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Case Records of the Massachusetts General Hospital: A 54-Year-Old Man with New Heart Failure. 
A 54-year-old man presented with severe symptoms of #heartfailure. An evaluation revealed a wide pulse pressure, displaced cardiac impulse, volume overload, and a diastolic murmur. A chest #radiograph showed enlargement of the cardiac silhouette. Additional diagnostic tests were performed. 
Figure 1: On posteroanterior and lateral radiographs of the chest obtained at the other hospital (Panels A and B, respectively), pulmonary vascular markings are increased in number and more prominent, a finding suggestive of pulmonary edema, and there is a small left pleural effusion. The cardiac silhouette is markedly enlarged, and the ascending aortic silhouette is ectatic. An #electrocardiogram obtained at this hospital (Panel C) shows sinus rhythm at a rate of 94 beats per minute, first-degree atrioventricular delay, poor R-wave progression, left atrial enlargement, probable left ventricular hypertrophy, and nonspecific ST-T wave abnormalities that are most notable in the apical leads; all these findings are similar to those seen on the tracing obtained at the other hospital. Tap the link in our bio to read the full case report. 
#primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation #cardiology
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Case Records of the Massachusetts General Hospital: A 54-Year-Old Man with New Heart Failure. A 54-year-old man presented with severe symptoms of #heartfailure . An evaluation revealed a wide pulse pressure, displaced cardiac impulse, volume overload

New England Journal of Medicine
Images in Clinical Medicine: Erythroderma and a Pulmonary Nodule. ⠀
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A 73-year-old man presented to the #dermatology clinic with a persistent, generalized #rash that had been present for 3 months and was associated with occasional itching. He had no history of any previous dermatoses or drug allergies; he was an active smoker, with a smoking history of 40 pack-years. Physical examination revealed a symmetric, generalized erythematous rash (left image), with overlying scaling and desquamation involving the hands and feet. He was initially treated with topical glucocorticoid therapy, then with oral prednisone and antihistamines, and then with intravenous glucocorticoids, but had no relief. Skin biopsy revealed a slight acanthosis and parakeratosis with a granulocytic infiltrate — findings that were consistent with an erythrodermic dermatitis. Given the patient’s smoking history and concern that there was an underlying neoplasm associated with the #dermatitis, a #radiograph of the chest was obtained, which showed an opacity in the left lung. Paraneoplastic erythroderma was suspected, and computed tomography of the chest confirmed the presence of a pulmonary nodule in the left upper lobe (middle image). The patient underwent upper lobectomy of the left lung and lymph node dissection. Histologic examination revealed a moderately differentiated squamous-cell carcinoma. Visit the link in our profile for the full case details. ⠀
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#oncology #lungcancer #dermatology #primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation
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Images in Clinical Medicine: Erythroderma and a Pulmonary Nodule. ⠀ ⠀ A 73-year-old man presented to the #dermatology clinic with a persistent, generalized #rash that had been present for 3 months and was associated with occasional itching. He had no

New England Journal of Medicine
New Image Challenge!⠀
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An 18-year-old man presented to the #emergencydepartment with #chestpain. What is the most likely childhood diagnosis associated with the findings of this coronary #angiogram? Tap the link in our bio to vote and to see how others responded.⠀
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#primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation #cardiology #emergencymedicine
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New Image Challenge!⠀ ⠀ An 18-year-old man presented to the #emergencydepartment with #chestpain . What is the most likely childhood diagnosis associated with the findings of this coronary #angiogram ? Tap the link in our bio to vote and to see how oth

New England Journal of Medicine
Patients reveal their most personal and painful life experiences when we build trusting relationships and encourage open dialogue. But how can we encourage the dialogue required for trauma-informed care in today’s #healthcare climate? Visit the link in our bio to read Sit Back and Listen — The Relevance of Patients’ Stories to Trauma-Informed Care, a Perspective by Dorothy Novick, M.D. 
#traumainformedcare #traumainformed #clinicalpractice #ptsd #healthcaredelivery #medicalethics #medicaleducation #meded #primarycare
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Patients reveal their most personal and painful life experiences when we build trusting relationships and encourage open dialogue. But how can we encourage the dialogue required for trauma-informed care in today’s #healthcare climate? Visit the link

