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Case Records of the Massachusetts General Hospital
Case 15-2012 — A 48-Year-Old Woman with Diplopia, Headaches, and Papilledema
Presentation of Case. Dr. Rocío Hurtado (Infectious Diseases): A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. The patient had been well until 2 weeks before admission, when diplopia developed, which improved when she covered either eye. One week…
- May 17, 2012
- Venna N., Coyle C.M., González R.G., Hedley-Whyte E.T.
- N Engl J Med 2012; 366:1924-1934
A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. Imaging revealed cysts in the fourth ventricle and spinal canal. A diagnostic procedure was performed.
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Review Article
Mechanisms of Disease: Diabetic Retinopathy
Until recently, the treatment for diabetic retinopathy relied almost exclusively on managing the metabolic dysregulation of diabetes mellitus until the severity of vascular lesions warranted laser surgery. Intensive metabolic control remains a highly effective means of controlling retinopathy and…
- March 29, 2012
- Antonetti D.A., Klein R., Gardner T.W.
- N Engl J Med 2012; 366:1227-1239
- CME
The incidence of diabetes is increasing, but that of diabetic retinopathy is falling, probably owing to better management of glucose levels, lipid abnormalities, and hypertension. Clinical trials of VEGF and PPAR-α inhibitors are improving vision and providing insights into pathogenesis.
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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
- Free Full Text
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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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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Review Article
Current Concepts: The Autosomal Recessive Cerebellar Ataxias
The autosomal recessive cerebellar ataxias are a group of little known and often neglected diseases that are best understood by following a practical, multidisciplinary approach that focuses on clinical rather than molecular considerations. This review focuses on the main forms in which cerebellar…
- February 16, 2012
- Anheim M., Tranchant C., Koenig M.
- N Engl J Med 2012; 366:636-646
- CME
- Video
Autosomal recessive cerebellar ataxia must be considered in any child or young adult with a progressive disorder of gait or balance or with hypotonia or excessive clumsiness. This review presents a practical approach to these neurodegenerative diseases.
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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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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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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…
- February 9, 2012
- Rhee E.P., Scott J.A., Dighe A.S.
- N Engl J Med 2012; 366:553-560
- CME
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.
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Images in Clinical Medicine
Perilymph Fistula Test
Figure 1.
- January 26, 2012
- Chu H. and Chung W.-H.
- N Engl J Med 2012; 366:e8
- Free Full Text
- Video
A 42-year-old man presented with severe nausea and vertigo, which were precipitated by the application of pressure just anterior to the left external auditory canal. Otoscopic examination revealed a cholesteatoma arising from the pars flaccida of the left tympanic membrane.
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Correspondence
Sildenafil for Severe Lymphatic Malformations
To the Editor: Lymphatic malformations are uncommon congenital vascular anomalies that can cause complications including obstruction of vital organs and their function, recurrent infection, and disfigurement. Current procedural treatments are only partially successful, and lymphatic malformations…
- January 26, 2012
- N Engl J Med 2012; 366:384-386
- Free Full Text
Lymphatic malformations are rare but can cause significant clinical problems in addition to cosmetic disfigurement. Sildenafil was used in a child whose pulmonary hypertension was caused by lymphatic malformation; the result was a marked decrease in the lymphatic malformation.
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Case Records of the Massachusetts General Hospital
Case 39-2011 — A Woman in Her 90s with Unilateral Ptosis
Presentation of Case. Dr. Xuemei Cai (Medicine): A woman in her 90s was seen in the emergency department at this hospital because of ptosis of the left eyelid. The patient had been in her usual health until 4 days earlier when, on awakening, she was unable to open her left eye. She reported no…
- December 22, 2011
- Venna N., Gonzalez R.G., Zukerberg L.R.
- N Engl J Med 2011; 365:2413-2422
A woman in her 90s came to the ER because of acute unilateral ptosis. During the next 8 weeks, weakness of the neck, fatigue, choking, and difficulty breathing developed, progressing to respiratory failure and death. An autopsy was performed.
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Images in Clinical Medicine
Blindness after Fat Injections
Figure 1.
- December 8, 2011
- Park Y.-H. and Kim K.S.
- N Engl J Med 2011; 365:2220
- Free Full Text
A 32-year-old man presented with vision loss in the left eye. One week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead to correct frown lines. During the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye.
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Clinical Problem-Solving
A Bird's-Eye View of Fever
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 78-year-old man presented to his…
- November 3, 2011
- Lee A.I., Koo S., Vaidya A., Katz J.T., Loscalzo J.
- N Engl J Med 2011; 365:1727-1732
A 78-year-old man presented with a 4-month history of worsening fatigue, weakness, and anorexia, with an unintentional weight loss of 11.4 kg. He reported fevers, chills, night sweats, dry mouth, nonproductive cough, dyspnea with minimal exertion, nausea, and postural light-headedness.
