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A Pregnant Woman With Lax Joints and SkinA 25-year-old woman presents for a prenatal visit. She has an unremarkable medical history except for hypermobility of the joints and a tendency to bruise easily. Her mother and sister also have very lax joints.
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Contact Dermatitis to CopperPain and pruritus of the neck and upper chest began to bother a 43-year-old woman several hours after she put on a new copper necklace. Vigorous scratching of the affected area caused excoriation of the skin, which can mask the eruption and complicate diagnosis.
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An Intriguing DiagnosisA 12-month-old previously healthy boypresented to the pediatric emergencydepartment (ED) with a 10-day historyof fever, irritability, and anorexia.The patient’s mother had originallynoted the development of 3 erythematouspapules on the patient’s back, leftaxilla, and chest; these were followedby the onset of daily fevers, with temperaturesranging from 38.8°C to41.1°C (102°F to 106°F). The lesionsgrew progressively larger and erythematous,and became ulceratedwith central eschars.
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Lymphomatoid granulomatosis with muscular involvementA 74-year-old woman with a history of breast cancer and cutaneous sarcoidosis was admitted after a fall from bed that resulted in a left hip fracture.
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ACP 2015: "Still, Do No Harm"I’ll admit I was a little nervous to attend the annual American College of Physicians (ACP) meeting this year, what with the MOC snafu and the fall out.
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Can Colonoscopy Interval be Safely Extended from 10 to 15 Years for Individuals at Average CRC Risk?New research suggests the interval "could potentially be extended" without significant harms and could reduce unnecessary invasive procedures. , ie, missed early detection and CRC-specific mortality.
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Research Focus: Recent Developments in HIV TherapeuticsResearch Focus: Recent Developments in HIV Therapeutics
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Multimedia: AMA House of DelegatesCHICAGO -- This special report from Greg Laub, MedPageToday videographer, gives a sense of the proceedings at the 2007 Annual Meeting of the AMA House of Delegates, with a debate regarding the sale of physician data from AMA's Physician Masterfile to pharmaceutical companies that use the data to compile physician prescribing data.
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Tympanic Membrane Perforation:An Unusual Complication of Varicella-Zoster Virus InfectionOtological complications associated with varicella-zostervirus infection are common; however, tympanic membraneinvolvement is rarely reported. We describe a patient withherpes zoster in whom hemorrhagic otitis media with tympanicmembrane perforation developed. To our knowledge,this is the first report of an HIV-infected patient with thisunusual presentation. [Infect Med. 2008;25:561-562]
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Middle-Aged Woman With Epistaxis, Facial Pain and Swelling, and OtalgiaFor 2 weeks, a 49-year-old woman has had mild, intermittent epistaxis with left-sided facial pain, swelling, and otalgia; the severity of the bleeding has increased during the past 24 hours. She also has congestion of the left naris of 1 month's duration.
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Treating Sepsis: An Update on the Latest Therapies, Part 1A milestone has been reached in the treatment of sepsis-the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to obtain cultures rapidly and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (Infect Med. 2009;26):134-143)
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Colorectal Cancer Screening: Old Obstacles, New TestsColorectal cancer (CRC) is highly preventable; however, it remains a significant cause of morbidity and mortality in Western countries. CRC develops in more than 125,000 Americans each year, and about 50,000 die of it.1 Screening and early intervention significantly reduce morbidity and mortality, and a number of organizations have published screening recommendations (Table). Nevertheless, only 1 of every 3 eligible adults elects to be screened.2
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Editor's CommentaryThere's a curse frequently attributed to the Chinese, "May you live in interesting times." It seems that we find ourselves living in interesting times right now. The Department of Homeland Security recently heightened our threat levelfrom code yellow to code orange. Duct tape, plastic wrap, and flashlights are in short supply at local hardware stores. There’s been more talk about smallpox and the smallpox vaccine, and parents and colleagues are eager for more information.
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Respiratory symptoms may develop years after IBD diagnosis What are the pulmonary manifestations of inflammatory bowel disease? key words: Inflammatory bowel disease, Ulcerative colitis, Crohn disease, Bronchiectasis, BOOP, Interstitial pneumonitisabstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)
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Health care–associated pneumonia: Meeting the clinical challengesABSTRACT: The risk factors for health care–associated pneumonia(HCAP) include hospitalization for 2 or more days withinthe past 90 days, residence in a nursing home or extended-carefacility, home infusion therapy, and long-term dialysis withinthe past 30 days. Distinguishing between community-acquiredpneumonia (CAP) and HCAP is important because of the implicationsfor therapy. Compared with CAP, HCAP is morelikely to be caused by multidrug-resistant organisms and is associatedwith a higher mortality rate. The management ofHCAP requires antimicrobial coverage of Pseudomonas aeruginosa,Acinetobacter species, extended-spectrum ß-lactamase–producing Enterobacteriaceae, and methicillin-resistant Staphylococcusaureus. Empirical narrowing of therapy is probablysafe in patients with culture-negative HCAP who have improvedwith broad-spectrum therapy. (J Respir Dis. 2008;29(5):208-213)
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Case In Point: What caused diffuse alveolar hemorrhage in a patient with gout?Allopurinol, commonly used to treat patients with gout, has been known to cause hypersensitivity reactions. We report a case of drug-induced delayed multiorgan hypersensitivity syndrome secondary to allopurinol use. To the best of our knowledge, this is the first reported case of diffuse alveolar hemorrhage in a patient presenting with allopurinol-induced rash with eosinophilia and systemic symptoms.