New England Journal of Medicine
Review Article: Mapping Symptoms to #Brain Networks with the Human Connectome. 
Complex #neurologic and #psychiatric syndromes cannot be understood on the basis of focal #brainlesions. Functional #neuroimaging, maps of interrelated regions called the #connectome, and the combination of lesion analysis with networks of the connectome offer a new way to understand neurologic function and disease. 
Figure 3: Using the Human Brain Connectome to Localize Symptoms from Focal Brain Lesions. #Lesions that cause the same symptom but occur in different brain locations (Panel A) can be overlaid on a map of anatomical connectivity (Panel B) or functional connectivity (Panel C) to determine whether they are part of the same connected brain network. With lesion network mapping, lesion locations from different patients that cause the same symptom are traced on a common atlas (Panel D, left column). Functional connectivity between each lesion location and the rest of the brain is computed with the use of the connectome (Panel D, middle column). Lesion network maps can then be overlapped to identify common connections (Panel D, right column). In this example, lesion locations that cause visual hallucinations are functionally connected to a part of the brain involved in visual imagery (red circles). Panel D is modified with permission from Boes et al. Tap the link in our bio to learn more. 
#humanconnectomeproject #neurological #neurology #medicalscience #neuroscience #meded #medicaleducation #medicalillustration
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Review Article: Mapping Symptoms to #brain Networks with the Human Connectome. Complex #neurologic and #psychiatric syndromes cannot be understood on the basis of focal #brainlesions . Functional #neuroimaging , maps of interrelated regions called the

New England Journal of Medicine
Clinical Implications of Basic Research: Femtosecond Lasers for Ophthalmic Surgery Enabled by Chirped-Pulse Amplification. 
This year’s #NobelPrize in #Physics, awarded to Donna Strickland and Gérard Mourou, recognizes their invention that enabled the development of femtosecond lasers. These lasers have revolutionized #ophthalmic surgery. 
Figure 1: Chirped-Pulse Amplification for Ultrashort-Pulse Lasers. An ultrashort pulse of low energy is stretched to reduce its peak power, amplified, and then recompressed back to an ultrashort duration. Both stretching and compression can be achieved with the use of pairs of gratings, with one pair configured to have positive dispersion and the other configured to have negative dispersion. Tap the link in our bio to learn more. 
#femtosecondlaser #science #surgery #ophthalmology #ophthalmologylife #ophthalmicsurgery
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Clinical Implications of Basic Research: Femtosecond Lasers for Ophthalmic Surgery Enabled by Chirped-Pulse Amplification. This year’s #nobelprize in #physics , awarded to Donna Strickland and Gérard Mourou, recognizes their invention that enabled th

New England Journal of Medicine
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Clinical Problem-Solving: Overcoming the Barrier. 
A 74-year-old man presented to the #emergencydepartment with #jaundice. Three days earlier, his wife had noted yellow discoloration of his eyes and skin, followed by progressive lethargy and confusion. A computed tomographic (CT) scan of the abdomen and pelvis without contrast enhancement shows a 3.6-cm air-containing cavity (arrow) in the posterior right hepatic lobe, a finding consistent with a hepatic abscess. Tap the link in our bio to learn more. 
#primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation #ctscan
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Clinical Problem-Solving: Overcoming the Barrier. A 74-year-old man presented to the #emergencydepartment with #jaundice . Three days earlier, his wife had noted yellow discoloration of his eyes and skin, followed by progressive lethargy and confusio

New England Journal of Medicine
Review Article: Bacterial Vaginosis and Desquamative Inflammatory Vaginitis. 
Bacterial vaginal infections are in two main classes: bacterial vaginosis, associated with a fishy-smelling discharge and increased pH, and desquamative inflammatory vaginitis, also associated with an increased pH. Both conditions increase the risk of pelvic inflammatory disease. Image: microscopic examination showing a high number of leukocytes (with a predominance of mononuclear leukocytes) and round parabasal cells, findings that are consistent with inflammation. Visit the link in our bio to learn more.

