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Usefulness of the Pulmonary Artery Catheter in a Perioperative Setting Øyvind S. Svendsen, Gaute K. Wathle, Paul Husby, et al. Am J Respir Crit Care Med 2016; 194: 1426-1427 An obstruction in superior vena cava (SVC) may decrease blood drainage from the upper half of the body, leading to head and neck swelling, upper extremity edema, and dyspnea, as well as cerebral edema. This condition, termed SVC syndrome, is rare during cardiac surgery. Malposition of SVC cannu...
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Images in Clinical Medicine Neurogenic Megacolon in Spinal Cord Injury Rukma R. Govindu, Michelle Kelley N Engl J Med 2016; 375: e45 DOI:10.1056/NEJMicm1604013 Copyright © 2016 Massachusetts Medical Society. A  44-year-old man with a 20-year history of quadriplegia from a gunshot wound to the neck presented to the emergency department with symptoms of a urinary tract infection. His medical history included chronic megacolon and neurogenic bladder, and he had been admitted...
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Images in Clinical Medicine Skin Mottling Damien Contou, Nicolas de Prost N Engl J Med 2016; 375: 2187 A 68-year-old woman was admitted to the intensive care unit with respiratory failure and hypotension. Her blood pressure was 70/50 mm Hg, and her heart rate was 125 beats per minute. Physical examination revealed skin mottling on the legs (Panel A). Laboratory values were notable for an arterial- blood lactate level of 4.5 mmol per liter (normal value, <2.0),...
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Images in Clinical Medicine Hemothorax after Thoracentesis Ittikorn Spanuchart, Scott Gallacher N Engl J Med 2016; 375: 1878 DOI: 10.1056/NEJMicm1507029 A 65-year-old woman with atherosclerotic cardiovascular disease and renal failure was hospitalized for acute respiratory failure and bilateral pleural effusions associated with pneumonia (Panel A). To rule out the presence of empyema, a diagnostic, ultrasonography-guided thoracentesis was performed in the left lung in th...
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Images in Clinical Medicine Diagnosing Myasthenia Gravis with an Ice Pack Wendy W. Liu, Adam Chen N Engl J Med 2016; 375: e39 DOI: 10.1056/NEJMicm1509523 A 68-year-old man presented with unilateral ptosis and no other symptoms. The neurologic examination revealed ptosis of the left eye after a sustained upward gaze (Panel A). The movements of the extraocular muscles were normal. Myasthenia gravis was suspected, and the ice-pack test was performed with the placement of an ...
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Images in Clinical Medicine Emphysematous Cystitis Kai-Yi Tzou, M.D. Yi-Te Chiang, M.D. N Engl J Med 2016; 375: 1779 A 72-year-old woman with poorly controlled hyperlipidemia and diabetes presented to the emergency department with a 5-day history of lower abdominal pain. She also had fever and reported nausea and vomiting. Physical examination revealed lower abdominal tenderness. Blood tests revealed leukocytosis associated with a left shift (neutroph...
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Images in Clinical Medicine Emphysematous Pyelonephritis N Engl J Med 2016; 375: 1671 A  51-year-old man presented with fever and general malaise of 2 weeks' duration. He had had diabetes mellitus for the preceding 20 years, and at the time of presentation this condition was poorly controlled. On admission to the hospital, his white-cell count was 10,800 per cubic millimeter (normal range, 3900 to 9800). The C-reactive protein level was 8.6 mg per deciliter, blood urea ni...
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IMAGING IN INTENSIVE CARE MEDICINE Grey Turner's sign associated with hemorrhagic pancreatitis Rostane Gaci, Cyril Cadoz, Laurent Hennequin, et al Intensive Care Med 2016 DOI 10.1007/s00134-016-4551-9 A 59-year-old man with a history of alcohol abuse was admitted to the emergency room with hemodynamic instability and acute abdominal pain radiating into the back. Physical examination revealed abdominal muscle guarding without jaundice. Hemoglobin levels were low (8 g/dL...
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Images in Clinical Medicine Cholesterol Embolization after Transcatheter Aortic-Valve Replacement Lu Devy, M.D., Florence Brunet-Possenti, M.D. Bichat Hospital Paris, France devy.lu87@yahoo.fr N Engl J Med 2016; 375: e25 An 88-year-old man with a history of myocardial infarction for which he had required quadruple coronary-artery bypass grafting presented with mottled-appearing purple discoloration of the skin on his toes. One month earlier, he had undergone tran...
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Images in Clinical Medicine Urinary Tract Tuberculosis Hiromichi Masuda, M.D. Koji Kamada, M.D., Ph.D. Shobara Red Cross Hospital Shobara, Japan m01081hm@jichi.ac.jp N Engl J Med 2016; 375; 1068 A 76-year-old man with diabetes and a 2-year history of mediastinal lymphadenopathy of un- known cause presented with fever and fatigue. Pyuria was seen on urinalysis. Contrast-enhanced computed tomography (CT) of the abdomen showed mild dilatation of the left renal pelvi...
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