Category Archives: Cases

Current Awareness and Treatment of Critical Limb Ischemia

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A 59-year-old male laborer presented with a non-healing, left great-toe ulcer. He also described severe rest-pain in his same forefoot. His past history was significant for insulin-dependent diabetes mellitus (IDDM), hypertension, dyslipidemia, renal insufficiency, obesity and 40 pack/years of smoking. [...]

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Start Palliative Care Consult at Time of Cancer Diagnosis

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Cheryl is a 55-year-old woman in good health with no significant medical history, who presented with low back pain radiating to her legs that has failed six weeks of conservative treatment with physical therapy and NSAIDS. She attributed a 20-pound weight loss over two months to increased exercise and a new dietary supplement [...]

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Minimally Invasive Spine Surgery: Fast Relief for Intractable Pain

A 54-year-old male presents with a four-year history of severe back pain, sciatica and difficulty walking. He has spinal stenosis and spondylolisthesis at L4-L5. The patient has loss of sensation and weakness. He is no longer able to work out or even enjoy recreational activities with his wife due to intense pain and the need for opiates. [...]

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Hernia Repair in a Liver Transplant Candidate

A 40-year-old woman is on the liver transplant list for Laennec’s cirrhosis with a MELD (Model for End-stage Liver Disease) score of 9. She presented to the hernia clinic with multiple recurrent abdominal wall hernias, resulting from prior operations [...]

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Morbid Obesity and Gastroesophageal Reflux Disease

ELIZABETH A. DOVEC, M.D. Case: A 45-year-old morbidly obese female with past medical history significant for hypertension presents for evaluation of burning epigastric and substernal pain that has recurred almost daily for the past four months.  She says these symptoms are worse when she lies down and after meals.  She denies difficulty swallowing.   The patient...

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Rapid Recogniton/Evaluation of Ischemic Stroke in Younger Patients

Ischemic stroke is a devastating neurologic disease and a significant cause of death and disability. While recognized in the elderly, disability from an ischemic cerebrovascular accident (CVA) can also be profound in younger patients.

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Dementia Case Study and Discussion

REBECCA ELON, M.D. Case Mrs. Jones was a successful businesswoman. After retiring at age 65 she remained active with local volunteer groups. After her 79th birthday, her husband became concerned because she had dropped out of most of her usual activities. She had always been a very outgoing person, but had become quiet and reserved....

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Lung Cancer Screening Benefits High-Risk Patients

By Stephen Cattaneo, M.D. Case:   In 2012, a 65-year-old female, current smoker with a 58-pack year smoking history (the equivalent of one pack per day for 58 years) underwent a chest X-ray as part of her pre-operative workup prior to left shoulder arthroscopic surgery. Her radiograph identified an incidental left lung lesion.  Subsequent diagnostic...

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Advanced Digital Replantation

By: Ryan Katz, M.D. CASE: In July 2011, MP sustained a near-complete amputation of his left thumb while using a power saw. The saw had passed through all the important anatomic structures, including the nerves, arteries, tendon, and bone. The digit, attached to the hand by only a small skin bridge, was nonviable. He was...

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Superficial Venous Thrombophlebitis: New Practice Guidelines

By: Sanjiv Lakhanpal M.D., FACS Case: LM, a 78-year old female was seen in the emergency room with leg pain and localized swelling in the calf.  The patient had no significant past medical history except for varicose veins, no history of prior leg clots or family history of clotting disorders. On physical exam, a tender,...

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