#gynecology #infectiousdisease 
#primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation
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Review Article: Bacterial Vaginosis and Desquamative Inflammatory Vaginitis. Bacterial vaginal infections are in two main classes: bacterial vaginosis, associated with a fishy-smelling discharge and increased pH, and desquamative inflammatory vagini

New England Journal of Medicine
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Long before standardized, data-based templates began to dictate the patient history, a teenager from Sudan walked into my pediatric practice in Philadelphia. He suffered from chronic headaches that defied all attempts at diagnosis. I ruled out sinusitis and migraines and the exotic parasites I remembered from medical school. I asked about stress and depression. He insisted he was fine. Tap the link in our bio to read the Perspective Sit Back and Listen — The Relevance of Patients’ Stories to Trauma-Informed Care by Dorothy R. Novick, M.D. ⠀
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#traumainformedcare #traumainformed #clinicalpractice #ptsd #healthcaredelivery #medicalethics #medicaleducation #meded #primarycare
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Long before standardized, data-based templates began to dictate the patient history, a teenager from Sudan walked into my pediatric practice in Philadelphia. He suffered from chronic headaches that defied all attempts at diagnosis. I ruled out sinusi

New England Journal of Medicine
Our experience with policies that offer incentives to physicians and hospitals to deliver higher-value care teaches us that before policies are implemented widely, rigorous studies should be conducted to determine whether they achieve their goals. Tap the link in our bio to read the Perspective Toward Precision Policy — The Case of Cardiovascular Care by Rishi K. Wadhera, M.D., M.P.P., and Deepak L. Bhatt, M.D., M.P.H. 
#healthpolicy #healthcare #healthcare #healthcaredelivery
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Our experience with policies that offer incentives to physicians and hospitals to deliver higher-value care teaches us that before policies are implemented widely, rigorous studies should be conducted to determine whether they achieve their goals. Ta

New England Journal of Medicine
The Human Connectome Project is a large-scale functional #neuroimaging effort to create a comprehensive map of the connectivity architecture of the #brain. To create the human #connectome, structural and functional neuroimaging data from thousands of healthy individuals were acquired with an #MRI scanner and averaged together. 
The result is a normative map of #anatomical and functional brain connectivity. The human connectome allows researchers to investigate functional connections between different regions of the brain and identify functional brain networks. Exploring these connections and networks can provide new insight into neurologic and neuropsychiatric symptoms. Tap the link in our bio to read the full review article Mapping Symptoms to Brain Networks with the Human Connectome, which includes an interactive graphic and video interview with the author, Michael Fox, M.D., Ph.D.

#humanconnectomeproject #neurological #neurology #medicalscience #neuroscience #meded #medicaleducation
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The Human Connectome Project is a large-scale functional #neuroimaging effort to create a comprehensive map of the connectivity architecture of the #brain . To create the human #connectome , structural and functional neuroimaging data from thousands of

New England Journal of Medicine
New Case Challenge: An 18-year-old man presented with #diplopia and #proptosis of the left eye. MRI showed enlargement and increased enhancement of the left medial and inferior rectus muscles, with a central area of hypoenhancement of the medial rectus muscle. What is the most likely diagnosis? Visit the link in our bio to vote and share your comments. Find the answers in the full text of the case, to be published on December 20.⠀
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Swipe for images: An axial, contrast‑enhanced, fat‑saturated T1‑weighted image of the orbits (Panel A) shows fusiform enlargement and increased enhancement of the left medial rectus muscle, with a central area of hypoenhancement (arrow). There is sparing of the musculotendinous insertion and no substantial surrounding fat stranding. A coronal, contrast‑enhanced T1‑weighted image of the orbits (Panel B) shows abnormal enlargement and central hypoenhancement of the left medial rectus muscle (arrow) and abnormal enlargement of the left inferior rectus muscle (arrowhead). An axial T2‑weighted image of the orbits (Panel C) shows increased signal intensity in the enlarged left medial rectus muscle (arrow), a finding suggestive of edema. There is mild proptosis of the left globe. ⠀ ⠀
#primarycare #clinicalpractice #medical #meded #medicalscience #medicaleducation
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New Case Challenge: An 18-year-old man presented with #diplopia and #proptosis of the left eye. MRI showed enlargement and increased enhancement of the left medial and inferior rectus muscles, with a central area of hypoenhancement of the medial rect

New England Journal of Medicine