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Colorectal cancer (CRC) continues to be one of the most commonly diagnosed cancers and contributes significantly to many cancer-related deaths despite sustained progress in diagnostic and treatment options. Many forms of CRC can be prevented through early and routine screening, when precancerous lesions may be detected and removed before they undergo malignant transformation or metastasis. Despite widespread efforts to improve CRC screening rates, at least 40% of age-eligible adults do not adhere to screening guidelines. A new generation of noninvasive, molecular-based diagnostic tests with high sensitivities and specificities has the potential to improve screening rates through optimal risk stratification of patients who may benefit from more invasive screening techniques. This review presents various guidelines and methods that are currently available for CRC screening, summarizes the rationale behind utilization of novel molecular-based diagnostic tests for CRC screening and prevention, and discusses appropriate screening techniques and intervals in populations of varying risk.

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are widely used laboratory markers of systemic inflammation.A thorough understanding of the similarities and differences between these two serological markers, including factors that affect measurements, is necessary for the proper utilization and interpretation of ESR and CRP.This review summarizes the current published literature (searched on MEDLINE through February 2016) surrounding the history and utilization of ESR and CRP, and examines factors that affect ESR and CRP measurements and discordance amongst these two inflammatory markers.As ESR and CRP lack sensitivity or specificity, these tests should be used only in combination with clinical history and physical exam for diagnosis and monitoring of pathological conditions. The clinical application of these tests in diagnosis is best applied to conditions in which there is high or low clinical probability of disease. Importantly, discrepancies between ESR and CRP measurements commonly have been reported in both inpatient and outpatient settings and this problem may be particularly prevalent in chronic inflammatory diseases. Numerous physiological factors, including noninfectious conditions and resolution of inflammation can contribute to abnormally high ESR/low CRP readings or vice versa.Although discordance may be encountered in certain settings, proper utilization of ESR and CRP measurements continues to play an important role in clinical management of many inflammatory and other conditions.

Ecchymosis is a large area of discoloration caused by extravasation of blood into the subcutaneous tissue. It is an objective physical finding that may provide valuable clues as to its possible etiology. Ecchymosis is associated with eponyms based on the physician who first described the physical findings, which can be divided into 4 anatomical categories: base of the skull, abdominal wall and retroperitoneum, groin and scrotum, and lower extremity. Classic external signs and eponyms associated with ecchymosis are reviewed. Knowledge of these signs on physical examination may prove to be a useful clue directing the examiner to consider potentially serious causes of disease.

Despite vast literature on warfarin, optimal strategies for temporarily discontinuing and restarting warfarin have not been established. To improve warfarin discontinuation processes, we investigated known medical and genetic factors that influence stable warfarin dose to determine how well they predict the time until patients become subtherapeutic after discontinuing warfarin.This was a retrospective cohort study of patients who temporarily discontinued warfarin before an elective procedure andhad at least 2 international normalized ratio (INR) values available during the discontinuation period. Data abstracted included date of discontinuation, warfarin dose, INR values, body surface area, gender, age, indication for warfarin, current medications, eGFR, and presence of bridging therapy with heparin. DNA variants were tested in CYP2C9, VKORC1, and CYP4F2 genes. Subjects were excluded if they received vitamin K, fresh frozen plasma, or prothrombin complexes to reverse anticoagulation. Asymptotic regression models were used to approximate decline in INR during warfarin clearance. Spearman correlations and Kruskal-Wallis tests were used to characterize associations of model estimates with quantitative variables and for group comparisons, respectively.Other than the expected association with baseline INR, correlations of model parameter estimates with clinical variables were generally weak and not statistically significant. The strongest associations with slope were with serum creatinine and eGFR. There were no significant associations with CYP2C9, VKORC1, or CYP4F2 DNA variants, but there were few subjects combined in the nonwild groups for CYP2C9. Estimated slope showed moderate correlation with observed dose.Known clinical and genetic predictors of therapeutic dose were not found to be strongly associated with the slope of INR decline after warfarin discontinuation.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the human nervous system caused by the JC virus. We report what is, to the best of our knowledge, the second reported case using a combination of mefloquine and mirtazapine in a patient with non-AIDS-related PML with a good clinical outcome. Conversely, the recent trial of mefloquine in 21 patients with AIDS and 3 without AIDS failed to show a reduction of JC viral DNA levels in the cerebral spinal fluid. However, the positive clinical response seen in our patient after the initiation of this combination therapy suggests that further studies in the form of randomized controlled trials for the treatment of non-AIDS-related PML are warranted.

Increased blood glucose is associated with adverse clinical outcomes among patients with major illnesses. This study examined the association between blood glucose and adverse outcomes among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, for which limited prior data were available.We studied a cohort of 209 hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. Univariate analyses and multivariate logistic regression analyses with backward elimination method were performed to evaluate factors associated with in-hospital complications, length of hospitalization, 30-day hospital readmission, and 90-day all-cause mortality.Multivariate logistic regression analysis with backward elimination method revealed that lower blood glucose and age at hospital admission were the most significant risk factors for in-hospital complication. Received respiratory support and in-hospital complications were the most significant risk factors for the length of hospitalization. There were no significant risk factors associated with 30-day hospital readmission and 90-day all-cause mortality.The analyses failed to reveal significant associations between higher blood glucose levels and adverse outcomes. We showed that lower glucose levels (hypoglycemia) results in higher risk for in-hospital complications. In-hospital complications results in longer length of hospitalization, which implies that lower glucose levels (hypoglycemia) indirectly may result in longer length of hospitalization. More studies are needed to better clarify the cause for these associations.

