this hospital from another hospital because of fever, sweats, and psychosis. The patient had been well until 4 months before admission,…
- February 16, 2012
- Freudenreich O., Basgoz N., Fernandez-Robles C., Larvie M., Misdraji J.
- N Engl J Med 2012; 366:648-657
- CME
A 39-year-old man with a recent diagnosis of HIV infection was admitted to this hospital with fever and bizarre, nihilistic delusions, including statements that he had died. A diagnostic procedure was performed.
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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…
- February 9, 2012
- Sandhaus R.A.
- N Engl J Med 2012; 366:567-569
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.
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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…
- January 19, 2012
- Lok A.S., Gardiner D.F., Lawitz E., et al.
- N Engl J Med 2012; 366:216-224
- 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.
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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…
- January 19, 2012
- Chung R.T.
- N Engl J Med 2012; 366:273-275
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 ...
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Images in Clinical Medicine
Jugular Venous C-V Wave in Severe Tricuspid Regurgitation
Figure 1.
- January 12, 2012
- Senguttuvan N.B. and Karthikeyan G.
- N Engl J Med 2012; 366:e5
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An 18-year-old man presented with a history of progressive anasarca and exertional dyspnea. His jugular venous pressure was elevated and showed prominent systolic pulsations that were eliminated when gentle pressure was applied at the base of the neck.
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Original Article
Glucocorticoids plus N-Acetylcysteine in Severe Alcoholic Hepatitis
Severe acute alcoholic hepatitis is a life-threatening alcoholic liver disease. Although glucocorticoid treatment is recommended, and improves survival,– mortality remains high, with 35% of patients dying within 6 months. Long-term alcohol consumption increases intestinal permeability, worsens…
- November 10, 2011
- Nguyen-Khac E., Thevenot T., Piquet M.-A., et al.
- N Engl J Med 2011; 365:1781-1789
- Free Full Text
- CME
In this trial involving patients with severe alcoholic hepatitis, treatment with acetylcysteine reduced 1-month mortality (8% vs. 24%, P=0.006), but differences in mortality at 6 months, the primary outcome, were not significant (27% vs. 38%, P=0.07).
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Original Article
Early Liver Transplantation for Severe Alcoholic Hepatitis
Liver transplantation for alcoholic liver disease has a favorable outcome but remains controversial. Reluctance to perform transplantation in patients with alcoholism is often based on the view that they are responsible for their illness and are likely to resume alcohol use after transplantation.…
- November 10, 2011
- Mathurin P., Moreno C., Samuel D., et al.
- N Engl J Med 2011; 365:1790-1800
- Free Full Text
- CME
Six months of abstinence is typically required before transplantation for alcoholic liver disease. In this study, early liver transplantation improved the 6-month survival rate among selected patients with severe alcoholic hepatitis (77%, vs. 23% without transplantation).
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Editorial
Transplantation for Alcoholic Hepatitis — Time to Rethink the 6-Month “Rule”
Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to post-transplantation care, has led the public…
- November 10, 2011
- Brown R.S.
- N Engl J Med 2011; 365:1836-1838
Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to ...
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Clinical Problem-Solving
It's Not All in Your Head
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 63-year-old man presented to the…
- October 6, 2011
- Towns K., Szmitko P.E., Smith C., Detsky A.S., Mourad O.
- N Engl J Med 2011; 365:1329-1334
- CME
A 63-year-old man presented to the emergency department with shaking chills and drenching sweats of 4 days' duration. He reported no weight loss, arthralgias, headache, visual changes, or new skin eruptions, but he had progressively worsening bilateral anterior thigh pain of 10 days' duration.
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Review Article
Current Concepts: Hepatocellular Carcinoma
Each year, hepatocellular carcinoma is diagnosed in more than half a million people worldwide, including approximately 20,000 new cases in the United States. Liver cancer is the fifth most common cancer in men and the seventh in women. Most of the burden of disease (85%) is borne in developing…
- September 22, 2011
- El-Serag H.B.
- N Engl J Med 2011; 365:1118-1127
- CME
Each year, more than half a million people worldwide receive a diagnosis of hepatocellular carcinoma, and hepatocellular carcinoma related to HCV is the fastest rising cause of U.S. cancer-related deaths. This review summarizes recent advances in prevention, surveillance, diagnosis, and treatment.
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Images in Clinical Medicine
Porphyria Cutanea Tarda
Figure 1.
- September 22, 2011
- Chan C.-C. and Lin S.-J.
- N Engl J Med 2011; 365:1128
- Free Full Text
A 51-year-old man with a history of heavy alcohol use, chronic HCV infection, and hepatic cirrhosis presented with an 8-month history of periorbital hair growth. Healing crusts and scars were evident in sun-exposed areas, and his urine had pink fluorescence under a Wood's lamp.
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Original Article
Response-Guided Telaprevir Combination Treatment for Hepatitis C Virus Infection
Chronic infection with hepatitis C virus (HCV) represents a serious health issue for nearly 200 million infected persons worldwide. Achievement of a sustained virologic response may be associated with improved long-term clinical outcomes, including increased survival. In patients infected with HCV…
- September 15, 2011
- Sherman K.E., Flamm S.L., Afdhal N.H., et al.
- N Engl J Med 2011; 365:1014-1024
- Free Full Text
In patients with chronic infection with HCV genotype 1 and undetectable HCV at weeks 4 and 12 of treatment, a 24-week regimen that included telaprevir, peginterferon, and ribavirin was not inferior to a 48-week regimen.
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Correspondence
Deferoxamine for Advanced Hepatocellular Carcinoma
To the Editor: We have previously reported that the iron chelator deferoxamine can prevent liver injury as well as the development of preneoplastic lesions in rats,, and we have proposed the use of deferoxamine as an anticancer drug. The antiproliferative effect of deferoxamine arrests the cell…
- August 11, 2011
- N Engl J Med 2011; 365:576-578
- Free Full Text
The iron chelator deferoxamine has shown some potential as an antitumor agent in a small number of patients with hepatocellular carcinoma who did not have a response to other agents.
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Review Article
Mechanisms of Disease: The Coagulopathy of Chronic Liver Disease
Chronic liver disease, particularly in the end stage, is characterized by clinical bleeding and decreased levels of most procoagulant factors, with the notable exceptions of factor VIII and von Willebrand factor, which are elevated. Decreased levels of the procoagulants are, however, accompanied by…
- July 14, 2011
- Tripodi A. and Mannucci P.M.
- N Engl J Med 2011; 365:147-156
Conventional wisdom is that chronic liver disease is an acquired bleeding disorder. However, the imbalance between procoagulant and anticoagulant activities can also lead to thrombosis. Studies are needed to assess the value of anticoagulants.
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Clinical Implications of Basic Research
Lessons from Sickle Cell Disease in the Treatment and Control of Malaria
Malaria, especially infection with Plasmodium falciparum, has exerted strong selective pressure on the human genome. In a well-characterized, balanced polymorphism, persons who are homozygous for the sickle hemoglobin mutation (in which valine replaces glutamic acid at position 6 in the β-globin…
- June 30, 2011
- Rosenthal P.J.
- N Engl J Med 2011; 364:2549-2551
Persons with sickle cell disease and carriers of the trait are protected against malaria. A study of mice infected with a plasmodium species similar to Plasmodium falciparum provides insight into how the severity of infection in humans may be modulated.
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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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