Author Archives: Tony Breu

Why doesn’t factor 12 deficiency cause bleeding? In July 1953, freight brakeman John Hageman’s doctors faced a scenario that might feel familiar to anyone who has ever done preoperative medicine consults. Hageman had planned to undergo a partial gastrectomy for peptic ulcer disease, but his preoperative tests showed a prolonged clotting time. In the 1950s,Continue reading “Episode 121 – The Forgotten Factor”

Why might the genetic mutations leading to hereditary hemochromatosis have offered an evolutionarily advantage to our Neolithic ancestors? A great paradox of medical genetics is that certain deadly inherited illnesses have persisted across generations because they may actually protect carriers from other deadly illnesses. The cystic fibrosis gene helps defend the lungs against tuberculosis, whileContinue reading “Episode 84 – History & Hemochromatosis: The Ins and Outs of Iron”

Why can a ketogenic diet help control seizures in epilepsy? Many forms of dietary therapy make intuitive sense. 18th-century sailors with scurvy were treated with lime juice and other sources of the missing vitamin C. Patients with diabetes mellitus are counseled to avoid foods with a high glycemic index. And those with chylothoraces, where aContinue reading “Episode 79 – Kurious Keto”

Why don’t we use immunosuppressants for artificial heart valves? Progressive heart valve failure leads to dreadful outcomes, including heart failure and death. Valve replacement surgery emerged in the 1950s and 1960s as a surgical remedy for calcified aortic stenosis and regurgitation. This began in 1952 when Charles Hufnagle was the first to implant a plasticContinue reading “Episode 78 – Valve Privilege”

Why is hyperthyroidism associated with atrial fibrillation? Many of us have evaluated for hyperthyroidism in patients with new-onset atrial fibrillation. The association between hyperthyroidism and sinus tachycardia may make sense, particularly given that other endocrine conditions associated with sympathetic surge (e.g., pheochromocytoma) show the same. However, the association with atrial fibrillation (AF) isn’t immediately apparent.Continue reading “Episode 77 – Irregularly Irregular”