Textbook Of Internal Medicine Research Articles

Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review.

Current non-surgical treatment for peripheral entrapment neuropathy is considered insignificant and unsustainable; thus, it is essential to find an alternative novel treatment. The technique of perineural injection therapy using 5% dextrose water has been progressively used to treat many peripheral entrapment neuropathies and has been proven to have outstanding effects in a few high-quality studies. Currently, the twentieth edition of Harrison’s Principles of Internal Medicine textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome (CTS). Hence, this novel approach has become the mainstream method for treating CTS, and other studies have revealed its clinical benefit for other peripheral entrapment neuropathies. In this narrative review, we aimed to provide an insight into this treatment method and summarize the current studies on cases of peripheral entrapment neuropathy treated by this method.

Racial disparities in skin tone representation of dermatomyositis rashes: a systematic review.

This systemic review assesses skin tone representation in images of DM rashes in medical education literature. A review was performed of 59 dermatology, 11 neurology, 10 neuromuscular, 7 rheumatology and 6 internal medicine textbooks published between 2011 and 2021 and 3 online image databases (UpToDate, VisualDx and DermNet NZ) that were available through an online medical school library. After extracting images, images with poor lighting or unclear rashes were removed. Authors graded skin tone independently on the Massey and Martin Skin Colour Scale (MMSCS) from 1 (very light) to 10 (very dark). The median score was taken for a final score, grouped within MMSCS 1-2, 3-4, 5-7 or 8-10. Inter-rater reliability was assessed using Kendall's coefficient of concordance (W). Six hundred and twenty-one images were extracted after reviewing 93 textbooks and 3 online databases. Of the 561 images analysed, 73.1% of images represented MMSCS 1-2, followed by 3-4 (13.4%), 5-7 (11.8%) and 8-10 (1.8%). Inter-rater reliability was high (W = 0.835). Of the images in MMSCS 5-10, 59.2% were in online databases and 80.6% of textbook images were in dermatology books. Patients with lighter skin tones were represented in a higher number of DM-related educational materials compared with patients with darker skin tones. Our findings add to current research implicating that darker skin tones are under-represented in cutaneous educational materials, specifically for DM. This leads to the inability to properly characterize skin involvement in DM and may lead to inappropriate exclusion from clinical trials due to erroneous skin scoring.

Ceguera de género en los libros de texto de medicina. El caso de las leucemias

ObjectiveTo analyse the existence of sex-differences in the content on leukemias in the Haematology and Internal Medicine textbooks recommended in the Medical Degrees, 2019–2020, by comparison with the sex-differences recognized in the scientific literature. MethodManifest content analysis of the content of chapters on leukemias in the books on hematology and internal medicine, clinical haematology and haematology undergraduate. Analysis categories: epidemiology, etiopathogenesis, diagnosis, treatment and prognosis of leukemias. ResultsEpidemiological information from the revised books has a greater consideration of sex differences in incidence and prognosis but does not contain data on mortality and survival. Etiopathogenesis is described in all books as the same physiological process for both sexes and no differences in the presentation of symptoms are described in any book. Three books describe a unique treatment that is assumed equal for both sexes; two books mention the treatment of acute myeloid leukemia in pregnant women and one in chronic myeloid leukemia. No book mentions sex-differences in pharmacokinetics, efficacy, or treatment toxicity, although there is greater evidence on unequal behavior between the sexes. ConclusionsThe contents of sex and gender differences in the leukemia chapters analyzed are insufficient compared to the evidence in the scientific literature today. Hematology textbooks might increase their scientific quality in future editions, including knowledge of sex-gender interaction in the sections of epidemiology, etiology, pathogenesis, diagnosis, treatment, prognosis, and consequences of leukemias, which will contribute to better professional practices, more efficient and equitable.

Assessment of the Role of Environmental factors and Associated Plants for the Mass Cultivation of Santalum album L in Nepal and India

