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Acute Pancreatitis Secondary to Neuroendocrine TumorRight upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors. The patient occasionally consumed alcohol and regularly smoked cigarettes (tobacco and marijuana). He denied nausea, vomiting, diarrhea, and diaphoresis. Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.
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3 Things I Would Tell Every Psychiatrist TodayFamily doc/psychiatrist Erik Vanderlip points to 3 big elephants in the room at the 2016 American Psychiatric Association meeting.
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Respiratory infections in diabetes: Reviewing the risks and challengesABSTRACT: Although the organisms that cause community-acquiredpneumonia are similar in diabetic and nondiabetic patients,those who have diabetes mellitus (DM) may have moresevere disease and a poorer prognosis. Elevated blood glucoselevels are associated with worse outcomes in patients withpneumonia, and the mortality risk may be as high as 30% in patientswith uncontrolled DM. Thus, appropriate treatment-and possibly prevention-of bacterial pneumonia should includeaggressive efforts directed at glycemic control. Other respiratoryinfections, such as influenza, tuberculosis, and fungalpneumonia, also are associated with greater morbidity in patientswith DM. Diabetic patients with tuberculosis are morelikely to present with bilateral lung involvement and pleural effusions.(J Respir Dis. 2008;29(7):285-293)
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Rheumatoid Arthritis: Clues to Early DiagnosisPrimary care physicians are usually the first to see patients with joint pain; consequently they represent the "front line" of RA care. This fact-coupled with the projection that the number of rheumatologists is expected to decline by 20% during the next 2 to 3 decades-underscores the pivotal role that primary care clinicians are now expected to play in the early diagnosis of RA.
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Managing the Patient With an Abnormal Liver Test: Part 2, Alkaline Phosphatase Elevations and Liver Enzyme Abnormalities in PregnancyThe first step in the workup of a patient with a persistent asymptomatic alkaline phosphatase (ALP) elevation is to measure gamma-glutamyltranspeptidase to determine whether the elevation is liver-related or bone-related.
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Bronze Skin in HemochromatosisA 60-year-old white man was evaluated for dyspnea on exertion. Hepatomegaly and abnormal skin pigmentation were noted, particularly in the upper extremities.
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Scrub Typhus: Two Cases Presenting as Abdominal PainScrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis.
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Severe pneumonia in children: Causes, diagnosis, and treatmentVaccines have substantially reduced the incidence ofpediatric pneumonias caused by Haemophilus influenzae type band certain serotypes of Streptococcus pneumoniae. However,other organisms are being identified more frequently, includingmethicillin-resistant Staphylococcus aureus (MRSA) and serotypesof S pneumoniae that are not covered by the pneumococcalvaccine. Although chest radiographs are still a basic componentof the assessment of pneumonia, CT scans are increasinglybeing used to differentiate effusion from empyema and consolidationand to evaluate for pleural fluid loculations, lung abscesses,and lung necrosis. ß-Lactams, particularly extendedspectrumcephalosporins, remain an important cornerstone ofthe treatment of complicated pneumonia. In areas where community-acquired MRSA is a concern, empirical coverage for thispathogen should be considered in patients with a severe ornecrotizing pneumonia. (J Respir Dis. 2008;29(2):85-92)
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A Woman With Delirium From Diabetic KetoacidosisMucormycosis, an angioinvasive yeast infection of the Mucorales order of the class of Zygomycetes, often grows in patients with diabetes mellitus, especially in the presence of diabetic ketoacidosis.
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Importance of CEA as a Tumor MarkerDuring investigation of a long-standing iron-deficiency anemia, a 67-year-old woman was found to have cecal colon cancer, Duke's stage B. A right hemicolectomy was performed at that time, and she had periodic follow-up examinations. Four years later, during a routine outpatient visit, her carcinoembryonic antigen (CEA) serum level was found to be 27.7 ng/mL (upper normal limit, 5 ng/mL). Four months earlier, her CEA level had been normal.
