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Gutknecht DR. ACP Journal Club. 13-year renal outcomes varied in patients with type 1 diabetes and new-onset microalbuminuria. Ann Intern Med 2011; 155:JC1-13. [PMID: 21768579 DOI: 10.7326/0003-4819-155-2-201107190-02013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gutknecht DR. ACP Journal Club. Review: Vibration testing and monofilament testing are most accurate for diagnosing large-fiber peripheral neuropathy in diabetes. Ann Intern Med 2010; 153:JC4-10. [PMID: 20956694 DOI: 10.7326/0003-4819-153-8-201010190-02010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gutknecht DR. Higher values of fasting plasma glucose within the normal range were associated with increased risk of type 2 diabetes. Evid Based Med 2008; 13:186. [PMID: 19043044 DOI: 10.1136/ebm.13.6.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gutknecht DR. Review: Ultra-short screening tests are not highly accurate for detecting depression in primary care. Evid Based Med 2007; 12:120. [PMID: 17885168 DOI: 10.1136/ebm.12.4.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Affiliation(s)
- Juan C Salgado
- Geisinger Medical Center, Department of General Internal Medicine, Danville, Pennsylvania 17822, USA
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Gutknecht DR. Candesartan prevented development of diabetes mellitus in heart failure. ACP J Club 2006; 144:11. [PMID: 16388561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Abstract
Intramuscular lipomas of the extremities are most often found in the thighs and shoulders. They are usually painless, but described herein is a case of extreme leg pain that was relieved when a lipoma in the thigh was identified and surgically resected.
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Affiliation(s)
- David R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822-1401, USA.
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Singh G, Dhawan R, Potteiger CE, Bedi A, Modesto TA, Gutknecht DR. Acute renal infarction secondary to left ventricular thrombus, masquerading as a renal calculus--a case report and brief review of literature. Angiology 2001; 52:717-20. [PMID: 11666137 DOI: 10.1177/000331970105201009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute embolic renal infarction is an entity that is often misdiagnosed as a renal calculus because of similar presenting symptoms. This leads to delay in the initiation of treatment and to increased morbidity. Few case reports exist relating cardiac emboli to acute renal infarction. The authors present a patient with a renal embolism secondary to left ventricular thrombus. A brief review of the literature highlighting the importance of clinical suspicion in making an accurate diagnosis, the utility of various diagnostic studies, and comparison of various treatment options is presented.
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Affiliation(s)
- G Singh
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA, USA
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Gutknecht DR. Evidence-based advertising? A survey of four major journals. J Am Board Fam Pract 2001; 14:197-200. [PMID: 11355052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Pharmaceutical advertisements are an important means of bringing drug information to physicians. Most advertisements are intended only to raise awareness, though there are those that do seek to persuade through presentation of research findings. Researchers have questioned the quality of the research reported in advertisements and wonder whether these advertisements would lead to improper prescribing. METHODS A consecutive 6-month sample of advertisements in 4 general medical journals, 3 from the United States and 1 from Canada, were reviewed to determine how research results are presented in pharmaceutical advertisements. RESULTS During this time there were 187 distinctive advertisements, with 43 data presentations in the 33 advertisements that contained quantitative research results. These results were examined using a critical appraisal worksheet. References to randomization and blinding were found in less than one half of the 43 data presentations. P values were frequently provided, but confidence intervals and references to power and number needed to treat were not provided in any of the advertisements. CONCLUSIONS Descriptions of research in pharmaceutical advertisements were brief and incomplete, and they inconsistently provided the basic design and statistical information needed to judge the results reported. More detail could make these advertisements more meaningful to critical readers.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA
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Gutknecht DR. Of pills and pillows: pseudopigmentation in a patient taking amiodarone. Cutis 2000; 66:294. [PMID: 11109154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Blue discoloration of the skin can alarm patients and physicians alike. Blue coloring may, however, have a trivial and easily correctable cause, as is shown in the following case.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822-1401, USA
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Gutknecht DR. Reimbursement for evaluation and management services. N Engl J Med 1999; 341:1621-2. [PMID: 10577128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
We report the case of a 69-yr-old patient with inoperable cancer of the lung who later developed acute cholecystitis-related to metastasis to the gallbladder wall. Secondary malignancies of the gallbladder are discussed.
