Unbounded Medicine

Via AACE from J Davidson, P Jellinger, L Blonde, H Lebovitz, C Parkin (2005):

The new position statement is this: Even if the initial A1C is from 6 to 7%, you should start pharmacotherapy.
This aggressive treatment has proved that mortality diminishes considerably.

Regards,
Jon Mikel Iñarritu, M.D.

technorati tags: diabetes, diabetes mellitus, A1C, AACE guidelines, guidelines, pharmacotherapy, medicina, […]

Boston Scientific ENTERYX Procedure Kits and Injector Single Packs .
via FDA Safety I nformation Alerts:
For those who haven’t consider endoscopic procdedures for the treatment of GERD, well, at least, you shouldn’t think in Enteryx treatment.
FDA and Boston Scientific notified healthcare professionals and patients about serious adverse events, including death, occurring in patients treated with ENTERYX, […]

This week’s Grand Rounds is hosted by Doc Shazam, she starts with a nice gruop categorization, the conclusion of this roundup is to let us know that in medicine’s blogsphere there is not all about medicine. Here we have the categories.

Specific Diseases
Training
Technology
Ethics
Humor
Delivery
Geek Stuff
Psychology
Medical Trivia, and
Narrative

So please, be sure to visit her site and stay up-to-date […]

via Reuters Health and Headache 2005;45:973-982:

National Headache Foundation guidelines for abortive treatment of migraine aren’t right?
This study states that the combination of acetaminophen, aspirin, and caffeine (AAC) is superior to sumatriptan in migraine’s early treatment.
Goldstein et al, compared the combination treatment with 50mg sumatriptan in 171 subjects treated when the first symptoms ofmigraine occurred. […]

We all know those evidence linking OSA to systemic hypertension (even if your patient is not obese), because the vasoconstriction and activation of renin-angiotensin-aldosterone axis. But now there is new evidence that OSA is an important risk factor for stroke.
A new observational cohort study of NEJM by Yaggi et al, states that OSA increases significantly […]

Here is another chest x-ray that shouldn’t have been taken:

As reference, you can trackback this earlier post.
Regards,
Jon Mikel Iñarritu, M.D.

technorati tags: tension type pneumothorax, medical images, CXR, chest x-ray, x-ray, medical emergency, clinical images, medicine, unbounded medicine, medicina, pneumothorax

This week, Grand Rounds 2.07 is hosted by MSSP Nexus Blog.

Rita is the creator and she is a natural born story teller. Now she comes with a StarTrek story very funny and so complete.
Next week’s GR will be hosted by Doc Shazam, be shure to update him her.
Regards,
Jon Mikel Iñarritu, M.D.

technorati tags: Grand Rounds, grandrounds, […]

Open fractures are surgical emergencies because of its complications (soft tissue damage, infection, hemorrhage).
We at emergency department need a classification system that it is intented to determine the degree of that damage.
We have to make a rapid (also a good) interrogation of lession mechanisms (what, when,  where, who, associated lessions). REMEMBER: If a low-grade open […]

Physical findings & Clinical Presentation:
• Severeconstant pleuritic pain that localizes over the anterior chest and may radiateto arms and back; it is differentiated from myocardial ischemia, becausethe pain intensifies with inspiration and is relieved by sittingup and leaning forward.• Pericardial friction rub is best heard with patientupright and leaningforward and by pressing the stethoscope firmly […]

A 64 years old politraumatized male, arrive to ER department directly to trauma room. He was on shock.

Refractary hypotension
Tachycardia and tachypnea

He had no signs of tamponade.

Here we have the images (best viewed in large size):

Post-surgery image (best viewed in large size):

The final diagnosis was Traumatic […]

22 year old female with painless slowly progressive, ophtalmoplegia with diplopia and ataxia.
On physical examination we found this:

Short stature.
Arrhythmic heart sounds.
Bilateral ptosis.
Ophtalmoplegia.

Bilateral fundoscopy examination:

A characteristic bilateral pigmentary retinosis.

An EKG was performed:

A first degree AV block was found on this patient.

Then we ordered a lumbar […]

A 76 years old female comes to the emergency department because shortness of breath. She has been postrated since 2 months ago, when she wasn’t able to move her legs anymore. Shortness of breath since 1 week ago (NYHA IV). She states that she has “rheumas”. She gives no other information. She has been taking […]