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NeurofibromatosisA 19-year-old man was referred for further investigation of multiple pigmented cutaneous lesions.
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Underarm Eruption in a Teenaged BoyTopical steroids and antifungals have not only failed to resolve the bilateral rash; the teen says they’ve made it worse. Your Dx?
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Image IQ: Rash with Chills, Neck Pain, Acute FeverRash began with one lesion followed by tender, disseminated eruption; fevers spiked to 102°F. Test your visual diagnostic skills.
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Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Disseminated Gonococcal InfectionTelltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
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Rash Around the Mouth of a 5-year-old ChildThe eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential?
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Woman With Type 2 Diabetes and AcromegalyA 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.
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Suture GranulomaAn 80-year-old woman presented with recurrent abdominal pain for 1 month, constipation, and vomiting. She had no diarrhea, rectal bleeding, or weight loss.
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Cullen Sign in PancreatitisA 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.
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Hilar Mass with Venous EncroachmentA 56-year-old man, who had a history of cigarette smoking, noticed a sudden swelling in his neck, mainly on the right side. Shortly thereafter, his right arm became enlarged.
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Man With Chronic Eustachian Tube Dysfunction, Otitis Media, and Hearing LossA 31-year-old man presents with a2-week history of a constant, dull acheand hearing loss in the right ear. Healso complains of intermittent sharppains that are usually followed bydrainage through the external auditorycanal. Another practitioner diagnosedacute otitis media with tympanic membraneperforation, for which he prescribeda 10-day course of amoxicillin.The patient completed the regimen buthas obtained no relief.
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Comparative Effectiveness Research-Part 2: The Impact on Decision MakingAs publicly funded health care payment programs have grown over decades because of demographic shifts and expansion of coverage, comparative effectiveness research (CER) has emerged to address value in health care. The American Recovery and Reinvestment Act of 2008 (ARRA) included $1.1 billion for CER initiatives, and the new health care legislation created the Patient-Centered Outcomes Research Institute, which will be funded with $500 million or more annually. In these efforts exist the promise to create informed decisions that will improve health care at both the individual and population levels.
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Keratoconus With Corneal HydropsThis 20-year-old woman with Down syndrome has bilateral keratoconus, a common, noninflammatory, paracentral corneal ectasia that is occasionally hereditary. Symptoms vary from none to severely blurred vision. Opacity of this patient's right cornea developed after her eye had teared excessively for 1 day, during which time she continually rubbed it.
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Chylothorax After Debridement of Necrotizing FasciitisA 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever.
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Eternal SpringsDoctors, especially primary care doctors, love stories. We love hearing them from patients and telling them to one another. “Anecdotal learning” it’s called by some (somewhat derisively because it’s not science).
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Stevens-Johnson Syndrome Due to Levofloxacin HypersensitivityLevofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs.
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Immunosuppression and Infection Risk in SOT RecipientsWith the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1
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Social Media and Medicine: A Winning CombinationDr Farris Timimi, Assistant Professor of Medicine at the Mayo Clinic and Medical Director of the Mayo Clinic Center for Social Media, discusses the potential of social media to change the landscape of clinical practice.
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Retroperitoneal FibrosisFor about 2 weeks, a 61-year-old woman with diet-controlled diabetes and hypertension had fatigue and generalized weakness. For the past 3 months, she had had poorly localized back pain and bilateral flank pain. She denied dysuria, fever, decreased urinary output, or weight loss.
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Familial Benign PemphigusFor 25 years, a 74-year-old man had an intermittent, painful, and pruritic rash that caused cracking and erosions in the axillae and groin. It worsened with sweating and in the summer and also when clothing or skin rubbed against the eruption. The patient’s father, a paternal uncle, and all 3 of the patient’s daughters had a similar rash. Cetirizine and a combination of xipamide, bacitracin ointment, clotrimazole, and triamcinolone cream were prescribed to treat the rash.