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Affiliation(s)
- D R Gutknecht
- Section of General Internal Medicine, Penn State Geisinger, Geisinger Medical Center, Danville 17822, USA
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA
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Abstract
Leg pain may be a presenting symptom of intra-abdominal disease. I report a case of subcutaneous emphysema of the thigh that was a complication of diverticular perforation and abscess formation. Healthy leg muscle was found at operation, showing that myonecrosis need not necessarily be present even with finding of extensive gas accumulation.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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Gutknecht DR, Koster CH, Tertoolen LG, de Laat SW, Durston AJ. Intracellular acidification of gastrula ectoderm is important for posterior axial development in Xenopus. Development 1995; 121:1911-25. [PMID: 7601004 DOI: 10.1242/dev.121.6.1911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is evidence suggesting that pHi elevation can induce differentiation to cement gland, an extremely anterior structure, during the early development of Xenopus laevis (Picard, J. J. (1975) J. Embryol. exp. Morphol. 33, 957–967; Sive, H. L., Hattori, K. and Weintraub, H. (1989) Cell 58, 171–180). We wanted to investigate whether axial development or neural induction are mediated in Xenopus via regulation of pHi. Our interest was stimulated further because certain signal transduction pathways, which are thought to mediate anterior neural induction (Otte, A. P., Van Run, P., Heideveld, M., Van Driel, R. and Durston, A. J. (1989) Cell 58, 641–648; Durston and Otte (1991), Cell-Cell Interactions in Early Development, pp. 109–127), are also known to modify the activity of proton extruders (Mitsuka and Berk (1991) Am. J. Physiol. 260, C562-C569; Wakabayashi, S., Sardet, C., Fafournoux, P., Counillon, L., Meloche, S., Pages, G. and Pouyssegur, J. (1993) Rev. Physiol. Biochem. Pharmacol. Vol. 119, pp. 157–186). We therefore measured pHi in explants of gastrula ectoderm and neurectoderm and identified ion exchangers that regulate pHi in these tissues. The measurements showed that pHi decreases in explants of both neurectoderm and uninduced ectoderm during the time course of gastrulation, this pHi decrease thus fails to correlate with neural induction. One important regulator of this cytoplasmic acidification is the Na+/H+ exchanger. The pHi set point, at which the acid extrusion activity of this alkalizing exchanger is shut off, shifts to more acidic values during the time course of gastrulation, thus permitting cytoplasmic acidification. We found also that preventing cytoplasmic acidification and thereby elevating pHi in late gastrula cells led to the specific suppression of posterior development. Neural induction and anterior development were unaffected by treatments leading either to an elevation of or a decrease in pHi. These findings indicate that the cellular processes mediating anterior development and neural induction are pHi tolerant, while the signals mediating posterior development require a sustained pHi decrease for their action, suggesting that downregulation of pHi is necessary for posterior axial development.
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Affiliation(s)
- D R Gutknecht
- Hubrecht Laboratorium, Netherlands Institute of Developmental Biology, Utrecht
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Abstract
Diagnosis and treatment of apparent deep venous thrombosis in a patient with spinal cord injury can be difficult. Heterotopic ossification in the paralyzed limbs of such patients can mimic deep venous thrombosis and can even produce false-positive findings on venograms. Anticoagulation, in turn, can be associated with soft tissue hemorrhage that may resemble thrombophlebitis and further confound interpretation of venograms. We have presented a case in which all these phenomena were present and in which a remaining risk of embolism was successfully managed through placement of a Greenfield filter.
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822
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Gutknecht DR. History and diagnosis. West J Med 1992; 157:87. [PMID: 1413761 PMCID: PMC1021925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gutknecht DR. Reorganizing the database: prevention through risk identification. Arch Intern Med 1991; 151:1454, 1458. [PMID: 2064501 DOI: 10.1001/archinte.151.7.1454b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- D R Gutknecht
- Department of General Internal Medicine, Geisinger Medical Center, Danville, PA 17822
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Goldfinger TM, Gutknecht DR. Coccidioidal meningitis in rural Pennsylvania. N Y State J Med 1983; 83:92-4. [PMID: 6572304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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