Sandalwood (White Sandal) is the fragrant heartwood of some species of genus Santalum. The widely distributed and economically important Santalum genus belongs to the family Santalaceae which includes 30 genera with about 400 species, many of which being completely or partially parasitic (John, 1947). The word Sandal has been derived from Chandana (Sanskrit), Chandan (Persian), Savtador (Greek) and Santal (French). There are references of Sandalwood in Indian mythology, folklore and ancient scripts. ‘Chandana’ the Sanskrit name ascribed to Santalum album L. was known and used in India from the earliest historic times and is frequently mentioned in the ancient Sanskrit writings, some of which dated before Christian era. Kautilya’s Arthashastra (320 B.C.) considered Sandal as one of the important forest products to increase royal revenue. Charaka Sanhitha, the major text book of internal medicine in Ayurveda (300 B.C.) quotes uses of Sandal over 160 time in the entire text. In treatment of major diseases like fever, piles, hemorrhagic conditions, diabetes, dropsy, mental disorders, management of poisons & skin disorders wide spread uses of sandal is seen. Susrutha Samhita (150 B.C.) a great text on Indian wisdom on surgical procedures, equally preferred sandal for the management of wounds. Sandal fumigation is indicated in warding off evils and organisms, which contaminate the wounds. Such fumigations hasten the wound healing & surgical wards remain aseptic. Dusting of wounds with sandal for early healing is common. In the Amarkosha (Lexicon 3rd or 4th Century A.D.) sandal is mentioned and it is said that ‘Vina-malayam anyathra chandanam vivarditha’

Assessment of the effect of education on correct prophylaxis of deep vein thrombosis among patients admitted to intensive care unit

Background: Thromboembolism is a serious complication in patients admitted to the intensive care unit. Education of the effective prophylaxis guidelines by physicians can be reduces the incidence of this illness in at-risk patients. The purpose of this study was to investigate the effect of education on the correct prophylaxis of deep vein thrombosis in patients admitted to the intensive care unit of Imam Khomeini Hospital in Urmia. Methods: This cross-sectional study was carried out on 252 patient records. In this study, the correct prophylaxis of deep vein thrombosis, according to the Harrison Principles of Internal Medicine Textbook, 19th edition (2015), was taught. This education was given to the physicians in the intensive care unit in terms of prophylaxis indications, proper dosage, type of prophylaxis and unnecessary prophylaxis. Results: Most of the patients were male (51.59%). Their age in pre and post intervention groups was 58.12 and 56.58 years respectively. After the training intervention, unnecessary prophylaxis (from 7.9% to 4.8% (p=0.54)], inappropriate administration of anticoagulant dose [from 51.6% to 18.2% (p = 0.025), and type of anticoagulant [from 10.3% to 4% (p=0.038)] were reduced. Correct prophylaxis frequency was increased from 30.2% to 73% (p= 0.045). Conclusion: Education sessions on the prophylaxis of venous thrombosis in high-risk patients can lead to the use of correct prophylaxis and maybe it reduces the frequency of deep vein thrombosis and its complications

Anti-angiogenesis Therapy in Cancer Treatment

Anti-angiogenesis Therapy in Cancer Treatment

Islet Transplantation for Type 1 Diabetes, 2015: What Have We Learned From Alloislet and Autoislet Successes?

The therapeutic potential of pancreatic islet allotransplantation, in which human donor islets are used, as a treatment for type 1 diabetes (T1D) has fascinated diabetes researchers and clinicians for decades. At the same time, the therapeutic potential of total pancreatectomy and islet autotransplantation (TPIAT) (in which one's own islets are used) as a preventive treatment for diabetes in patients who undergo total pancreatectomy for chronic, painful pancreatitis has received relatively less attention. This is ironic, since the latter has been much more effective than the former in terms of successful glucose management and duration of efficacy. The reasons for this disparity can be partially identified. TPIAT receives very little attention in textbooks of internal medicine and general surgery and surprisingly little print in textbooks of endocrinology and transplantation. T1D is much more predominant than TPIAT as a clinical entity. Provision of insulin or replacement of islets is mandatory and a primary goal in T1D. Provision of pain relief from chronic pancreatitis is the primary goal of total pancreatectomy in TPIAT, whereas treatment of diabetes, and certainly prevention of diabetes, has been more of a secondary consideration. Nonetheless, research developments in both fields have contributed to success in one another. In this Perspective, I will provide a brief history of islet transplantation and contrast and compare the procedures of allo- and autoislet transplantation from three major points of view 1) the procedures of islet procurement, isolation, and transplantation; 2) the role and complications of immunosuppressive drugs; and 3) the posttransplant consequences on β- as well as α-cell function.

Left Atrial Myxoma Presenting with Orthostatic Hypotension in a 30 Year Young Female: A Case Report and Review

Cardiac tumors are divided into primary and secondary tumors. Primary cardiac tumors are very rare, with an autopsy incidence of 0.001% to 0.03%. Most (>80%) primary cardiac tumors are benign, and myxoma is by far the most common. Myxoma constitutes about 50% of all benign cardiac tumors in adults. Most myxomas (>80%) are found in the left atrium. We report a rare case of a massive left atrial myxoma causing mitral valve obstruction and presenting as positional dizziness. Though cardiac myxomas are known to present with various non-specific clinical symptoms, orthostatic hypotension is not listed as a presenting symptom of atrial tumors in most textbooks of internal medicine or cardiology. So this case is rare in this sense.

