…Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. A healthy, lean 46-year-old woman who is a nonsmoker…

Figure 1. An 83-year-old woman with long-standing atrial fibrillation who had previously undergone atrioventricular nodal ablation and pacemaker placement presented with symptoms of progressive heart failure. Physical examination was notable for elevated jugular venous pressure, precordial lift, a…

Figure 1. A 67-year-old woman presented with dyspnea and peripheral edema due to severe tricuspid regurgitation. Having had rheumatic heart disease, she had undergone replacement of the mitral and aortic valves with Starr-Edwards heart valves 38 years earlier. During her recent admission,…

…bluish or greenish hue. Once the dye has been passed (after 2 days, in this patient), the color of the urine returns to normal. The patient had no clinical problems after the dye was passed.

…attractive candidate for combination therapy with other growth factors, such as VEGF or basic fibroblast growth factor, both of which failed in phase 2 clinical trials to improve neovascularization in patients with ischemic heart disease. Certainly, the findings reported by Li et al. will stimulate further…

…69-year-old man presented at the emergency room with stabbing pain and swelling of the right lower leg on standing up from a seated position. On clinical examination, rupture of the Achilles' tendon was suspected. Plain radiographs showed a complete rupture of a calcified Achilles' tendon (Panels A…

Figure 1. A 37-year-old man was referred for evaluation of distal renal tubular acidosis. Laboratory evaluation revealed a serum potassium level of 3.3 mmol per liter, a bicarbonate level of 16 mmol per liter, a calcium level of 9.3 mg per deciliter (2.3 mmol per liter), a phosphate level of 2.1 mg…

Figure 1. A 20-year-old man who had had idiopathic end-stage renal failure since he was 12 years of age and who was undergoing dialysis once weekly (with stable serum electrolyte, blood urea nitrogen, and serum creatinine levels) presented with a large, nontender mass on his hard palate that had…

Figure 1. A 28-year-old man with idiopathic dilated cardiomyopathy who had had St. Jude aortic- and mitral-valve replacements 3 years earlier presented with decompensated heart failure. The examination was notable for marked jugular venous distention, an S 3 gallop, and a palpable left ventricular…

Figure 1. A 71-year-old woman received a diagnosis of systemic sclerosis more than 30 years ago when she presented with Raynaud's phenomenon and cutaneous sclerosis. At that time she did not require long-term therapy. She now presents with fever and venous ulceration of both legs. On physical…

Femoral venous catheterization is a rapid way to obtain intravenous access in hospitalized or emergency department patients. In this video, you will learn how to safely place a femoral line. Placement of a femoral line may be indicated in the following situations: to obtain vascular access when…

Figure 1. A 35-year-old woman with bipolar disorder was found wandering on a highway screaming and crying, with disorganized speech. She was evaluated in the emergency department, and computed tomography of the head revealed a hypodense area. The patient reported that she had a nail in her uterus.…

Figure 1. A 65-year-old woman with a history of hypertension and cigarette smoking presented with complete loss of vision in the inferior field of the left eye, which she had noticed an hour before presentation. She reported having had two transient episodes of amaurosis in the left eye the…

Figure 1. An 89-year-old woman was admitted to the hospital with hypercapnic respiratory failure. She had a long history of osteoporosis. Bone densitometry revealed a T score for the lumbar spine of −4.8. She was taking subtherapeutic vitamin D and calcium supplements and had declined treatment…

Figure 1. A 19-year-old woman presented to the emergency department with a 10-day history of intermittent odynophagia, voice changes, and fever. Before her visit to the emergency department, she was treated with azithromycin and prednisone for pharyngitis and, subsequently, with 2 days of…

Figure 1. A 74-year-old man was referred because of left exophthalmos and outward displacement of the orbit (Panel A). His symptoms had progressed slowly over a 4-year period but had worsened rapidly during the preceding 2 days, causing diplopia, impaired ocular movement, orbital pain, and…

…begins with an assessment of risk. Risk stratification is a dynamic practice whereby the clinician incorporates newly acquired information in a clinical-decision model that also considers the desires and preferences of the patient. In this case, the presence of diabetes carries both an increased risk…

…cerebrovascular events in patients with carotid disease, although the definition and execution of medical therapy vary from trial to trial. In five randomized clinical trials (including ACAS and ACST) of medical therapy alone for asymptomatic carotid stenosis as compared with endarterectomy plus medical therapy,…

…successful translation of pioneering work by the late Judah Folkman and his colleagues, who proposed that vascularization is essential for the growth of clinically relevant invasive carcinomas. A recent study by Fischer and colleagues 2 indicates that a monoclonal antibody against another angiogenic protein…

…normal after the intravenous fluids were discontinued. The patient's mental status further improved, and there was a gradual improvement in the clinical and laboratory markers of pancreatitis. The normal 25-hydroxyvitamin D level rules out vitamin D toxicity. The episode of acute pancreatitis could…