Alan C. Moss, MD


Extraintestinal Manifestations of Inflammatory Bowel Disease: Common and Manageable

Extraintestinal manifestations of inflammatory bowel disease affect the musculoskeletal, dermatologic, ocular, renal and pulmonary systems.

Alan M. Spira, MD


Ebola Hemorrhagic Fever and Marburg Hemorrhagic Fever

Ebola virus and Marburg virus are responsible for Ebola hemorrhagic fever (EHF) and Marburg hemorrhagic fever (MHF), respectively.

Alan P. Knutsen, MD


When to suspect allergic bronchopulmonary aspergillosis

Abstract: Inhalation of Aspergillus is responsible for a variety of lung infections and diseases; Aspergillus fumigatus is the most common causative agent. Allergic bronchopulmonary aspergillosis (ABPA), caused by sensitivity to A fumigatus, is diagnosed primarily in persons with asthma or cystic fibrosis. Differentiating ABPA from other Aspergillus-related lung infections and diseases is often challenging. A patient's symptoms, underlying risk factors, and any prior pulmonary disease contribute to the diagnosis. Findings include pulmonary infiltrates, total serum IgE levels greater than 1000 IU/mL, IgE and IgA anti-A fumigatus antibodies, peripheral blood and pulmonary eosinophilia, and central bronchiectasis. Untreated ABPA often results in chronic bronchiectasis, pulmonary fibrosis, and dependence on corticosteroids; an accurate diagnosis of ABPA is critical to avoiding irreparable disease. (J Respir Dis. 2006;27(3):123-134)

Alan T. Kelley, MD, MPH


Lower Quadrant Pain and Emesis in a Young Boy

The 9-year-old was admitted after 1 day of symptoms; he had no fever, diarrhea, constipation, dysuria, or rash. More details here. What's your diagnosis?

Alan Wasserman, MD


Chest Pain: Is It Life-Threatening, or Benign?

Ruling out coronary artery disease is the first step in assessing chest pain.

Albert E. Stanek, MD


Case In Point: Coexisting Hodgkin disease and lung cancer in a patient with AIDS

The patient was a 41-year-old manwith a history of HIV infection diagnosed10 years before admission.He had been noncompliant withtreatment, and therapy with tenofovir,efavirenz, and lamivudinehad not been started until 2 monthsbefore admission, when he presentedto another hospital. At thetime, his CD4+ cell count was156/µL and his viral load was45,743 copies/mL. He also had ahistory of incarceration; had usedinjection drugs, cocaine, alcohol,and marijuana; and had a 20-packyeartobacco history.

Albert I. Wertheimer, PhD, MBA


Is Prior Authorization for Prescribed Drugs Cost-Effective?

With the increasing managed care restrictions on health care coverage, a look into the efficacy of some of these procedures is needed. This study examines the cost burden of implementing prior authorization (PA) for prescription drugs. Seventy-five prescriptions dispensed by 2 Philadelphia pharmacies requiring PA were tracked and the savings analyzed. Requiring PA proved to be financially beneficial to MCOs but resulted in an increase in uncompensated time for physicians and pharmacies. Two classes of drugs, antihistamines and proton pump inhibitors, accounted for 48% of the medications requiring PA. By educating plan members in advance concerning coverage limits for these medications, MCOs could decrease the use of PA and reduce the amount of time spent by physicians, pharmacists, and patients in dealing with this procedure. (Drug Benefit Trends. 2008;20:136-139)

Albert L. Vincent, PhD


Disseminated Fusariosis Following Cutaneous Injury From Contact With a Palm Tree

Opportunistic fungal infections are increasingly common inpatients who undergo hematopoietic stem cell transplant(HSCT). Voriconazole is frequently used in allogeneicSCT recipients who receive immunosuppressant therapy forgraft versus host disease to prevent invasive aspergillosis.Indications for voriconazole use include invasive aspergillosis,candidemia, Scedosporium apiospermum infection, and fusariosis.We describe a case in which disseminated Fusarium infectiondeveloped in an HSCT recipient who was receiving voriconazoletherapy. [Infect Med. 2008;25:528-530]

Albert Lai, MD


Pneumococcal Pneumonia: Update on Therapy in the Era of Antibiotic Resistance

Sir William Osler once called pneumococcalpneumonia “the captain of themen of death.”1 Pneumonia is the sixthleading cause of death in the UnitedStates and the fourth leading causeamong Americans 80 years of age andolder.2

Albert Wertheimer, PhD, MBA


Why Is the Trial Dose Not Available?

An important study demonstrated the efficacy of chlorthalidone for the treatmentof systolic hypertension in elderly persons,1 and the results have been validatedby other studies.

Albert Y. F. Kong, MD


Hairy Hyperpigmented Lesion on a Teenager’s Back

A 16-year-old boy with asymptomatic, hyperpigmented, hairy lesion on his left upper back. The pigmentation, first noted 5 years earlier, had progressively spread across his torso. The coarse and dark hair confined to the hyperpigmented area had appeared at age 13 years. Medical history uneventful. Review of systems showed no abnormalities. No family history of similar skin lesions.