Bisimulation-based Consistency Checking on Syndrome Feng-Shi-Re-Bi in Rheumatoid Arthritis

Checking the consistency of knowledge items between textbook and clinical practice is very important for traditional Chinese medicine (TCM). According to the textbook of internal medicine of TCM, rheumatoid arthritis (RA) is a disease with four main syndromes (also called pattern) and Feng-Shi-Re-Bi is a minor one and the associated literature data are not rich. Bisimulation is an equivalence relationship/method in formal methods which can be used to compare the consistency of system's description and its behaviors. In TCM, knowledge items from textbook can be taken as system's description, and knowledge items from clinical practice can be taken as the behaviors of the system. For RA's Feng-Shi-Re-Bi syndrome, employing bisimulation method, the consistency of knowledge items between textbook and clinical practice have been checked. As a result, on Feng-Shi-Re-Bi syndrome, most knowledge items in textbook can be simulated by the clinical practice e.g., syndrome, symptom, herbal formula, herbal medicine. What's more, in clinical practice, there are also variations based on basic rules of traditional Chinese medicine. In brief, bisimulation is a proper method for consistency checking between TCM textbook and clinical practice.

Charles Miller Fisher, un grande de la neurología

C. Miller Fisher MD, one of the great neurologists in the 20th century, died in April 2012. Born in Canada, he studied medicine at the University of Toronto. As a Canadian Navy medical doctor he participated in World War II and was a war prisoner from 1941 to 1944. He did a residency in neurology at the Montreal Neurological Institute between 1946 and 1948, and later on was a Fellow in Neurology and Neuropathology at the Boston City Hospital. In 1954 he entered the Massachusetts General Hospital as a neurologist and neuropathologist, where he remained until his retirement, in 2005. His academic career ended as Professor Emeritus at Harvard University. His area of special interest in neurology was cerebrovascular disease (CVD). In 1954 he created the first Vascular Neurology service in the world and trained many leading neurologists on this field. His scientific contributions are present in more than 250 publications, as journal articles and book chapters. Many of his articles, certainly not restricted to CVD, were seminal in neurology. Several concepts and terms that he coined are currently used in daily clinical practice. The chapters on CVD, in seven consecutive editions of Harrison's Internal Medicine textbook, are among his highlights. His death was deeply felt by the neurological community.

COPD patients' rights: Can they be won?

The Yellow Emperor's classic textbook of internal medicine (Figure 1) and the Hippocratic (Figure 2) corpus of documents originated more than 2,000 years ago.

A tribute to Franklin H. Epstein

A tribute to Franklin H. Epstein

“Low Caliber Stool” and “Pencil Thin Stool” are Not Signs of Colo-Rectal Cancer

Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of "low caliber stool" or "pencil thin stool." Most textbooks of internal medicine and gastroenterology consider "small caliber stool" as one of the presenting signs of colorectal cancer (CRC). A review of the literature reveals that this rather lay misconception-i.e. presence of tumor results in narrowing of the colon, which in turn decreases the caliber of the stool-was conceived late in the nineteenth century. In the absence of reliable data to support this concept, the authors of gastroenterology textbooks in the mid-twentieth century practically dismissed the concept. Nevertheless, this misconception somehow permeated the standard textbooks of medicine and even the newer editions of text-books of gastroenterology. Our own everyday experience shows that low caliber stool is noticed whenever we have loose stool. Since diarrheal states are much more common than CRC, in the absence of authentic symptomatology of CRC, such as rectal bleeding, change in the bowel habit, tenesmus, left-sided abdominal cramps, anemia, etc., the referral of these patients for colonoscopy based solely on "decreased stool caliber" is unwarranted. Such unwarranted referrals expose the patients to unnecessary risks and discomforts and put a strain on an already over-stretched healthcare resources.

