Tumor Melt

Tumor Melt: Primary Effusion Lymphoma of the Heart

A 45-year-old African-American man with a history of acquired immunodeficiency syndrome presented with exertional syncope. Other pertinent symptoms included progressive dyspnea, lower-extremity edema, poor appetite, fevers, and 60-lb weight loss. The outpatient medication regimen included tenofovir/emtricitabine, ritonavir, and atazanavir with a CD4 count of 173 and a human immunodeficiency RNA viral load of 32,783. He had a history of a right thigh Kaposi sarcoma diagnosed in 2007 but no opportunistic infections. Examination revealed fever, hypotension, tachycardia, a soft diastolic murmur, and signs of right-sided heart failure. Laboratory findings included pancytopenia and marked hypoalbuminemia (albumin 1.0, pre-albumin 5.5).

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--Peter Kriekard, MD, Joel A. Garcia, MD, Loes Nardi-Korver, MD, Mori J. Krantz, MD, FACC, FACP

--This article originally appeared in the September 2012 issue of The American Journal of Medicine.

The Heart of the Matter

In this case, a man with multiple cardiac symptoms suffers cardiac arrest during his medical evaluation, is revived, and is then treated for a very unusual tumor.

The patient was a 46-year-old, previously healthy man who presented with complaints of shortness of breath and chest heaviness. Further inquiry revealed generalized fatigue and numerous episodes of profuse sweating over the preceding 2 months. A review of systems was otherwise negative.

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 --Evan L. Hardegree, MD, Sandeep M. Patel, MD, Joseph J. Maleszewski, MD, Rick A. Nishimura, MD, Diana S. Dean, MD

 --This article originally appeared in the September 2012 issue of The American Journal of Medicine.

Incentivizing $ Adherence

Financial Reinforcers for Improving Medication Adherence: Findings from a Meta-analysis

Increasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications.

Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined.

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--Nancy M. Petry, PhD, Carla J. Rash, PhD, Shannon Byrne, PhD, Shehryar Ashraf, MD, William B. White, MD

--This article originally appeared in the September 2012 issue of The American Journal of Medicine

Enhancing Medical Adherence

Adherence to a medical regimen is defined as the extent to which a patient takes a prescribed medication. The term “adherence” is often used interchangeably with “compliance,” but adherence is currently the preferred term because it implies a responsibility that is shared by both the patient and the healthcare provider.

Many barriers to appropriate medication adherence have been described in the past, including problems when treating asymptomatic conditions such as hypertension and hyperlipidemia, the cost of medication, the side effects of medications, and the complexity of medication dosing regimens. Other issues that could affect adherence to drug therapy are summarized in Table 1.

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--William H. Frishman, MD

--This article originally appeared in the September 2012 issue of The American Journal of Medicine