The Washington Manual of Medical Therapeutics– April 2010 Edition

Established for over 40 years as the “bible” of the medical ward. The Washington Manual of Medical Therapeutics is now in its Thirty-Third Edition and builds upon that proud tradition–with even more of the current information you need delivered in a time-saving, quick-reference style. Its portability, comprehensiveness, and ease of access makes it a favorite on-call resource for housestaff and faculty around the world. In this edition, color has been added for better navigation, new decision support algorithms have been added, and an improved templated and bulleted format facilitates a quicker answer. With this edition you now have the capability to upload this content to your handheld device and receive updates to the information throughout the activation period. Plus, you have access to eight medical calculators that include: GFR – Cockcroft-Gault Method (Adult); Urea Reduction % (Hemodialysis); Transtubular Potassium Gradient; Osmolal Gap; Anion Gap; Serum Osmolality; Reticulocyte Index; and Body Mass Index (BMI).



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Retinal Hemangioblastoma in von Hippel–Lindau Disease

An 18-year-old woman presented with a 2-month history of visual loss in the right eye. Visual acuity was 20/100 in the affected eye and 20/20 in the left eye.
Ophthalmoscopy revealed an orange–yellow tumor (Panel A, arrow) with tortuous feeding vessels and optic-disk edema (Panel A, arrowhead), indicating retinal hemangioblastoma. The patient underwent ruthenium plaque radiotherapy, cryotherapy, and photodynamic therapy, which induced complete tumor regression and sclerosis of the dilated vessels (Panel B).

After treatment, the visual acuity improved, to 20/70. A systemic evaluation, including magnetic resonance imaging of the brain, computed tomography of the abdomen, and measurement of urinary vanillylmandelic acid levels, was unremarkable. However, genetic studies revealed a mutation in the von Hippel–Lindau tumor-suppressor gene VHL, confirming von Hippel–Lindau disease.

Visual disturbance caused by exudation or retinal detachment due to retinal hemangioblastoma may be the initial symptom of von Hippel–Lindau disease. Thorough, systemic evaluation is important to detect potential tumors of the central nervous system, adrenal glands, kidneys, and pancreas early enough to permit treatment.

Securing A Chest Tube