We report the case of a patient with rhabdomyolysis-induced acute renal failure occurring in the setting of Anoplasma phagocytophilum infection based on the presence of morulae in neutrophils and concomitant statin use. Although the pathogenesis is unknown, we believe the combination of concurrent statin use in the setting of the infection promoted this complication. We describe proposed mechanisms including cytokine activation, alteration of the muscle membrane components, and ionic balance as contributing factors.

Community-acquired pneumonia (CAP) is a common medical condition resulting in excess morbidity, mortality, and high rates of hospitalization. Despite high hospitalization rates for CAP, the relationship between abnormal glucose levels (hyperglycemia and hypoglycemia) and the seriousness of the illness as measured by length of stay (LOS) is not well established. We examined relationships of CAP to multiple factors that impact predictability and severity of the disease process. They include glycemic control; hospital utilization, including LOS; 30-day hospital readmission; intensive care unit (ICU) admissions, adjusting for comorbidities; illness severity; and timing of antibiotic treatment.We conducted a retrospective observational cohort study of adult patients hospitalized for CAP between January 1, 1992 and June 23, 2007. Case screening was conducted electronically using International Classification of Diseases, 9th Revision (ICD-9) codes 480.0-487.9. Subsequent medical record abstraction yielded 969 qualifying cases with comprehensive data on past and current medical problems.Serum glucose levels at admission were independently associated with LOS for CAP patients. Patients with levels between 90 mg/dL and 140 mg/dL on admission had shorter LOS compared to those with levels of90 mg/dL and140 mg/dL (median 3.9 vs 4.2 days, P = .04). Multivariate analyses confirmed the univariate results. Serum glucose levels at initial hospitalization were not associated with 30-day hospital readmission (P =.34) or ICU admission (P = .48).Abnormal glucose levels are an independent predictor of increased LOS for CAP. Control of blood glucose may lead to improved outcomes, including shortened LOS, and should be a priority in CAP management.

In response to the goals of the Wisconsin Partnership Program and the National Institutes of Health (NIH) Initiatives to Improve Healthcare, the Wisconsin Network for Health Research (WiNHR) was formed. As a collaborative, multi-disciplinary statewide research network, WiNHR encourages and fosters the discovery and application of scientific knowledge for researchers and practitioners throughout Wisconsin. The 4 founding institutions--Aurora Health Care/Center for Urban Population Health (CUPH), Gundersen Lutheran Medical Foundation, Marshfield Clinic Research Foundation, and the University of Wisconsin-Madison--representing geographically diverse areas of the state, are optimistic and committed to WiNHR's success. This optimism is based on the relevance of its goals to public health, the quality of statewide health care research, and, most importantly, the residents of Wisconsin who recognize the value of health research.

This manuscript represents a brief review of the current oral anticoagulants that have come on the scene over the past decade and that are now in various stages of development through the process of phase II and III clinical trials. A brief review of the oral thrombin and direct factor Xa inhibitors is presented to apprise the practicing clinician of the status of these new agents. Efficacy and safety issues are mentioned as they relate to each agent and the need for alternative agents to replace the vitamin K antagonists for long-term anticoagulation therapy. Although none of the agents discussed in the review have been approved for clinical use, data accumulated thus far from the clinical studies have provided some degree of encouragement and optimism for their future approval.

We present a case of non-cirrhotic extrahepatic portal hypertension in a 31-year-old woman following extensive abdominal laparotomy for the drainage of multiple retroperitoneal and liver abscesses following a perforated appendix. Chronic portal, splenic, and mesenteric vein thrombosis with portal hypertension was caused by a hypercoagulable state due to the abdominal infection and abdominal surgery. Various etiological aspects of chronic extraheptic venous thrombosis have not been documented due to the low incidence of these events. We discuss these aspects in the context of our patient.

Anorexia nervosa is a common problem in young adults that may present with a variety of metabolic and hematologic abnormalities, as well as weight loss and psychological disturbances. We present a young man with a long history of anorexia nervosa who developed pancytopenia associated with decreased bone marrow cellularity and abnormal architecture and marrow infiltration with an amorphous, gelatinous substance characteristic of anorexia nervosa. The patient also developed osteopenia with evidence of excessive calcium excretion. The pancytopenia and marrow function reverted to normal with therapeutic and dietary intervention. The effects of eating disorders can result in serious consequences with respect to an individual's health and well-being. A host of hematologic abnormalities that are associated with anorexia nervosa have the potential of increasing the risk of infection and bleeding. Additionally, because of the insidious development of anemia in some patients, decreased performance status and chronic fatigue can pose significant compromises in one's daily activities and work effort. Anorexia nervosa is a chronic illness that is distinctly more common in females than in males (ratio of 10 to 1), but can affect males in an equally debilitating manner, requiring multiple modalities of therapeutic intervention and consultation. We present the case of a male referred to the hematology department because of pancytopenia, chronic fatigue, and back pain. A diagnosis of anorexia nervosa had been made 10 years prior at the age of 18 years.