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Physical Abuse-or Mimic?A childhood filled with multiple fractures and unending ED visits convinced this young woman that she would not give birth to children of her own.
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Recognizing the impact of obstructive sleep apnea in patients with asthmaAbstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)
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What caused this patient's cough and mild hemoptysis?The authors describe a previously healthy patient who required surgical resection of a large mucoid tumor lined with atypical columnar epithelium. The diagnosis was mucinous cystadenocarcinoma, a rare type of pulmonary cancer that is difficult to identify.
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Methicillin-Resistant Staphylococcal Pneumonia in a NeonateA 19-day-old infant was brought to the emergency department (ED) after a day of fever, coughing, and difficulty in breathing. He had been born at full term via vaginal delivery. There was no history of prolonged rupture of membranes. The mother was group B streptococcus-positive and had been treated appropriately before the delivery. The infant received 48 hours of empiric antibiotic therapy after his birth; blood cultures were negative at the birth hospital. The infant had been doing well before the ED visit.
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Astrocytoma in PregnancyHeadache and vomiting suddenly developed in a 41-year-old woman who was 16 weeks pregnant. The next day, she suffered an episode of tonic-clonic seizures associated with a 15-minute loss of consciousness.
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Papillary Cystic Neoplasm of the PancreasA 24-year-old woman was concerned about a protruding epigastrium mass that had grown since it was first noted 4 months earlier. She had no abdominal pain, nausea, or vomiting.
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Renal Artery StenosisAfter suffering with a severe, disabling headache for 2 weeks, a 20-year-old soldier sought medical treatment. He had no significant medical history other than his 6-year history of smoking.
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Eruptive Xanthomas in a Heavy Drinker and SmokerA 36-year-old man was admitted to the hospital with acute mid-epigastric pain and vomiting. He was a heavy drinker and had smoked between 50 and 60 cigarettes a day for the last 15 years.
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A Case of Attention Deficit Disorder?Attention to ADD seems to be escalating. It almost seems to be a fad. Doesn’t everyone want to be able to focus better?
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Radiologists caution against CT misuse in swine flu diagnosisImaging experts are lining up to caution physicians not to read too much into study findings suggesting that chest CT is better than general radiography for examining A-H1N1 flu patients.
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Acute DVT Associated With IVC Compression by a Uterine MassDeep venous thrombosis as a complication of leiomyoma uteri is rare and only a few cases have been reported to date.
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Superior Mesenteric Artery Syndrome in a Young WomanThis gastrovascular disorder is rare yet life-threatening when it occurs. It is caused primarily by any process that leads to increased acuity of the aortomesenteric angle.
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Diverticulosis in an Elderly WomanAn 84-year old woman, who depends on a weekly dose of magnesium citrate to have a bowel movement, has extensive diverticulosis throughout the length of the colon.
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Porphyria Cutanea Tarda in a Middle-Aged ManA 50-year-old man with a history of diabetes, hypertension, seizure disorder, and alcohol abuse sought treatment for a rash and painful ulcerations of the hand, face, and scalp, which had bothered him for 1 month. The patient also complained of pruritus.
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Bullet in the BrainWhile evaluating this 26-year-old man for suspected sinusitis, skull films revealed the fragments of a 32-caliber gunshot embedded in his brain. The anteroposterior and lateral radiographs show three metallic bullet fragments; the largest remnant is on the left side of the occipitoparietal region. The patient reported being shot at age 11 but denied any residual neurologic signs.
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Depression:ABSTRACT: Antidepressants and psychotherapy are effective treatments for major depression. In selecting an antidepressant, consider any previous response or family history of a response to a medication as well as anticipated side effects. Advise patients that antidepressants take at least 4 to 6 weeks to have a full therapeutic effect and that only about half of patients respond to the first drug prescribed. If the patient fails to respond or experiences intolerable side effects, it is usually advisable to substitute an antidepressant with a different mechanism of action. A combined approach using medication and psychotherapy often produces optimal results.
