Questions discussed in this category
There seems to be little guidance on vitamin replacement in these patients. Vitamin K level < 50 yet PT/INR is normal. Is the vitamin K assay usefu...
Do any special adjustments need to be made for any particular biologic therapies?
Of note, there is ~150 cc small bowel left and no further surgery was offered.
Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...
Would you send a CMV DNA PCR in blood, and if you elect to treat with anti-CMV medication, how long would you treat and what parameters would you use,...
Would you recommend repeat POEM, Heller myotomy, or pneumatic dilation?
How do you practically approach a tailored elimination diet in young patients with numerous food impactions and esophageal strictures who are intermit...
Do you discontinue the use of certain medications that have been associated with microscopic colitis (ie, PPIs, SSRIs)?
Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?
Vasculitis involving aorta, subclavian, common carotid, SMA, IMA, renal artery, and celiac artery.
When do you determine SSRI therapy is unsafe to pursue in such situations?
How do you counsel patients in this scenario?
I have a patient with recently diagnosed primary biliary cholangitis/cirrhosis (PBC) with SSc. Her laboratory values are within normal limits, but end...
Would chemoRT be preferred over surgery if there is LVI or PNI?
Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?
HFE gene mutations in C282Y and H63D are negative.
Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...
Does histology (radioresistant or radiosensitive) play into this decision?
Would portal hypertensive gastropathy or colopathy sway you away from using it?
And if delayed, should chemotherapy be started?
Since the COVID-19 pandemic, increasingly we see management of acute cholecystitis with cholecystostomy tubes as opposed to surgery, even amongst pati...
IgG4 manifestations include autoimmune pancreatitis and periaortic soft tissue mass.
From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated.
What is the role of SBRT versus microwave ablat...
How has this impacted your counseling and management?
Would you start with a baseline ultrasound and then pursue further workup such as fibroscan if fatty liver is present, or other?
For example, in patients who are HbSAg negative, anti-HBc positive and HbSAb negative, does vaccination reduce reactivation risk?
Or offer resection followed by adjuvant therapy?
The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...
Is liquid biopsy helpful? Would you treat if this shows somatic mutation?
Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...
How do you approach de-escalation or justify therapy maintenance? Do you have tiers of medications that you attempt to de-escalate first? In one parti...
A female in her 50s with iatrogenic Cushing's Syndrome presenting for management of SLE with low disease activity (but not remission) in the setting o...
(Patient with active RA despite hydroxychloroquine)
Would the etiology of the thrombocytosis play a role in your decision-making?
Should they be placed on routine EGD surveillance and if yes at what intervals?
Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?
When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?
How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA?
When do you in...
If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?
Have you noted significant diarrhea until the ileostomy is reversed?
Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?
Is there a specific brand or formulation you prefer?
The literature supporting the use of probiotics does not standardize the type or dose of probiot...
The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....
If so, what agent(s) do you prefer?
Would you offer liver transplant in the setting of metastatic disease?
The case I am considering involves a patient with biopsy-proven fibrosing dacryoadenitis.
Would you offer low dose or standard dose aspirin instead?
If so, how would positive levels guide your management?
Would you try atezolizumab/bevacizumab or switch to a TKI?
Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?
For example in a patient with a history of PE?
i.e. EGD surveillance for varices?
ex. VEGFR2 expression, inflammatory signature, PDL1, etc.
Do you continue atezolizumab alone? Would you avoid anticoagulation?
In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?
Do you screen even asymptomatic patients?
In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...
This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet
Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT? What if the size is >5 cm?
Would your recommendations change if you were treating a GI primary (e.g. rectal or anal cancer) vs non-GI primary?
If so, for what platelet count threshold and do you have a preference as to which agent?
Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...
Do you have any preferred dose fractionation schedules? What kind of margins do you use?
Arterial events have clear instructions to permanently discontinue on the FDA label. Especially in HCC without many other treatment options, giv...
Would you ever considering re-starting immunotherapy before completing the taper?
According to the new guildelines on managing immunotherapy related ...
Are there any indications to choose one over the other?
