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Biomedical subjects

Daniel J Brotman

Publications and source records attributed to Daniel J Brotman.

47 records · Page 3Linked to original sources
PubMed2003

Should patients on warfarin for 3 months for idiopathic proximal deep venous thrombosis receive bridging therapy precolonoscopy (with expected biopsy)?

A 63-year-old woman presents to discuss periprocedure anticoagulation management. She has been on oral warfarin with an international normalized ratio between 2 and 3 for the past 3 months because of an idiopathic left popliteal vein thrombosis. A colonic polyp was identified during her purely diagnostic colonoscopy performed as part of her age- and gender-appropriate cancer screening. Immediate repeat colonoscopy with polypectomy is recommended. The clinician is asked to provide periprocedural anticoagulation recommendations.

Anticoagulants↗
PubMed2003

The metabolic syndrome as a vicious cycle: does obesity beget obesity?

Most attempts at weight loss are frustrated by the body's propensity to maintain fat mass. There are genetic and environmental mechanisms behind this phenomenon, such as thrifty genes, sedentary lifestyle and abundant food resources. We will outline a physiologic mechanism that may perpetuate obesity once it develops. Specifically, we suggest that obesity-induced hyperinsulinemia facilitates fuel storage as fat. This can be exacerbated by high glucocorticoid activity, low growth hormone (GH) activity and the paradoxical increase in free fatty acid (FFA) flux resulting from basal lipolysis in an expanded fat mass. We also outline mechanisms by which obesity may perpetuate low GH and increased glucocorticoid activity in the metabolic syndrome.

Fatty Acids↗
PubMed2003

Spinal metastasis as the initial manifestation of a nonsecretory glucagonoma.

Glucagonomas are rare functional endocrine tumors of the pancreas that classically present with symptoms of glucagon excess, including rash, hyperglycemia, diarrhea, and weight loss. Metastatic disease at presentation is common but is often limited to the liver and regional lymph nodes. We describe an unusual case of a patient with glucagonoma who presented with a pathologic vertebral fracture. This tumor had no evidence of active hormone secretion but tested positive for glucagon by immunohistochemical staining.

Adult↗
PubMed2003

When patients on warfarin need surgery.

When a patient who has been taking warfarin long-term needs to undergo surgery, how to manage his or her anticoagulation is controversial. We believe most patients should stop taking warfarin 5 days before elective surgery, and most do not need to receive heparin in the perioperative period as a bridge to surgery.

Anticoagulants↗
PubMed2003

Rational use of D-dimer measurement to exclude acute venous thromboembolic disease.

Clinical diagnosis of venous thromboembolic (VTE) disease is often inaccurate because signs and symptoms are nonspecific. Testing for the absence of D-dimer levels in the blood of patients with suspected deep venous thrombosis and pulmonary embolism can assist in ruling out these illnesses. Some highly sensitive D-dimer assays have sufficient specificity to assist in the exclusion of VTE disease. Numerous clinical management trials using D-dimer measurement in association with additional diagnostic tests have shown that it is safe to withhold anticoagulant therapy in selected patients with suspected VTE disease who have negative D-dimer assay results. Applying these diagnostic strategies can potentially decrease the need for radiological testing. The simplicity of measuring D-dimer levels creates the potential for misuse. For safe patient management, clinicians must understand the indications for and limitations of D-dimer measurement in the diagnosis of VTE disease.

Antifibrinolytic Agents↗
PubMed2002

The metabolic syndrome: a tug-of-war with no winner.

The metabolic syndrome may be viewed as a state of insulin-counterregulatory overdrive: counterregulatory hormones and fatty acids chronically duel with insulin, causing a cascade of biochemical interactions resulting in insulin resistance, hypertension, and dyslipidemia. Even before beta cells fail and type 2 diabetes ensues, the deadly quartet is quietly rehearsing.

Exercise↗