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Dry Powder Inhalers: Teaching Correct Use to Maximize BenefitDry powder inhalers are used by millions of patients with asthma or chronic obstructive pulmonary disease. Although these devices are easier to use than metered-dose inhalers, errors still occur and drug efficacy may be reduced or lost.
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Update on Chronic ConstipationThere are numerous treatment options, including a variety of over-the-counter agents to help patients with constipation. Here, a review of the more popular choices.
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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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A rare diagnosis: Endobronchial schwannomaEndobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.
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Successful Aging: Strategies to Help Maintain and Nurture a Healthy BrainOur brains can be trained to function better as we age, and it doesn't take the Fountain of Youth to get there. In this podcast, geriatric psychiatrist Helen Lavretsky prescribes strategies to challenge our brains. She notes: "The more we challenge our brain, the more new nerve pathways and circuits we form."
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Molluscum Conagiosum in a 6-year-old BoyA 6-year-old boy had a nonpruritic rash on his back for 10 days. There was no associated fever. The child's mother had placed a bandage over the lesions to prevent transmission to her other children.
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Recognizing tracheobronchomalaciaAbstract: Tracheobronchomalacia is a form of expiratory central airway collapse characterized by softening of the airway wall cartilaginous structures. Symptoms often mimic asthma and chronic obstructive pulmonary disease. Pulmonary function test results may suggest a diagnosis, but findings are neither sensitive nor specific. Bronchoscopy and novel dynamic radiographic studies contribute to the diagnosis and help differentiate true malacia from other forms of expiratory central airway collapse. Treatment options include medication; noninvasive ventilatory support; interventional bronchoscopy with airway stent insertion; and open surgical procedures, such as tracheostomy, tracheal resection, and tracheoplasty. (J Respir Dis. 2006;27(8):327-335)
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Chronic Fatigue Syndrome: Is Infection to Blame?Is chronic fatigue syndrome related to infection? If so, how does this affect the approach to therapy? Because patients with chronic fatigue syndrome (CFS) frequently report an infection-like event at the onset of their condition, the possible role of viral or other infections has been extensively investigated.
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What Is Causing This Persistent Diarrhea?A 52-year-old woman presented with a 12-day history of diarrhea and mild stool incontinence that began 2 to 3 hours after a routine screening colonoscopy. Six or 7 bowel movements of liquid, orange-yellow feces occurred each day for 12 days. The patient reported that associated nausea, flatulence, and severe abdominal cramping were relieved by the bowel movements. She also reported that a small amount of mucus was occasionally observed in the stool and that bright red blood streaks appeared on used toilet paper, although the stool itself was not bloody. She was able to tolerate a full diet, although food exacerbated the urgency. She was afebrile during this illness.
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Violent Purple-Red Thigh Rash in an Aged WomanThis pruritic rash appears to be a drug reaction to a cephalosporin. This class of drug often produces allergic reactions in the skin; this was quite an ordinary one, neither vasculitic nor urticarial. The mucosa was not affected, which ruled out Stevens-Johnson syndrome.
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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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Crossed Renal Ectopia With FusionFrequent urinary tract infections and unexplained hypertension (160/100 mm Hg) occurred in a 38-year-old man with no significant medical history. The heart and chest were normal; a right lower quadrant mass was detected in the abdomen. Red blood cells were found in the urine. An abdominal CT scan demonstrated that the left kidney was fused to the lower pole of the right kidney with the left pelvicaliceal system to the left of the midline; these findings are consistent with crossed fused renal ectopia. Cystographic and cystoscopic examinations were normal.
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Gastrointestinal Involvement of Systemic AmyloidosisThe authors present a case of AL amyloidosis with rare GI involvement and an equally rare presenting symptom.
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Life-Threatening Asthma, Part 1:Initiation of early aggressive therapy is critical to averting fatal outcomes in exacerbations of acute life-threatening asthma.
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Matters of the Heart: Pericardial TamponadeA 70-year-old woman with no previousmedical problems had had progressivedyspnea and generalized weaknessfor the past several days. She washypotensive (73/31 mm Hg), tachycardic(120 beats per minute), andtachypneic (28 breaths per minute);oxygen saturation (room air) via pulseoximetry was 84%.
