IMAGES IN CLINICAL MEDICINE Thrombectomy in Acute Ischemic Stroke David C. Lauzier, Akash P. Kansagra N Engl J Med 2022; 386:1351DOI: 10.1056/NEJMicm2116727 A 63-year-old man with atrial fibrillation, hypertension, and type 2 diabetes presented to the emergency department with weakness on the left side and difficulty speaking, both of which had begun 6 hours earlier. On examination, he had dysarthria, 0/5 strength in the left arm, and 1/5 strength in the l...

IMAGES IN CLINICAL MEDICINE Pulmonary-Artery Aneurysm with Acute Dissection Asvin M. Ganapathi, Curt J. Daniels N Engl J Med 2022; 386:273DOI: 10.1056/NEJMicm2104225 A 35-year-old woman with idiopathic pulmonary arterial hypertension presented to the emergency department with a 1-day history of chest pain. She had been undergoing evaluation for lung transplantation and was known to have a 12-cm pulmonary-artery aneurysm that had been enlarging over the pre...

Why Should We Be Measuring Ionized Magnesium? Magnesium in the Human Body Magnesium (Mg) is the 4th most abundant cation in the human body. The majority of it is found intracellularly, more than half in bone, about a third in muscle, and the remaining in soft tissue and extracellular fluid (Figure 1). Magnesium is found in the diet from a variety of sources: green leafy vegetables (Mg is found in chlorophyll), nuts and seeds, fruits, yogurt, and unrefined grains suc...

JAMA Diagnostic Test Interpretation September 17, 2021 Interpreting SARS-CoV-2 Test Results KC Coffey, Daniel J. Diekema, Daniel J. Morgan, et al JAMA. Published online September 17, 2021. doi:10.1001/jama.2021.16146 Case A53-year-old woman was referred to the gastroenterology clinic for endoscopy because of a submucosal gastric nodule. She had not received a COVID-19 vaccination and lived in Maryland, which...

JAMA Diagnostic Test Interpretation September 17, 2021 Interpreting SARS-CoV-2 Test Results KC Coffey, Daniel J. Diekema, Daniel J. Morgan, et al JAMA. Published online September 17, 2021. doi:10.1001/jama.2021.16146 Case A53-year-old woman was referred to the gastroenterology clinic for endoscopy because of a submucosal gastric nodule. She had not received a COVID-19 vaccination and lived in Maryland, which...

IMAGES IN CLINICAL MEDICINE Bronchoesophageal Fistula Pierluigi di Mauro and Vittorio Ferrari N Engl J Med 2020; 383:e137DOI: 10.1056/NEJMicm2018535 A 50-year-old man presented to the emergency department with a 5-day history of shortness of breath, chest pain, and a cough. Fifteen days before presentation, he had received a diagnosis of large-cell neuroendocrine carcinoma of the lung with brain metastases. The oxygen saturation was 93% while the patient w...

CLINICAL DECISIONS Doctor, How Long Should I Isolate? Siri R. Kadire, Valeria Fabre, and Richard P. Wenzel N Engl J Med March 10, 2021DOI: 10.1056/NEJMclde2100910 Case Vignette 病例介绍 A Woman with Covid-19 一名女性新冠肺炎患者 Siri R. Kadire, M.D. A 24-year-old woman with no relevant medical history presented to the emergency department with a 1-week history of cough and shortness of breath. She stated that she had not had any contact with people...

ORIGINAL ARTICLE Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19 Andre C. Kalil, Thomas F. Patterson, Aneesh K. Mehta, et al N Engl J Med December 11, 2020DOI: 10.1056/NEJMoa2031994 Abstract BACKGROUND Severe coronavirus disease 2019 (Covid-19) is associated with dysregulated inflammation. The effects of combination treatment with baricitinib, a Janus kinase inhibitor, plus remdesivir are not known. METHODS We conducted a dou...

IMAGES IN CLINICAL MEDICINE Green UrineVCAD510 JN0-643 Maja Boshkovska Spaseski, and Dejan Spaseski N Engl J Med 2020; 383:e128DOI: 10.1056/NEJMicm2017137 A 62-year-old man with chronic obstructive pulmonary disease presented to the emergency department with a 2-day history of dyspnea and was found to have hypercapnic respiratory failure. Intubation was performed, mechanical ventilation and a continuous infusion of propofol were initiated, and the patient ...

Capnocytophaga canimorsus Infection Robert D.H. Markewitz and Tobias Graf N Engl J Med 2020; 383:1167DOI: 10.1056/NEJMicm1916407 A 62-year-old man presented to the emergency department with a 1-day history of fever and a 3-day history of chest pain. His medical history was notable for coronary heart disease and for a splenectomy that he had undergone after a car accident. Four days before presentation, he had been bitten on the left hand by his dog and h...