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Differential Diagnosis and Management of Low Back Pain in the Primary Care Setting

Not all patients are candidates for surgical management of low back pain, and may instead benefit from other, less invasive options.

Acute aortic occlusion: Common presentation of an uncommon catastrophe

There is scant systematic literature available on acute aortic occlusion. A review of 46 cases in a single center found 2 primary causes, including embolism (65%) or thrombosis (35%).1 Smoking and diabetes were found to be the risk factors for thrombotic occlusion and pre-existing cardiac disease and female gender risk factors for embolism. Acute aortic occlusion due to embolization of a large thrombus from left atrial appendage occurred in a patient with atrial fibrillation at our institution recently (Radha Sharma,MD, personal communication, February 2008). Case reports have described embolization of atrial myxoma to the abdominal aorta resulting in aortoiliac occlusion.2,3

Cinema Consults: Our Picks for the Best Movies of 2003

Addressing Treatment Challenges and Advancing Care in Psoriasis

An examination of the physical, emotional and social burden of psoriasis, and the continued need for research to advance care for patients.

Adjusting for Crossover in Analyses of Letrozole vs. Tamoxifen

Letrozole treatment over 5 years was still associated with significantly better overall survival than 5 years with tamoxifen.

Watch for Retirement and Estate Pitfalls

Honesty Is the Best Policy: Effective communication is essential for achieving a good death.

Every day, an oncology nurse has a conversation with a patient that goes something like this: The patient asks, How much longer do you think I can live with this aggressive tumor?

Asystole during sleep in a 46-year-old male athlete

A number of electrocardiographic abnormalities have been described in athletes.1 Among these are sinus bradycardia and varying degrees of atrioventricular (AV) block. These findings have been attributed to the "athlete's heart," and are felt to be due to enhanced vagal tone seen with excellent physical conditioning. Secondarily it has also been suggested that there are intrinsic changes within the sinoatrial and AV nodes themselves, including prolonged sinus node recovery time and AV nodal Wenckebach, and these abnormalities persist following autonomic blockade.

Incidence of death and MI associated with stopping clopidogrel after ACS

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

Incidence of death and MI associated with stopping clopidogrel after ACS

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

Iatrogenic dilated cardiomyopathy and spectrum of current treatment modalities

Our increasing ability to intervene in high-risk patients—with lower risks and greater chances for successful outcomes—is felt across the broad spectrum of cardiovascular disease. This is particularly evident in patients with dilated cardiomyopathy (DCM).

Revisit the Old Major Wire Houses' Game