Medicina de Família e Comunidade e doenças gastroenterológicas

O médico de família e comunidade é figura central em um sistema de saúde que pretende seguir o modelo de Atenção Primária à Saúde (APS), definido na conferência de Alma Ata, em 1978. Fazem parte das suas competências: comprometimento com a pessoa e enfoque em prevenção e gestão de recursos. É sua função diagnosticar e tratar os quadros mais prevalentes tendo em vista essas competências até o momento em que uma maior complexidade tecnológica seja requerida. Uma vez que os sintomas relacionados ao trato digestivo representam queixas muito comuns na prática clínica diária, fazem parte do cotidiano do médico generalista. Uma busca na literatura foi conduzida nos bancos de dados Pub Med, Lilacs e Biblioteca Cochrane sobre estudos que relacionam Medicina de Família e Comunidade (MFC) e Doenças Gastroenterológicas publicados nos últimos 30 anos em inglês, espanhol ou português. Livros de textos de MFC e Clínica Médica também foram consultados.Oobjetivo foi demonstrar o papel do médico de família e comunidade no diagnóstico e tratamento de doenças gastroenterológicas. Como resultado foi constatado que grande parte dos casos de dor epigástrica, queimação retroesternal, sangramento retal e diarréia podem ser plenamente resolvidos pelo médico de família e comunidade. O acompanhamento de doenças gastroenterológicas crônicas estabilizadas, como as hepatites virais, também podem ser de sua responsabilidade. Conclusão: a maior parte das queixas gastroenterológicas que chegam ao médico de família e comunidade não necessita de encaminhamento ao especialista, pode ser resolvida ao nível da APS. Assim, o sistema de saúde é “otimizado”: as consultas dos especialistas tornam-se mais rápidas, aumenta-se o valor preditivo positivo das provas diagnósticas e diminui-se a possibilidade de erro do nível secundário/terciário.

Potential Drugs for Improving Chronic Fatigue Syndrome

Back to table of contents Previous article Next article LETTERFull AccessPotential Drugs for Improving Chronic Fatigue SyndromeSayed Shahabuddin Hoseini,Shahriar Gharibzadeh,Sayed Shahabuddin HoseiniSearch for more papers by this author,Shahriar GharibzadehSearch for more papers by this author,Published Online:1 Oct 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Chronic fatigue syndrome (CFS) is the current name for a disorder Characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. Specific symptoms reported by CFS patients are fatigue, difficult concentration, headache, sore throat, tender lymph node, muscle ache, joint ache, feverishness, and allergies. There are several hypotheses about its etiology, including postinfectious, immunological, neuroendocrine, neurological, and psychological ones. A CNS dysfunction brought about by abnormal cytokine release in response to antigenic challenge has been described. 1 Substantial evidences show a pivotal role for proinflammatory Cytokines (e.g., interleukin1, interleukin6, and tumor necrosis factor-α) in induction of CNS mediated responses such as fever, somnolence, and sickness behavior in acute infections. A significant elevation in serum levels of interleukin-1, and tumor necrosis factor-α in the patient with chronic fatigue syndrome have been reported. 2Recently, biological agents that bind and neutralize the tumor necrosis factor have become available: 1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1, is assessed to be effective in psoriasis. 32) Infliximab, a chimeric mouse-human monoclonal antibody to the tumor necrosis factor, has shown successful trials for treating inflammatory bowel disease.3) Adalimumab, a fully human antibody to the tumor necrosis factor, is used in cutaneous sarcoidosis. 4) Thalidomide has immunomodulatory and anti-inflammatory effects including inhibition of synthesis of the tumor necrosis factor –α. It is effective for treating Behçets syndrome. 4 We suggest that these drugs, which are approved by FDA for some of the aforementioned diseases, can be useful in treating patients with chronic fatigue syndrome. Even modest improvement in symptoms can make an important difference in the patient’s degree of self-sufficiency and ability to appreciate life’s pleasures. 5 Surely, clinical trials should be done to assess the efficacy versus side effects of these drugs on affected patients. Faculty of Medicine, Medical Sciences/Tehran University, Tehran, IranNeuromuscular Systems Laboratory, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, IranReferences1 . Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic fatigue syndrome: a review. N Z Med J 2005; 118:U1780Google Scholar2 . Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls. Psychiatry Res 2005; 134:101–104Google Scholar3 . Bos JD, de Korte J: Effects of etanercept on quality of life, fatigue, and depression in psoriasis. Lancet 2006; 367:6–7Google Scholar4 . Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of recurrent perforating intestinal ulcers with thalidomide in Behcet’s disease. Ann Pharmacother 2004; 38:808–811.Google Scholar5 . Straus SE: Chronic fatigue syndrome, in Harrison’s Textbook of Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545–2547Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 19Issue 4 Fall, 2007Pages 472-472 Metrics PDF download History Published online 1 October 2007 Published in print 1 October 2007

