The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 51-year-old woman is evaluated for a 6-month history of diarrhea and bloating. She reports four to six loose stools per day, with occasional nocturnal stools. She has had a few episodes of incontinence secondary to urgency. She has not had melena or hematochezia but notes an occasional oily appearance to the ...

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In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health. Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A ...

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It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications. “It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer. There are ...

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The Food and Drug Administration (FDA) recently released a statement about power morcellation during hysterectomy and myomectomy (surgery to remove uterine fibroids), raising concerns about these devices spreading unanticipated cancers. There have been several reports in the literature and the press alike of this happening and when it does it significantly worsens the prognosis.  The American Congress of Obstetrician and Gynecologists (ACOG) is now re-exploring this issue. Pending a full review ...

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In the contest to get a creative name, few pathogens have done worse than hepatitis C. In the 1970s there were two known viruses that caused hepatitis: liver inflammation. You might have already guessed that these two viruses were called hepatitis A and hepatitis B. It was known at that time that people sometimes developed hepatitis after blood transfusions and that the majority of those patients tested negative for hepatitis ...

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May marks Celiac Disease Awareness Month, with the goals of raising awareness of the disease and its potential health complications, and also to help elucidate which patients warrant diagnostic testing for the disease. A few days ago on Twitter, I noticed that #glutenfree was trending (again). It is fascinating to observe how gluten-free businesses are beyond booming as diseases and conditions such as celiac disease, wheat allergy, and non-celiac gluten intolerance ...

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I received a panic call from Jim, who had been a patient for over ten years.  His 5-year-old daughter had passed out.  Amanda was rushed to the ICU for new onset diabetes.  After stabilization, she was transferred by helicopter to a university hospital for an insulin pump insertion.  He knew that her life, his life, would never be the same. Two weeks later, I received another call from Jim.  This time, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a 5-year history of hypothyroidism. Her only medication is levothyroxine. On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/72 mm Hg, and pulse rate is 80/min; ...

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DNA Day came and went this past April. On this date in 1953, the work of James Watson and Francis Crick (and, though she doesn’t appear as an author, Rosalind Franklin) describing the structure of DNA was published. The paper, published in Nature, connected a string of dots that stretched back a century, to Gregor Mendel’s work describing the heredity of peas. That string of dots (or peas, as the case may ...

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