Table of Contents

April 01, 2019; Volume 86,Issue 4

From the Editor

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Can a humanities background prevent physician burnout?
Brian F. Mandell, MD, PhD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 225-226; DOI: https://doi.org/10.3949/ccjm.86b.04019

Osler urged physicians to study the humanities. Can it prevent professional dissatisfaction and burnout?

Commentary

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Personalizing guideline-driven cancer screening
Gautam Mankaney, MD and Carol A. Burke, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 228-230; DOI: https://doi.org/10.3949/ccjm.86a.19037

Screening can lead to early diagnosis and prevent death from cancer, but the topic provokes controversy.
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The old humanities and the new science at 100: Osler’s enduring message
Salvatore Mangione, MD and Marc J. Kahn, MD, MBA, MACP

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 232-235; DOI: https://doi.org/10.3949/ccjm.86a.19019

One hundred years after his death, what can Osler teach the high-tech physician of today?

The Clinical Picture

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Gastroparesis in a patient with diabetic ketoacidosis
Ahmad Muneer Sharayah, MD, Noor Hajjaj, MD, Ramy Osman, MD and Douglas Livornese, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 238-239; DOI: https://doi.org/10.3949/ccjm.86a.18116

Computed tomography showed new, severe gastric distention. A scan 11 months previously had been normal.

Smart Testing

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Is neuroimaging necessary to evaluate syncope?
Erika Hutt-Centeno, MD, Robert Wilson, DO and Kenneth A. Mayuga, MD, FHRS, FACC, FACP

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 240-242; DOI: https://doi.org/10.3949/ccjm.86a.18016

If the diagnosis is unclear after the history and examination, then electroencephalography during tilt-table testing can help.

1-Minute Consult

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How should I treat acute agitation in pregnancy?
Joshua D. Niforatos, MTS, Jonathon W. Wanta, MD, Anna P. Shapiro, MD, Justin A. Yax, Do, DTMH and Adele C. Viguera, MD, MPH

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 243-247; DOI: https://doi.org/10.3949/ccjm.86a.18041

This is an obstetric emergency. Intervention should progress in a stepwise manner.

Review

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Spontaneous coronary artery dissection: An often unrecognized cause of acute coronary syndrome
Nureddin K. Almaddah, MD, Mohamed S. Morsy, MD, Dwight Dishmon, MD and Rami N. Khouzam, MD, FACC, FACP, FASNC, FASE, FSCAI

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 252-256; DOI: https://doi.org/10.3949/ccjm.86a.18078

SCAD accounts for up to 35% of acute myocardial infarctions in women 50 or younger, and even more in pregnant women.

Symptoms to Diagnosis

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A woman, age 35, with new-onset ascites
William C. Lippert, MD, MPH, Eun Y. Lee, MD and Aibek E. Mirrakhimov, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 257-262; DOI: https://doi.org/10.3949/ccjm.86a.17082

She also has jaundice, hepatomegaly, and multiple abnormal laboratory results. What is the next step?

Review

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Acute kidney injury after hip or knee replacement: Can we lower the risk?
Edward J. Filippone, MD, FASN and Anju Yadav, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 263-276; DOI: https://doi.org/10.3949/ccjm.86a.18044

Various risk factors have been identified, and some are potentially modifiable.
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Unusual effects of common antibiotics
Maria Elena Ruiz, MD and Glenn W. Wortmann, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 277-281; DOI: https://doi.org/10.3949/ccjm.86a.17050

Less recognized but potentially serious adverse effects of commonly prescribed antibiotics.

Departments

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Rapidly progressive pleural effusion January 2019
Scott Davidson, MD

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 236; DOI: https://doi.org/10.3949/ccjm.86c.04001

Readers comment about deviation from guidelines during treatment of a patient with rapidly progressive pleural effusion (January 2019) and the effect of metformin on vitamin B₁₂ levels (January 2019).
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In reply: Rapidly progressive pleural effusion January 2019
Zaid Zoumot, MBSS, Samar Farha, MD and Ali Wahla, MBSS

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 236; DOI: https://doi.org/10.3949/ccjm.86c.04002
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Metformin for type 2 diabetes January 2019
Robert S. Moskowitz, MD, FACP

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 237; DOI: https://doi.org/10.3949/ccjm.86c.04003

Readers comment about deviation from guidelines during treatment of a patient with rapidly progressive pleural effusion (January 2019) and the effect of metformin on vitamin B₁₂ levels (January 2019).
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In reply: Metformin for type 2 diabetes January 2019
Vinni Makin, MBBS, MD, FACE and M. Cecilia Lansang, MD, MPH

Cleveland Clinic Journal of Medicine April 2019, 86 (4) 237; DOI: https://doi.org/10.3949/ccjm.86c.04004