Potential Drugs for Improving Chronic Fatigue Syndrome

Back to table of contents Previous article Next article LETTERFull AccessPotential Drugs for Improving Chronic Fatigue SyndromeSayed Shahabuddin Hoseini,Shahriar Gharibzadeh,Sayed Shahabuddin HoseiniSearch for more papers by this author,Shahriar GharibzadehSearch for more papers by this author,Published Online:1 Oct 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Chronic fatigue syndrome (CFS) is the current name for a disorder Characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. Specific symptoms reported by CFS patients are fatigue, difficult concentration, headache, sore throat, tender lymph node, muscle ache, joint ache, feverishness, and allergies. There are several hypotheses about its etiology, including postinfectious, immunological, neuroendocrine, neurological, and psychological ones. A CNS dysfunction brought about by abnormal cytokine release in response to antigenic challenge has been described. 1 Substantial evidences show a pivotal role for proinflammatory Cytokines (e.g., interleukin1, interleukin6, and tumor necrosis factor-α) in induction of CNS mediated responses such as fever, somnolence, and sickness behavior in acute infections. A significant elevation in serum levels of interleukin-1, and tumor necrosis factor-α in the patient with chronic fatigue syndrome have been reported. 2Recently, biological agents that bind and neutralize the tumor necrosis factor have become available: 1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1, is assessed to be effective in psoriasis. 32) Infliximab, a chimeric mouse-human monoclonal antibody to the tumor necrosis factor, has shown successful trials for treating inflammatory bowel disease.3) Adalimumab, a fully human antibody to the tumor necrosis factor, is used in cutaneous sarcoidosis. 4) Thalidomide has immunomodulatory and anti-inflammatory effects including inhibition of synthesis of the tumor necrosis factor –α. It is effective for treating Behçets syndrome. 4 We suggest that these drugs, which are approved by FDA for some of the aforementioned diseases, can be useful in treating patients with chronic fatigue syndrome. Even modest improvement in symptoms can make an important difference in the patient’s degree of self-sufficiency and ability to appreciate life’s pleasures. 5 Surely, clinical trials should be done to assess the efficacy versus side effects of these drugs on affected patients. Faculty of Medicine, Medical Sciences/Tehran University, Tehran, IranNeuromuscular Systems Laboratory, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, IranReferences1 . Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic fatigue syndrome: a review. N Z Med J 2005; 118:U1780Google Scholar2 . Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls. Psychiatry Res 2005; 134:101–104Google Scholar3 . Bos JD, de Korte J: Effects of etanercept on quality of life, fatigue, and depression in psoriasis. Lancet 2006; 367:6–7Google Scholar4 . Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of recurrent perforating intestinal ulcers with thalidomide in Behcet’s disease. Ann Pharmacother 2004; 38:808–811.Google Scholar5 . Straus SE: Chronic fatigue syndrome, in Harrison’s Textbook of Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545–2547Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 19Issue 4 Fall, 2007Pages 472-472 Metrics PDF download History Published online 1 October 2007 Published in print 1 October 2007

Fehlinformation zum Tabakrauchen in deutschen Medizin-Lehrbüchern

Smoking is a major risk factor for coronary heart disease and lung cancer. While nicotine causes addiction, heart and lung diseases are caused by other substances contained in tobacco smoke. This study assessed whether these facts are adequately portrayed in German medical textbooks. The sections on cardiovascular and lung cancer risk factors in 28 German textbooks of internal medicine, available in two bookstores as well as the library of Göttingen University (Germany), were scanned for the words "smoking" and "nicotine" as risk factors for coronary artery disease and lung cancer. In 12 of the 25 textbooks covering cardiovascular disease, smoking was mentioned as a risk factor for coronary artery disease; another 12 textbooks listed nicotine or nicotine addiction. In one textbook both terms were used. While smoking was referred to in all 21 textbooks that also discussed risk factors for lung cancer, nicotine was not mentioned in this context. Many German textbooks of internal medicine contain misleading terms for the health effects of smoking, which may influence the thoughts and possibly also the behaviour of their readers. The use of the words "smoking" and "nicotine" as synonymous within the context of cardiovascular risk factors, suggesting a causal relationship between nicotine and coronary heart disease, is incorrect and should be removed from the specialist medical literature.

Research and headstream of scope of chest bi

The name of chest bi was originated from Neijing (Internal Canon), with its discussion related to the lung. The concept of chest bi was broadened and varied in the latter works of traditional Chinese Medicine in later generations. Nowadays, the textbook of Internal Medicine of Chinese Medicine, the state and the professional standards define thechest bi to coronary heart disease, thus reducing the scope of chest bi.

