Bernard Karnath, MD

The authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.

A 28-year-old man presented with chest pain, hemoptysis, and wheezing. He had a history of intermittent shortness of breath that occurred at least 3 times a year in the past 3 years; fever; and loss of appetite associated with headache, vomiting, and weakness. His medical history also included asthma, chronic gastritis, and more than 5 episodes of pneumonia since 1996. A test for hepatitis C virus (HCV) had yielded positive results.

ABSTRACT: Effective smoking cessation strategies typically encompass the use of some pharmacotherapy with counseling by physicians. Give the Fagerstrom test to patients who want to quit smoking to determine their degree of nicotine dependence. For low-nicotine-dependent smokers, the use of 1 smoking cessation product for a short period has proved successful; for high-dependence smokers, a combination of products, such as nicotine gum and a nicotine patch, can be used. Other available smoking cessation products are the nicotine nasal spray, the nicotine inhaler, and sustained-release bupropion. Increasing the dose or duration of nicotine gum and patch has improved abstinence rates among high- dependence smokers. Quit rates have also been shown to increase with the dose of bupropion.

ABSTRACT: Recent evidence suggests that viral infection is the most likely underlying cause of Bell's palsy. Rapidity of onset is a clue to the diagnosis; unilateral facial weakness or paralysis develops over 24 to 48 hours. Rule out other causes of peripheral facial paralysis, such as Ramsay Hunt syndrome and Lyme disease. Although most cases of Bell's palsy resolve without medical or surgical intervention, older patients and those with abnormal electroneurographic results are less likely to have complete recovery of facial function. Early treatment with an oral corticosteroid is likely to enhance recovery; concurrent use of acyclovir may also be helpful. Surgical decompression has been effective in patients with abnormal electroneurographic results.

Sir William Osler once called pneumococcalpneumonia “the captain of themen of death.”1 Pneumonia is the sixthleading cause of death in the UnitedStates and the fourth leading causeamong Americans 80 years of age andolder.2

ABSTRACT: The emergence of drug-resistant pneumococci has changed the empiric treatment of community-acquired pneumonia. Newer fluoroquinolones with activity against Streptococcus pneumoniae offer an alternative in the treatment of infection with penicillin-resistant strains. These agents are not recommended as first-line therapy because of concerns about the development of resistance. Reserve the fluoroquinolones for patients who are allergic to macrolides and β-lactams, have failed to respond to a first-line agent, or have a documented infection with a highly resistant strain. The pneumococcal vaccine is recommended for all persons aged 65 years and older, adults with chronic car-diopulmonary diseases, and immunocompromised persons. Consider revaccination every 6 years in asplenic patients and immunocompromised persons. In addition, vaccination against influenza can help prevent secondary pneumonia and reduce the need for hospitalization.

A 39-year-old man sought evaluation ofnewly erupted skin lesions on his arms.Ten days earlier he had fallen on hisforearms, but no bruises appeared atthat time.