Alberto Montero, MD


Worsening Neurological Symptoms in an Older Man With History of Rectal Cancer

A 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.

Aleksander Shalshin, MD


Massively Dilated Esophagus

For the past year, a 52-year-old man had dysphagia, which he described as a “knot stuck in the throat” and an associated 25-lb weight loss. He denied fever, chills, headache, abdominal pain, and diarrhea. The patient had been living in the Dominican Republic until about 1 year earlier, when he moved to the United States. He had a 30 pack-year smoking history; he also had hypertension, asthma, and coronary artery disease (none of which were pharmacologically treated). He denied alcohol and illicit drug use.

Aleksandra Walasek


Actinic Keratosis and Squamous Cell Carcinoma: Photodamage in Progress

Actinic keratosis and squamous cell carcinoma often are clinically indistinguishable. Get tips on what to look for and how to treat.

Alessandra Haskin


Temporary Henna Tattoo Could Leave an Indelible Mark

When in the Caribbean, why not get a tattoo? This man could now tell you exactly why to resist the vacation temptation.

Alex Green, DO


Middle-Aged Woman With Numerous Skin Lesions

A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications-none of which are new.

Alex J. Mechaber, MD


Paraesophageal Hiatal Hernia

A 97-year-old woman with a history of hypertension and a paraesophageal hiatal hernia presented with abdominal distention and shortness of breath. Three days earlier, she had fallen and sustained a hairline pelvic fracture; she was evaluated in the emergency department and given narcotics for the pain. Subsequently, the patient's abdomen became increasingly distended, and she had no bowel movement for 3 days.

Alex M. Gerber, DO


Woman With Lousy Eyelashes

For several months, a 45-year-old woman had ocular irritation, tearing, blurred vision, and swelling of the eyelids in both eyes. During that time, she had been treated for allergic conjunctivitis and blepharitis by several physicians, including an ophthalmologist. Her medical history included lupus and seasonal allergies, for which she was taking hydroxychloroquine and loratadine.

Alex Ward, PhD


Economic Burden Associated With Parkinson Disease

The objective of this study was to estimate the annual cost burden of Parkinson disease (PD) in the United States. Resource use and cost profiles were developed using all-payer statewide hospital discharge data from 6 states; emergency department visit, long-term–care, and national survey data; fee schedules; and published study findings. (Average direct and indirect costs per patient were calculated in 2007 US dollars.) The annual cost per patient was $21,626 (direct cost: $12,491). When applied to the US PD population (N = 500,000), the annual average cost was approximately $10.78 billion (direct costs, $6.22 billion; indirect costs, $4.56 billion). PD has substantial economic consequences for patients and their families, insurers, and society. (Drug Benefit Trends. 2009;21:179-190)

Alexander Butkevich, MD


Rate-Related Septal Infarct Pattern

A 64-year-old asymptomatic woman with a 10-year-history of hypertension was referred for blood pressure control. She had no other significant medical history. The patient denied exertional chest discomfort or dyspnea. Her medications included atenolol, lisinopril, and hormone replacement therapy.

Alexander Feoktistov, MD, PhD


Boy With Frequent, Severe Unilateral Headaches

A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.

Alexander G. Duarte, MD


Evaluating hypoxemia in the critically ill

Abstract: Prompt correction of hypoxemia is a basic goal in the treatment of critically ill patients. Improvements in global oxygen delivery may be achieved by several means, such as providing an adequate fraction of inspired oxygen and using packed red blood cell transfusions for volume resuscitation. Low levels of positive end-expiratory pressure often help improve arterial oxygen tension. Measurement of mixed venous oxygen saturation (Sv?248-175?O2) can be useful in patient assessment. Sv?248-175?O2 may be decreased in patients with hypoxemia, hypovolemia, or anemia and may be elevated in patients with sepsis. Serum lactate levels may not quantitate the degree of tissue hypoxia, but serial measurements can help monitor the patient's response to therapy. For patients with septic or hypovolemic shock, early fluid resuscitation with isotonic crystalloid solution is essential. Catecholamine vasopressors can be useful when fluid administration fails to restore adequate blood pressure. (J Respir Dis. 2005;26(5):209-219)

Alexander K. C. Leung, MD


Teenager With Small Red Papules on Her Arms and Thighs

17-Year-old girl with a 7-month history of small, red papules on her arms and thighs. Rash is not painful or itchy. Otherwise in good health.

Alexander M. Sy, MD



An 18-year-old woman from Mexico was hospitalized because of severe headache with nausea and vomiting. Her headaches had started 4 years earlier and had progressively worsened. They occurred mainly in the occipital region and were pulsating, worse on bending down, and unrelieved by any medication. They were often accompanied by dizziness and presyncope.

Alexander S. