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Catheter-Directed Low-Dose Alteplase In The Management Of Pulmonary Embolism (pe) Resulting In Fatal Intracranial Hemorrhage (ich): A Case Report [Meeting Abstract]

Mendelson, JS; Lewis, T; Papadopoulos, J; Schwartz, DR
ISI:000390749603330
ISSN: 1535-4970
CID: 2414702

Refractory Toxic Shock-Like Syndrome from Streptococcus dysgalactiae ssp. equisimilis and Intravenous Immunoglobulin as Salvage Therapy: A Case Series

Islam, Marjan; Karter, Dennis; Altshuler, Jerry; Altshuler, Diana; Schwartz, David; Torregrossa, Gianluca
Infections from Streptococcus dysgalactiae ssp. equisimilis (SDSE) can cause a wide variety of infections, ranging from mild cellulitis to invasive disease, such as endocarditis and streptococcal toxic shock-like syndrome (TSLS). Despite prompt and appropriate antibiotics, mortality rates associated with shock have remained exceedingly high, prompting the need for adjunctive therapy. IVIG has been proposed as a possible adjunct, given its ability to neutralize a wide variety of superantigens and modulate a dysregulated inflammatory response. We present the first reported cases of successful IVIG therapy for reversing shock in the treatment of SDSE TSLS.
PMCID:5002456
PMID: 27597908
ISSN: 2090-6625
CID: 2238042

Apical ballooning and cardiomyopathy in a melanoma patient treated with ipilimumab: a case of takotsubo-like syndrome

Geisler, Benjamin P; Raad, Roy A; Esaian, Diana; Sharon, Elad; Schwartz, David R
Although animal studies have shown that the immunomodulator ipilimumab causes inflammation of the myocardium, clinically significant myocarditis has been observed only infrequently. We report a case of suspected acute coronary syndrome without a culprit lesion on cardiac angiography and takotsubo cardiomyopathy (TC)-like appearance on echocardiography in a patient with metastatic melanoma who received four standard doses of ipilimumab. Apical ballooning, hyperdynamic basal wall motion, systolic anterior motion of the mitral valve, and associated severe left ventricular outflow tract obstruction were present. Restaging with positron emission tomography-computed tomography done soon after discharge incidentally revealed increased fludeoxyglucose uptake in the apex. This case illustrates that a TC-like syndrome might be caused by autoimmune myocarditis after ipilimumab treatment although this was not biopsy-confirmed. Post-marketing surveillance should capture cardiac events occurring in patients treated with ipilimumab to better document and clarify a relationship to the drug, and biopsies should be considered. Physicians utilizing this novel agent should be aware of the potential for immune-related adverse events.
PMCID:4335413
PMID: 25705383
ISSN: 2051-1426
CID: 1474732

Iatrogenic Manganism: Acute Manganese Toxicity With Involvement Of The Globus Pallidus [Meeting Abstract]

Murthy, V; Mahmoudi, M; Basavaraj, A; Mendelson, J; Weisstuch, J; Schwartz, DR
ISI:000377582808453
ISSN: 1535-4970
CID: 2161902

Local anesthetics

Chapter by: Schwartz, David R; Kaufman, Brian
in: Goldfrank's toxicologic emergencies by Hoffman, Robert S; Howland, Mary Ann; Lewin, Neal A; Nelson, Lewis; Goldfrank, Lewis R; Flomenbaum, Neal [Eds]
New York : McGraw-Hill Education, [2015]
pp. ?-?
ISBN: 0071801847
CID: 2505952

Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock

Li, Albert S; Berger, Kenneth I; Schwartz, David R; Slater, William R; Goldfarb, David S
BACKGROUND: In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility. METHODS: An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists-a cardiologist, a pulmonologist, and a nephrologist-jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient's presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise. RESULTS: Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy. CONCLUSIONS: Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students' minds.
PMCID:3991870
PMID: 24725336
ISSN: 1472-6920
CID: 917892

A 25-year-old man with fulminant hepatic failure after treatment with corticosteroids

Denson, Joshua L; Maller, Abigail; Beckwith, Christine A; Schwartz, David R
PMID: 24189865
ISSN: 0012-3692
CID: 687762

Drug-induced Agranulocytosis

Chapter by: Schwartz, David; Esaian, Diana; Papadopoulos, John
in: Drug-induced complications in the critically ill patient : a guide for recognition and treatment by Papadopoulos, John [Eds]
Mount Prospect, IL : Society of Critical Care Medicine, 2012
pp. ?-?
ISBN: 0936145811
CID: 1507082

Electroconvulsive Therapy for Severe Refractory Neuroleptic Malignant Syndrome [Meeting Abstract]

Livshits, Z.; Larocque, A.; Schwartz, D. R.; Papadopoulos, J.; Ying, P.; Nelson, L. S.; Hoffman, R. S.
ISI:000289628600058
ISSN: 1556-3650
CID: 131936

Adverse drug reactions resulting in hyperthermia in the intensive care unit

McAllen, Karen J; Schwartz, David R
Hyperthermia is frequently seen in the intensive care setting and is associated with significant morbidity and mortality. It is often initially misdiagnosed as fever associated with infection. Atypical presentations of classic syndromes are common. Clinical suspicion is the key to diagnosis. Adverse drug reactions are a frequent culprit. Syndromes include adrenergic 'fever,' anticholinergic 'fever,' antidopaminergic 'fever,' serotonin syndrome, malignant hyperthermia, uncoupling of oxidative phosphorylation, and withdrawal from baclofen. This review describes the pathophysiology of hyperthermia, as distinct from fever, and the physiology, diagnosis, and treatment of serotonin syndrome, neuroleptic malignant syndrome, malignant hyperthermia, and baclofen withdrawal. Much of the available evidence regarding the treatment of these disorders is based on single case reports, case series, or animal models. Therapeutic modalities consist of identification/withdrawal of possible offending agent(s), support directed at lowering temperature and preventing/treating complications, as well as targeted pharmacologic therapy directed at the specific cause. Early recognition and treatment using a multidisciplinary approach are essential to achieve the best possible outcome
PMID: 20502177
ISSN: 1530-0293
CID: 140044