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Clinical Therapeutics
Panretinal Photocoagulation for Proliferative Diabetic Retinopathy
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- October 20, 2011
- Bressler N.M., Beck R.W., Ferris F.L.
- N Engl J Med 2011; 365:1520-1526
- CME
Proliferative retinopathy develops in a 55-year-old man with type 2 diabetes. Panretinal photocoagulation, which causes reduced production of VEGF by destroying hypoxic retinal cells, is recommended. Diminished peripheral vision and night vision can occur.
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Interactive Medical Case
A Bird's-Eye View of Fever
A 78-year-old man presented to his primary care physician with a 4-month history of worsening fatigue, generalized weakness, and anorexia, with an unintentional weight loss of 11.4 kg (25 lb). He reported subjective fevers, chills, drenching night sweats, dry mouth, a nonproductive cough, dyspnea…
- October 13, 2011
- Ross J.J., Koo S., Lee A.I., Mushlin S.B., Milner D.A.
- N Engl J Med 2011; 365:e33
- Free Full Text
- CME
A 78-year-old man presented with four months of worsening fatigue, generalized weakness, and anorexia with an unintentional weight loss of 25 pounds (11.4 kg). He reported subjective fevers, chills, drenching night sweats, dry mouth, nonproductive cough, ...
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Images in Clinical Medicine
Orbital and Cerebral Arteriovenous Malformations
Figure 1.
- September 29, 2011
- Choudhri O. and Chang S.D.
- N Engl J Med 2011; 365:e28
- Free Full Text
An 8-year-old girl had a 3-month history of progressively impaired vision in the right eye, with paresthesias and spastic paresis of the left arm and leg. Examination of the right eye revealed the tortuous blood vessels of a complex intraorbital arteriovenous malformation.
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Case Records of the Massachusetts General Hospital
Case 24-2011 — A 36-Year-Old Man with Headache, Memory Loss, and Confusion
Presentation of Case. Dr. M. Brandon Westover (Neurology): A 36-year-old right-handed man was seen in the neurology clinic of this hospital because of headaches, confusion, and memory loss. The patient had been well until 1 month earlier, when nausea, fevers, chills, diarrhea, malaise, and myalgias…
- August 11, 2011
- Bienfang D.C., McKenna M.J., Papaliodis G.N., Gonzalez R.G., Stemmer-Rachamimov A.
- N Engl J Med 2011; 365:549-559
A 36-year-old man was seen because of headaches, confusion, and memory loss, followed by visual and hearing loss. MRI showed hyperintense lesions in the white matter and corpus callosum. Funduscopic examination showed vascular narrowing and beading.
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Clinical Implications of Basic Research
Stem Cells and Eye Development
Stem cells hold promise in the treatment of many different types of disease. The generation of induced pluripotent stem cells (iPSCs) by reprogramming somatic cells has provided unprecedented opportunities for studying basic biology and modeling human diseases. In addition, the differentiation of…
- July 28, 2011
- Zhang K. and Ding S.
- N Engl J Med 2011; 365:370-372
A recent study suggests that the optic cup can form in vitro from clumps of cells made up of embryonic stem cells, which indicates that these cells may have a capacity for self-organizing.
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Case Records of the Massachusetts General Hospital
Case 22-2011 — A 79-Year-Old Man with a Rash, Arthritis, and Ocular Erythema
Presentation of Case. Dr. Sebastian Unizony (Rheumatology): A 79-year-old man was seen in the rheumatology clinic at this hospital because of a rash, joint swelling and pain in the hands, and ocular erythema. The patient had been in his usual health until approximately 2.5 months earlier, when pain…
- July 21, 2011
- Kroshinsky D., Stone J.H., Nazarian R.M.
- N Engl J Med 2011; 365:252-262
- CME
A 79-year-old man was seen in the clinic because of a rash, painful and swollen hands, and red eyes. There was scleral erythema, urticaria on the torso, palpable purpura on the legs, and swelling and tenderness of the hand joints. A diagnostic procedure was performed.
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Correspondence
Closed-Eye Ocular Injuries in the Iraq and Afghanistan Wars
To the Editor: It was estimated in 2008 that 300,000 military personnel in the United States had blast-induced traumatic brain injury (TBI), the signature injury in current conflicts. Of concern to ophthalmologists are ocular injuries arising from exposure to such blast forces. Penetrating eye…
- June 2, 2011
- N Engl J Med 2011; 364:2172-2173
- Free Full Text
Comprehensive ophthalmic evaluation was conducted in 46 veterans hospitalized because of traumatic brain injury after blast exposure in Iraq or Afghanistan. Evidence of closed-eye injury was found in 20 of these patients.
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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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