Authors
Latest:
Rebound Headache: Keys to Effective TherapyWhich of these scenarios is familiarto you? •A local pharmacist calls to say thatyour patient wants another refill for thecombination analgesic containing aspirin,caffeine, and butalbital that youprescribed last week. Pharmacy recordsindicate that this patient has received250 tablets of this medication inthe last 34 days.
Latest:
AspergillosisA 35-year-old HIV-positive man had a thick, black, otherwise asymptomatic patch on the top of his tongue. He did not have diabetes.
Latest:
Torus MandibularisDuring a new-patient evaluation, a 49-year-old Hispanic man was found to have several nontender, hard nodules protruding from the lingual area. The nodules had evolved slowly over several years. The patient reported no trauma to the area. He was a long-time smoker and took no medications. His medical and family histories were unremarkable.
Latest:
Lymphangioma CircumscriptumFor 10 years, a 22-year-old woman had had an erythematous, translucent patch of grouped blisters on her left thigh. A recent increase in the size of the patch prompted the patient to seek treatment. There was no burning or tingling at the site. The patient reported that the erythema occasionally cleared; however, the blisters always remained. She denied fever, weight loss, and other constitutional symptoms.
Latest:
Pulmonary Function Tests:ABSTRACT: Indications for pulmonary function tests (PFTs) have widened substantially, ranging from screening smokers for early lung disease to determining the diagnosis and prognosis of pulmonary conditions. Current indications also include screening for drug-induced lung toxicity and preoperative screening for lung resection surgery. In the workup of respiratory symptoms, such as dyspnea, cough, and wheezing, PFTs can identify obstructive or restrictive patterns that may suggest a diagnosis such as asthma or interstitial lung disease. The ratio of FEV1 to forced vital capacity is very sensitive to the presence of airflow limitation, although bronchoprovocation testing may be needed to diagnose asthma, especially in patients with mild intermittent disease. Measurements of lung volumes and carbon monoxide-diffusing capacity (DLCO) provide crucial information in selected patients. For example, a reduced DLCO may be a sign of more advanced disease, such as emphysema or pulmonary hypertension.Since the first description of the spirometer by John Hutchinson in the late 1800s, pulmonary function tests (PFTs) have expanded to include spirometry; lung volumes; carbon monoxide-diffusing capacity (DLCO) (transfer factor); respiratory muscle performance; and exercise and functional testing, such as the 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET).
Latest:
Posaconazole: A New Triazole AntifungalPosaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
Latest:
The Metabolic Syndrome: Early Clues, Effective ManagementThe metabolic syndrome represents a clustering of conditions and/or risk factors that lead to an increased incidence of type 2 diabetes mellitus and cardiovascular disease. These conditions include abdominal obesity, dyslipidemia, hypertension, insulin resistance, and a proinflammatory state.
Latest:
Nitrofurantoin Pulmonary Toxicity: A Rare but Serious ComplicationNitrofurantoin has been widely used for the treatment and prevention of recurrent urinary tract infections since its introduction into clinical practice in 1953. Although it continues to be an effective antibiotic, nitrofurantoin is associated with several adverse effects, including pulmonary toxicity.
Latest:
Erythema ab Igne in a 66-Year-Old Black WomanThis 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.
Latest:
New Advances in Antiretroviral TherapyIt is estimated that approximately 33.2 million persons worldwide were living with HIV infection in 2007.1 With the development of effective antiretroviral treatment strategies, HIV infection has now become a manageable chronic disease.2 Despite advances in treatment, drug resistance, long-term adverse effects, and high adherence requirements represent ongoing challenges to durable viral suppression.
Latest:
Decision Making Regarding Prescription Drugs: Out-of-Pocket PressuresDr Schommer is professor, University of Minnesota College of Pharmacy, Minneapolis. Cindy Chen, Jagannath Muzumdar and Siting Zhou are doctoral candidates at the University of Minnesota College of Pharmacy.
Latest:
Smallpox Vaccination: The Risks for Patients With Atopic DermatitisBecause of recent threats of bioterrorism, smallpox vaccination was reinstated in the United States earlier this year. Since January 2003, more than 35,000 civilian and public health care workers in 54 jurisdictions have been vaccinated.
Latest:
Spinal Epidural LipomatosisA 62-year-old man who was receiving long-term corticosteroid therapy for Wegener granulomatosis presented with progressive leg weakness over 1 week. He had the stigmata of Cushing syndrome: moon facies, truncal obesity, and a dorsocervical fat pad.
Latest:
Traumatic Brain Injury and Fecal RetentionA 31-year-old man with a history of traumatic brain injury was hospitalized because of failure to thrive, constipation, and intermittent diarrhea with soiling.
Latest:
Inhalational anthrax, part 2: Prevention and treatmentWhen untreated, inhalational anthrax typically resultsin a rapidly fatal illness. Evidence suggests that both theanthrax vaccine and prophylaxis with ciprofloxacin or doxycyclineare effective in preventing illness after inhalational anthraxexposure. The current anthrax vaccine appears to have anadverse-effect profile that is similar to that of other adult vaccines.For patients with active infection, the CDC recommendsa multi-antibiotic regimen that should include doxycycline ora fluoroquinolone and 2 additional antibiotics that have proteinor RNA synthesis inhibition, such as rifampin and clindamycin.Monoclonal antibodies directed against anthrax toxinsmay also play a role in treating active infection. (J Respir Dis.2008;29(6):249-254)
Latest:
Further Evidence That HTLV Protects Against HIV ProgressionPrevious case reports have suggested an association betweenhuman T-cell lymphotropic virus (HTLV) types 1 and 2infection and chronic nonprogressive HIV infection. Evidenceis lacking about the specifics of how the two are related. Wereport 2 cases of chronic nonprogressive HIV infection (of9 and 13 years' duration, respectively) in women in whomHTLV coinfection was diagnosed. These cases provide clinicalsupport that HTLV coinfection may serve as a protective factoragainst progression of HIV infection. Possible reasons for thisrelationship and potential future research are discussed.[Infect Med. 2008;25:416-420]
Latest:
Examination of the Oral Cavity: What to Look ForRoutine inspection of the oral cavity is not a part of every patient encounter. There exist, nevertheless, clear indications for physical examination of the mucosal surfaces between the lips and the anterior tonsillar pillars; these include symptoms such as pain, erythema, and swelling that are referable to this area.
