Review of tuberculosis meningitis

Thwaites, Guy E, Ronaldvan Toorn, and JohanSchoeman. “Tuberculous meningitis: more questions, still too few answers.” Lancet neurology 12.10 (2013):999-1010.


Posted in Background question, Diagnosis, EUH, Therapy | Tagged

Review of hemobilia

Chin, Marcus W, and RobertEnns. “Hemobilia.” Current Gastroenterology Reports 12.2 (2010):121-9.
Posted in Background question

Checking Hepatitis B surface antigen levels after treatment

HBsAg levels at 6 months of LMV-ADV combination therapy can help predict treatment response. More potent treatments should be considered for cases positive for HBeAg, with high baseline HBV DNA and high HBsAg levels after 6 months treatment.

Kim, Jeong H, et al. “Hepatitis B surface antigen levels at 6 months after treatment can predict the efficacy of lamivudine-adefovir combination therapy in patients with lamivudine-resistant chronic hepatitis B.” Clinical and molecular hepatology 20.3 (2014):274-82.

Quantitation of hepatitis B surface antigen is an increasingly popular method to determine the treatment response in chronic hepatitis B patients. The clinical value of HBsAg level measurement during rescue therapy for lamivudine-resistant CHB patients have not been evaluated to date. Therefore, this study investigated the correlation between HBsAg level and treatment response in LMV- resistant CHB patients treated with adefovir add-on therapy.

Posted in EUHMidtown | Tagged

Diagnosis and therapy of pulmonary hypertension (PH) & review of sarcoidosis-associated hypertension (SAPH)

Review article on diagnosis and treatment of PH: Bazan, Isabel S, and Wassim HFares. “Pulmonary hypertension: diagnostic and therapeutic challenges.” Therapeutics and Clinical Risk Management 11(2015):1221-33.

Reviews epidemiology, diagnosis, prognosis, and treatment considerations for SAPH and discusses lung transplantation as a treatment option: Shino, Michael Y, et al. “Sarcoidosis-associated pulmonary hypertension and lung transplantation for sarcoidosis.” Seminars in respiratory and critical care medicine 35.3 (2014):362-71.

Posted in Background question

Review of ocular syphilis

Davis, Janet L. “Ocular syphilis.” Current opinion in ophthalmology 25.6 (2014):513-8.

Posted in Diagnosis, EUH, Therapy | Tagged

What is the preferred imaging modality for necrotizing fasciitis?

Magnetic resonance imaging (MRI) is the most effective method for documenting the soft tissue lesions and evaluating their distribution.

In practice, several key points deserve emphasis:
• the absence of MRI abnormalities of the intermuscular fasciae virtually rules out necrotizing fasciitis
• the presence of gas (signal-free areas on all sequences) is highly specific but rare
• extensive thickening of the intermuscular fasciae with an appearance suggesting incomplete vascularization supports a diagnosis of necrotizing fasciitis
• the presence of lesions confined to the peripheral fasciae and to small portions of the adjacent intermuscular fasciae is of borderline significance

Malghem, Jacques, et al. “Necrotizing fasciitis: contribution and limitations of diagnostic imaging.” Joint bone spine 80.2 (2013):146-54.

A very important point is that imaging studies play only an ancillary role and must never delay the surgical treatment of deep necrotizing fasciitis, a condition whose outcomes, including patient survival, depend heavily on the promptness of appropriate therapy

Posted in EUHMidtown | Tagged

Diagnosing Chronic thromboembolic pulmonary hypertension

Go to: Chronic thromboembolic pulmonary hypertension (CTEPH)

Select Diagnosis on the left.

Making the diagnosis:
-suspect chronic thromboembolic pulmonary hypertension in patients with(1, 2)
-symptoms of progressive dyspnea on exertion and exercise intolerance
-pulmonary hypertension and history compatible with, but not limited
to, pulmonary embolism
-unexplained pulmonary hypertension
-diagnosis of chronic thromboembolic pulmonary hypertension typically includes
all of the following(1)
-pulmonary hypertension as demonstrated by transthoracic
echocardiography (TTE) and confirmed by right heart catheterization
-systolic pulmonary artery pressure > 40 mm Hg, and mean pulmonary
artery pressure > 25 mm Hg at rest
-pulmonary vascular resistance > 3 Wood units (240 dynes-second-cm-5)
-abnormal pulmonary angiogram or ventilation-perfusion (V/Q) scan showing
persistent obstruction of main, lobar, segmental, or subsegmental pulmonary
arteries despite 3 months of therapeutic anticoagulation
-exclusion of other causes of pulmonary hypertension including exclusion of
left-sided heart disease by pulmonary capillary wedge pressure < 15 mm Hg

Posted in VA | Tagged