Medicine Nexus Global Feed

Medicine Nexus Launches

BP — Wed, 28 Feb 2007 15:17:08 +0000

Medicine Nexus is now open to the public. If you are interested in exploring the potential of online collaborative clinical problem solving, sign up for your free medical blog and let the conversation begin…

Uninvited Guests

BP — Mon, 12 Feb 2007 04:34:51 +0000

Here’s a case of a 41-year-old woman who presented to her PCP with fatigue, fevers, and a Hgb of 5.0. Six months earlier she experienced a short bout of tachypnea, and a CXR showed bilateral hilar lymphadenopathy. Her CBC at that time was normal except for a normocytic anemia (Hgb 8.7). Hilar lymph node biopsy was non-diagnostic and she was lost to follow up until her presentation above.

Significant exam findings included temp 100.2 F, clear lungs, moderate hepatomegaly, and no lymphadenopathy.

Notable labs:
WBC 1.2 (ANC 400), Hgb 5.0 (MCV 87), Plt 654, LDH 203,
Cr 1.1, Prot 7.4, Alb 2.2, SPEP: polyclonal gammopathy

Bone marrow biopsy was performed and a specimen is shown below.

I’m pretty sure we have this one figured out, but what do you think it going on?

Welcome to Gen Med Forum

BP — Wed, 07 Feb 2007 03:29:46 +0000

This is a new blog dedicated to discussion of challenging and unsolved medicine cases. I’ll be posting cases as they come up; please leave a comment if you have an idea about a case. You can also sign up to be an author for this blog and add your own case. Here’s to some online teamwork.

All Too Persistent Hodgkins

BP — Tue, 06 Feb 2007 05:53:45 +0000

This is a case of a 23 yo woman diagnosed with NS Hodgkins, treated initially with ABVD x6 cycles with rapid relapse, ICE x2 cycles with partial response followed by auto PBSCT, which unfortunately showed persistent disease. Twelve months after original diagnosis and three months after PBSCT, she underwent modified mantle radiation with 30 Gr to the mediastinum and bilateral neck, which induced remission for nine months. When she relapsed again, she presented with dyspnea on exertion, and a TTE showed a mass impinging on the left atrium leading to tamponade physiology. Decadron 40 mg daily along with palliative XRT to the mediastinum relieved her symptoms, but they recurred one month later, during which she developed hypoxic respiratory failure and hypotension and was intubated according to her and her family’s wishes.

Below are her PET and chest CT at the time of relapse after mantle radiation and chest x-rays one day before and one day after intubation, all showing her profound tumor burden.

At this point, palliative/salvage chemo options include BEACOPP (clearly minus bleo) or Stanford V. Any thoughts regarding choice of therapy or alternative approaches?

Welcome to the OncBlog

BP — Sun, 04 Feb 2007 14:16:28 +0000

This is the home of a new blog for oncology cases. More content coming, so check back soon…

Welcome to the HemeBlog

BP — Sat, 03 Feb 2007 04:32:15 +0000

This is the inaugural post for the new and improved HemeBlog, now a part of Medicine Nexus. Within this blog, you will find challenging and unusual cases that often are still unsolved or lack clear treatment options. Please leave comments on forthcoming posts with your thoughts, hunches, or additional questions. You can also contribute to this blog by becoming an author. Enjoy!