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Inverted DiverticulumColonoscopy revealed diverticulosis in a 47-year-old man who had presented with rectal bleeding. A polypoid lesion was noted in the sigmoid colon.
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Cough and Cold Treatments for Children: Does Anything Work?Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."
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Severe Facial Scar on a Young Girl: Was This Child Abused?A normal genital examination does not preclude sexual abuse.
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Relfex Sympathetic DystrophyA 44-year-old man sought relief from severe pain, swelling, and restricted radiocarpal and digital motion of his left hand. Four months before, he had suffered a fracture of the distal radius metaphysis (Colles' fracture), which was treated by closed reduction with long-arm cast immobilization for 6 weeks.
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Pericardial tamponade caused by Actinomyces after bronchoscopyActinomyces odontolyticus isa rare cause of pleuropericardialinfection, with only 1 caseidentified in the literature. Inthat instance, the infectionwas believed to be secondaryto gastric surgery. We present apatient with pericarditis andpericardial tamponade causedby A odontolyticus. The infectionoccurred after an ultrasound-guided subcarinalbronchoscopic needle biopsyperformed for a suspicious mediastinalmass found on a CTscan of the chest. We describethe case presentation, the microbiologyand treatment of Aodontolyticus infection, andthe classic features of pericarditisand cardiac tamponade.
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Bilobar pulmonary sequestration: A rare case involving 2 adjacent lobesWe present a case of a 20-year oldman with massive hemoptysisresulting from pulmonarysequestration that involved 2lobes (the right lower and middlelobes). Preoperative embolizationand subsequent surgicalbilobectomy were performed.Although the patienthad a difficult and prolongedpostoperative course, he eventuallyhad a full recovery.
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Internuclear OphthalmoplegiaFor a month, an obese 50-year-old woman with type 2 diabetes mellitus, hypercholesterolemia, and hypertension had blurry vision in both eyes. During this time, she also had ataxia and right-sided numbness. For the past 2 days, she had had horizontal, binocular diplopia with right gaze.
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Artificial Intelligence Proves Effective for Atrial Fibrillation DetectionA single AI-enabled ECG identified AF with a sensitivity of 79%, a specificity of 79.5%, and an overall accuracy of 79.4%, according to a new study.
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Cutaneous Leukocytoclastic VasculitisThis hypersensitivity reaction may be secondary to medications, infection, collagen-vascular disorders, or an occult malignancy. When it is localized to the skin, prognosis is excellent.
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Cutaneous Mycobacterium InfectionThis rash, which covered a 68-year-old woman's body, was noted to have worsened during the past 2 months. A cephalosporin antibiotic had failed to clear the condition. The patient, a nursing home resident, suffered from emphysema, asthma, and heart disease. She had been receiving oxygen therapy and prednisone for 1 year.
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Bronchiectasis, part 2: ManagementSystemic antibiotics are the mainstay of the managementof acute exacerbations of bronchiectasis. Antibiotic selection should include coverage for Streptococcus pneumoniaeand Haemophilus influenzae; particular attention alsoshould be paid to the presence of Staphylococcus aureus andPseudomonas species. There is some evidence that long-termlow-dose macrolide therapy can reduce the incidence of acuteexacerbations and decrease sputum production. There alsomay be a role for the use of inhaled antibiotics in the treatmentof bronchiectasis. Airway clearance strategies, such as chestpercussion and postural drainage, are clearly useful in patientswith cystic fibrosis and may be useful in managing bronchiectasisin other patients. Surgical resection can be considered if apatient has localized disease that is refractory to medical managementor if he or she is unwilling to undergo long-term medicaltherapy. (J Respir Dis. 2008;29(1):20-25)
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SPRINT, ACCORD-BP, EMPA-REG: A Few Notes on BP Control in DiabetesWhich pivotal study offers the results to rely on when setting BP goals to reduce CV risk in your patients with type 2 diabetes?
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Prevention and Management Issues in StrokeQ:Based on the latest evidence, what constitutesoptimal management and follow-up for patientswith asymptomatic carotid stenosis?
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Hypertension in Dialysis Patients: Primary Care PrimerWhen CKD 4-5 progresses to ESRD, how should hypertension management be changed? Or, should it?
