429. Advanced Dementia.
An 89-year-old male nursing home resident with a 10-year history of Alzheimer’s disease presents with a temperature of 38.3°C, a productive cough, and a respiratory rate of 28 breaths per minute. Nurses report that for the past 6 months he has been coughing at breakfast and having trouble swallowing. He has profound memory deficits, no longer recognizes his daughter (who is his health care proxy), is bedbound, is able to mumble a couple of words, and is unable to perform any activities of daily living. The nurse asks whether he should be hospitalized. How should this patient be evaluated and treated?
438. Why Does the Weeping Willow Weep? Reconceptualizing Oncogenesis in Breast Cancer.
Like other human anatomical systems, the mammary ducts and glands at the time of lactation adhere to a perfect fractal geometry - which is destroyed by breast cancer. Could a loss of fractal geometry of the blood supply to human tissue be an early step in oncogenesis?
439. Case Records of the Massachusetts General Hospital. Case 30-2015: A 50-Year-Old Man with Cardiogenic Shock.
作者: Thurman M Wheeler.;Joshua N Baker.;David A Chad.;Jodi L Zilinski.;Stacey Verzosa.;Daniel A Mordes.
来源: N Engl J Med. 2015年373卷13期1251-61页
A 50-year-old man with a history of cardiomyopathy and progressive muscle weakness was admitted with cardiogenic shock. Electroencephalography showed total suppression of cerebral activity; ventilator support was withdrawn, and he died. An autopsy was performed.
440. Images in Clinical Medicine: Oral Manifestation of Crohn's Disease.
A 13-year-old boy presented with a 9-month history of episodic unilateral swelling of the face and oral pain. He reported having loose, nonbloody stools. Granulomatous inflammation consistent with Crohn's disease was found on histopathological examination.
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