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A Rare Finding of Lymphangiomatosis: Case ReportPatient was hemoccult positive with anemia but colonoscopy and EGD were negative. What test would you order next?
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Chylothorax: A review of current management strategiesABSTRACT: The most common causes of chylothorax are neoplasm-particularly lymphoma-and trauma. The usual presentingsymptom is dyspnea resulting from the accumulationof pleural fluid. The diagnosis of chylothorax is established bymeasuring triglyceride levels in the pleural fluid; a triglyceridelevel of greater than 110 mg/dL supports the diagnosis. The initialapproach to management involves chest tube drainage ofthe pleural space. The administration of medium-chain triglyceridesas a source of fat is often useful. If drainage remains unchanged,parenteral alimentation should be started. Surgicalintervention is indicated if conservative management is notsuccessful or if nutritional deterioration is imminent. If chylothoraxpersists after ligation of the thoracic duct, options mayinclude percutaneous embolization, pleuroperitoneal shunt,and pleurodesis. (J Respir Dis. 2008;29(8):325-333)
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Bone Density in Postmenopausal Women Swayed by Mood ChangesPrimary care physicians need to be aware of the relationship, especially because the incidence in older women is high.
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Paget's Disease of BoneA serum alkaline phosphatase (ALP) level three times higher than normal, found on routine laboratory examination, prompted further evaluation of a 57-year-old man. At admission, his temperature was 36.8°C (98.2°F), blood pressure was 120/85 mm Hg, pulse rate was 90 beats per minute, and respiration rate was 19 breaths per minute. The physical examination was unrevealing, and the patient's personal and family medical histories were unremarkable.
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Milroy DiseaseA male infant was delivered at term to a 24-year-old woman. The pregnancy had been uncomplicated; the vaginal delivery was normal. Apgar scores were 7 at 1 minute and 9 at 5 minutes. Birth weight was 3020 g (6 lb 11 oz); length, 51 cm (20 in); and head circumference, 36 cm (14 in).
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Man With Worsening Dyspnea, Epistaxis, and a Distended AbdomenA 49-year-old man has had dyspnea on exertion for 1 month; it has worsened during the past 2 days. He has also had 2 episodes of epistaxis and increasing abdominal distention, without pain, during the past 6 months.
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Case In Point: Odontogenic pneumomediastinum after routine dental extractionWe describe a rare case in which chest pain and subcutaneous emphysema developed while the patient was undergoing routine dental extractions under local anesthesia and inhaled nitrous oxide. The patient was found to have extensive pneumomediastinum on a CT scan of the chest. The patient received supportive care and 24-hour high-flow oxygen (100%) and was discharged the next day without any residual symptoms. At a 10-day follow-up visit, neck and chest radiographs revealed no further subcutaneous emphysema.
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Paget Disease of the MaxillaA 72-year-old woman first noticed progressive enlargement of the maxillary area of her face 18 years earlier. She denied facial trauma and significant dental caries. Her medical history consisted of breast cancer managed by a mastectomy and type 2 diabetes mellitus of 3 years’ duration.
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Recognizing the impact of obstructive sleep apnea in patients with asthmaAbstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)
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Two Cases of Episodic, Asymptomatic, Erythematous EruptionsA 31-year-old white woman presents with an erythematous skin eruption of 2 weeks' duration that consists of papules on the cheeks and several disk-shaped papules and plaques on the back, posterior neck, and right upper anterior chest.
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Gallbladder AgenesisA 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis (A and B). The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits, or urinary symptoms.
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Punctate KeratodermaSince his twenties, a 71-year-old man had had multiple tiny, pinhead, whitish yellow papules on his palms. They were asymptomatic but made his skin feel like sandpaper. Other members of his family had similar lesions.
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Fever in a Woman With an Abnormal White Blood Cell CountThe patient has a small-fiber sensory neuropathy that is managed with lamotrigine. She is a physical therapy student who has frequent patient contact. She drinks alcohol occasionally but denies smoking and illicit drug use; she says she is not sexually active.
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Bilateral Leg Ulcers in a Cachectic ManA 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.