Sensitivity and Specificity of Tests of Liver Injury

Editor - In the recent “Outpatient Practice Management Tips: Tests of Liver Injury”, Musana et al.1 make a broad statement that “All tests of liver injury are neither highly sensitive nor specific.” This statement, by itself, is probably not accurate, nor helpful in the practical sense. The following quotes from Harrison's Principles of Internal Medicine textbook illustrate the problems with your statement regarding liver disease and tests of liver function: “Diagnosis of liver disease is greatly aided by the availability of reliable and sensitive tests of liver injury and function.”2 “To increase both the sensitivity and the specificity of laboratory tests in the detection of liver disease, it is best to use them as a battery.”3 Thus, I would rather the statement read “No single test of liver injury is neither highly sensitive nor specific.” Harrison's Principles of Internal Medicine is clear in the basic wisdom of diagnosing liver injury that these tests are highly sensitive when used in a battery and goes on to add: “When more than one of these tests provide abnormal findings, or the findings are persistently abnormal on serial determinations, the probability of liver disease is high. When all test results are normal, the probability of missing occult liver disease is low.”3

Pulmonary embolism: Is it truly missed in the emergency department?

Study objectives: Emergency medicine and internal medicine literature states that pulmonary embolism is a common entity that is frequently misdiagnosed in the emergency department (ED) and often fatal when untreated. Definitive diagnosis entails costly radiographic studies, and it is likely that these studies continue to be overused, especially in low-risk patients. Our goals are to review current literature for statistics about the prevalence, misdiagnosis, and mortality of pulmonary embolism and to determine whether these were applicable to the ambulatory, hemodynamically stable patient presenting to the ED with signs and symptoms consistent with pulmonary embolism. Methods: We conducted an ancestral search for epidemiology statistics for pulmonary embolism, starting with review articles on pulmonary embolism in commonly referenced emergency medicine and internal medicine textbooks and peer-reviewed publications. Results: We located 20 articles for our search. These reported an incidence of pulmonary embolism ranging from 500,000 to 780,000 annually, with more than 400,000 missed diagnoses. There was general agreement on mortality for untreated disease, approximately 30% (range 18% to 35%). Either directly or indirectly, the most commonly referenced citation was dated 1975. This citation drew from government mortality statistics from the 1960s, inpatient and autopsy study data from the 1940s to 1960s, and author estimates to extrapolate: mortality rate, total incidence of disease, and number of cases that are misdiagnosed. There were no citations that assessed this information in the ED setting. Conclusion: Current epidemiology about pulmonary embolism may be applicable to inpatients or the recently deceased but is unlikely to provide an accurate representation of disease in the outpatient setting. Studies to provide incidence and outcome data for pulmonary embolism in the ambulatory ED patient are necessary. Study objectives: Emergency medicine and internal medicine literature states that pulmonary embolism is a common entity that is frequently misdiagnosed in the emergency department (ED) and often fatal when untreated. Definitive diagnosis entails costly radiographic studies, and it is likely that these studies continue to be overused, especially in low-risk patients. Our goals are to review current literature for statistics about the prevalence, misdiagnosis, and mortality of pulmonary embolism and to determine whether these were applicable to the ambulatory, hemodynamically stable patient presenting to the ED with signs and symptoms consistent with pulmonary embolism. Methods: We conducted an ancestral search for epidemiology statistics for pulmonary embolism, starting with review articles on pulmonary embolism in commonly referenced emergency medicine and internal medicine textbooks and peer-reviewed publications. Results: We located 20 articles for our search. These reported an incidence of pulmonary embolism ranging from 500,000 to 780,000 annually, with more than 400,000 missed diagnoses. There was general agreement on mortality for untreated disease, approximately 30% (range 18% to 35%). Either directly or indirectly, the most commonly referenced citation was dated 1975. This citation drew from government mortality statistics from the 1960s, inpatient and autopsy study data from the 1940s to 1960s, and author estimates to extrapolate: mortality rate, total incidence of disease, and number of cases that are misdiagnosed. There were no citations that assessed this information in the ED setting. Conclusion: Current epidemiology about pulmonary embolism may be applicable to inpatients or the recently deceased but is unlikely to provide an accurate representation of disease in the outpatient setting. Studies to provide incidence and outcome data for pulmonary embolism in the ambulatory ED patient are necessary.