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Sebaceous CystA painless swelling on the dorsum of the scalp had been present for many years in a 36-year-old man. An increase in the size of the lesion prompted the man to seek medical evaluation.
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Wolff-Parkinson-White Syndrome: What Treatment?A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.
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Ovarian Hyperstimulation SyndromeFor 4 days, a 34-year-old pregnant woman had dyspnea and right-sided chest pain. She denied fever, chills, sweats, cough, lower extremity pain, and edema. Surgical and social histories were unremarkable. She was taking progesterone and clomiphene citrate for the past 6 months for assisted reproduction.
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Gastric Outlet Obstruction Shown in Barium Swallow StudyAn 88-year-old woman was brought to the emergency department after she choked on a piece of meat. She had dysphagia of many years’ duration and progressive weight loss over the past 5 years.
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An apical cavitary lesion in a 51-year-old manA 51-year-old man with a long history of alcohol abuse and heavy cigarette smoking presented to our hospital with worsening of a chronic cough, which had become productive of thick green sputum and was associated with posttussive emesis. He denied fevers and chills but had a recent and unintentional weight loss of about 5 kg. He had a history of squamous cell carcinoma of the right tonsil, which remained in remission for more than 4 years after chemotherapy, radiation therapy, and resection. There was no recent history of travel or any occupational exposures or known contacts with tuberculosis or animals (wild or domestic).
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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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Herpes Encephalitis in Monoclonal GammopathyNinety percent of adult cases of encephalitis are caused by herpes simplex virus (HSV) type 1, and HSV type 2 encephalitis is clinically indistinguishable from HSV-1 encephalitis.
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Asthma or Something Else? That Is the QuestionWorsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in for evaluation. Diagnosed with asthma 2 years earlier, she was compliant with, but unresponsive to treatment. Your impressions?
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Pulmonary function testing: Applying techniques in infantsAbstract: As in adults and older children, pulmonary function testing in infants may help detect certain obstructive or restrictive diseases. However, different techniques and equipment must be used. The most commonly performed noninvasive tidal breathing test involves use of a face mask with a pneumotachograph; an alternative method is respiratory inductive plethysmography. Ratios derived from volume-time and flow-time tracings can help identify patients with obstructive lung disease, who have a shorter time to peak expiratory flow:expiratory time ratio than do healthy persons. Instead of spirometry, the rapid thoracic compression technique can be used to measure expiratory flow and construct a flow-volume curve. This method, which is performed with the patient under sedation, increases flow rates over tidal flow values and enhances the ability to detect abnormal airway function. (J Respir Dis. 2006;27(4):158-166)
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Hypomelanosis of ItoA 6-year-old girl with mental retardation was seen for a physical examination. She was being followed by a neurologist for seizures that began in her first year of life. She had no acute health problems.
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Is This Toddler Having Seizures? What's Your Diagnosis?Episodes of lost balance, "wiggling" eyes, a family history of convulsions: does this toddler have epilepsy, or is something else going on?
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Benign Prostatic Hyperplasia:Traditionally, urologists have cared for patients with benign prostatic hyperplasia (BPH). However, because of demographic fluctuations, changes in the health care system, and the development of effective pharmacologic therapy for BPH, primary care physicians are increasingly involved not only in initial patient evaluation but also in continuing management. Here we provide guidelines for treatment of uncomplicated BPH--with special emphasis on medical therapies.
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A 60-Year-Old Man Who Requires SplenectomyElective splenectomy has been scheduled for a 60-year-old man with severe idiopathic thrombocytopenic purpura (ITP) that has responded poorly to treatment. His current platelet count ranges from 5000/μL to 10,000/μL despite several months of aggressive therapy, including 2 courses of high-dose corticosteroids and 2 courses of intravenous immunoglobulin.
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A Patient's Journey: Me and My 'Lame' CancerA 69-year-old in an active surveillance program asks what the revised USPSTF position on PSA testing means for guys like him.
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Man With a Potentially Life-Threatening Waterborne InfectionA 79-year-old man presents to theemergency department with a painfullesion on his right forearm. Three daysearlier, he had scratched his arm whileremoving crabs from a trap. Initially,the scratch had bled slightly, and hehad self-treated with an over-the-counterantibiotic ointment and an adhesivebandage.