Latest:
Allergic Rhinitis and Asthma: Role of Environmental DeterminantsA review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.
Latest:
H1N1 Influenza Virus of Swine Origin: Emergence of a New Pandemic StrainA novel H1N1 influenza virus has emerged from swine and is causing a worldwide pandemic. Children and young adults have been most affected, in terms of both numbers of cases and severity of disease. Perhaps the most striking feature of the pandemic so far is that fewer than half of those hospitalized or killed by this virus have had identifiable prior medical conditions or risk factors.
Latest:
The Mysterious Case of the Boy who BarkedA 14-year-old with an odd facial rash has vocal outbursts at school, especially when teased and at home when stressed. What’s wrong? Your Dx?
Latest:
Hematemesis Secondary to a Bronchogenic CystA 24-year-old man with an unremarkable medical history presented to the emergency department with abdominal pain and hematemesis of 3 days' duration. His symptoms were postprandial, and each episode yielded up to half a cup of blood without clots. He denied using NSAIDs or alcohol. He had had an episode of hematemesis 2 years earlier that resolved spontaneously, for which he had not sought treatment. His vital signs were normal, and his physical examination was notable only for moderate epigastric tenderness without rebound or guarding.
Latest:
Aspirin-exacerbated respiratory disease: An easy-to-overlook diagnosisAbstract: Patients who have aspirin-exacerbated respiratory disease (AERD) usually experience upper and lower respiratory tract symptoms about 1Z|x to 2 hours after taking aspirin or another NSAID that inhibits the enzyme cyclooxygenase-1. In addition to symptoms such as nasal congestion, rhinorrhea, paroxysmal sneezing, periorbital edema, laryngospasm, and intense flushing, patients may have severe--often life-threatening--exacerbations of asthma. AERD occurs in about 10% to 20% of patients with asthma and in about 30% of asthmatic patients with nasal polyposis. However, AERD also occurs in patients who do not have any of these predispos- ing conditions. In patients with AERD, aspirin desensitization can improve asthma control, reduce the need for corticosteroids, and reduce the need for sinus surgery. (J Respir Dis. 2006;27(7):282-290)
Latest:
A rare complication of empyema: Thoracic aorta perforationThis case represents an unusualcomplication of cellulitiscaused by methicillin-resistantStaphylococcus aureus.
Latest:
Renal Artery Stenosis Complicating Essential HypertensionA 73-year-old man who had a history of long-standing essential hypertension, congestive heart failure, mild renal insufficiency, atrial fibrillation, and a mitral valve replacement presented with refractory hypertension. His medications included labetalol, irbesartan, and furosemide.
Latest:
The Dangers of ATVsAn all-terrain vehicle-ATV-is described by the American National Standards Institute as one that "travels on low pressure tires, with a seat that is straddled by the operator, and with handlebars to be used for steering."1 By this definition, an ATV is designed for interactive riding by a single operator. Drivers are able to shift their weight freely in all directions depending on the situation and terrain. According to ATV safety standards and recommendations, children younger than 6 years are never to be on an ATV of any size-alone or with someone else.
Latest:
Multiple Myeloma With a Gastric PlasmacytomaTwo weeks after being treated for a fracture of the left humerus and several palpable breast lesions, a 63-year-old African American woman was hospitalized for generalized weakness and confusion. She had a history of type 2 diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, and low-grade B-cell lymphoma (which had been in remission for 2 years).
Latest:
3 Things Your COPD Patients May Not Tell You"I'm having trouble catching my breath." "I can't pay for my inhaler." "I'm just so sad." They may not tell us, so we need to ask. Here's my experience.
Latest:
Foreign-Body Retrieval: Diamonds in the RugaeProgressive weakness, confusion, and decreased oral intake preceded hospital admission for this 73-year-old man with a history of Parkinson dementia and resection for esophageal adenocarcinoma. The real problem, seen here, was revealed on a chest x-ray film.
Latest:
The Charcot Foot: A Missed Diagnosis Can Cost a LimbThis enigmatic, destructive, and deforming condition most often affects persons who have diabetes.
Latest:
Nonadherence to therapy is often the culprit Difficult-to-control asthma, part 2: Optimizing therapy key words: Asthma, Allergic rhinitis, GERD, Rhinosinusitisabstract: Common causes of poorly controlled asthma include nonadherence to long-term inhaler therapy; environmental exposures; and uncontrolled comorbidities, such as allergic rhinitis. Adherence can be limited by many factors, including inadequate patient education, medication cost, prior failed treatment, poor physician-patient relationship, unrealistic expectations for therapy, and depression. For patients who have a poor perception of their symptoms, emphasizing the "disconnect" between symptoms and pulmonary function can help motivate them to monitor themselves with a peak flow meter and to adjust their medication accordingly. For patients with allergic triggers, instituting allergen-specific environmental controls can decrease symptoms and urgent care visits for asthma. Chronic rhinosinusitis and gastroesophageal reflux disease can also contribute to difficult-to-control asthma, and treatment of these comorbidities can help reduce asthma symptoms. (J Respir Dis. 2007;28(9):365-369)