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Papers discussed in this category
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J. Hepatol., 2016-05-01
Eur. J. Cancer, 2011-09-01
Lancet Oncol., 2015-10-01
Practical radiation oncology, 2015
Radiother Oncol, 2014 Jun
J Clin Oncol, 2013 May 1
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-10
Practical radiation oncology, 2015
Journal of the National Cancer Institute, 2017-09-01
J Gastrointest Cancer,
BMC Palliat Care, 2015 Aug 04
Lancet (London, England), 2018-03-24
J. Hepatol., 2019 Apr 06
Gastroenterology, 2018 May 17
Clin. Gastroenterol. Hepatol., 2018 Nov 28
Hepatology (Baltimore, Md.), 2019-10
Clin. Cancer Res., 2015 Oct 23
Invest New Drugs, 2015 Apr 12
J Hepatol, 2021 May 26
N Engl J Med, 2020 May 14
NEJM Evidence, 2022 June 6
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-04-10
Cancer, 2019-09-15
Journal of psoriasis and psoriatic arthritis, 2019-04
Arthritis Rheumatol, 2016 Jan
Liver Cancer, 2019 Sep 18
Arthritis care & research, 2017-03
Clin Exp Dermatol, 2018 May 24
Oncotarget,
Blood, 2020 Sep 10
Blood Adv,
The New England journal of medicine, 2018-07-05
J Gastroenterol, 2019 Nov 12
Am Heart J, 2010 Sep 18
N Engl J Med,
Lancet (London, England), 2017-01-07
The Lancet. Oncology, 2019-02
JAMA Oncol, 2020 Dec 10
Hepatology, 2019 Oct 14
Lancet,
Gut, 1999-04
Gut, 2012-12
Annals of the rheumatic diseases, 2019-04
Ann Rheum Dis, 2014 Mar 21
Am J Transplant, 2016 Jun 09
Transplantation, 2021 Apr 27
Surgery, 2017 Jun 16
J Pharm Pract, 2019 Mar 27
Arthritis and rheumatism, 1992-08
Arthritis and rheumatism, 1995-12
Seminars in respiratory and critical care medicine, 2002-12
Clinics in liver disease, 2019-05
Eur J Gastroenterol Hepatol,
Neth J Med,
Semin Respir Crit Care Med, 2020 Aug 10
Seminars in arthritis and rheumatism, 2016-02
Bull Soc Ophtalmol Fr,
Am J Hum Genet, 2021 Jan 7
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-08-20
Annals of the rheumatic diseases, 2015-06
Neth J Med,
Medicine (Baltimore),
Am J Clin Nutr, 2017 Jul 05
Autoimmun Rev, 2012 Nov 30
Proc (Bayl Univ Med Cent), 2020 Jan 30
Medizinische Klinik (Munich, Germany : 1983), 2002-11-15
Journal for scientific research. Medical sciences, 2001 Apr
Gut, 2006 May 18
Arthritis & rheumatology (Hoboken, N.J.), 2017-10
Arthritis Rheumatol, 2020 Apr 01
Ann Rheum Dis, 2022 Jul 07
Lancet Gastroenterol Hepatol, 2023 Feb 01
Dig Liver Dis, 2022 Aug 16
BMC endocrine disorders, 2024 Nov 18
International urology and nephrology, 2024 Nov 04
Cancers, 2024 Sep 22
Clinics (Sao Paulo, Brazil), 2018 Dec 10
Metabolites, 2020 Jul 11
Protein & cell, 2014 Jul 12
Trends in biochemical sciences, 2016 Jan 05
Journal of clinical medicine, 2020 Dec 23
Blood, 2014 Oct 15
Int J Radiat Oncol Biol Phys, 2019 Oct 1
Frontiers in oncology, 2020 Mar 24
International journal of radiation oncology, biology, physics, 2023 Apr 08
Cancer, 2023 Jul 28
Gastrointestinal endoscopy, 2012-01
Gastrointestinal endoscopy, 2012 Feb
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-03-10
N Engl J Med,
Nat Med, 2020 Apr 06
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Jan 09
American journal of clinical oncology, 2023 Dec 22
Cancer, 2023 Jul 06
The Lancet. Oncology, 2023 Dec 08
Cardiovascular and interventional radiology, 2023 Jul 10
Therapeutic drug monitoring, 2022 Jun 01
The Journal of allergy and clinical immunology, 2012-02
Gut, 2023 Jul 09
The New England journal of medicine, 2024 Jun 27
Pharmacological research, 2016 Aug 10
The Annals of pharmacotherapy, 2018 Aug 06
Am J Gastroenterol,
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 2016 Nov
Journal of hepatology, 2022 Jun 01
Gastrointestinal endoscopy, 2011-06
Gastrointestinal endoscopy, 2023 Nov 10
Anticancer research, 2021 Apr
The Journal of infection, 2011-11
Alimentary pharmacology & therapeutics, 2006 Nov 15
Journal of tropical medicine, 2017 Feb 26
The New England journal of medicine, 2021 Mar 04
Inflammatory bowel diseases, 2014 Dec
Inflammatory bowel diseases, 2024 Nov 04
The American journal of gastroenterology, 2023 Dec 22
Gut, 2019 Dec 20
Cancer, 2010-04-15
Clinical and translational radiation oncology, 2019 Jan 11
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2019 Jun 05
Nutrients, 2016 Jan 02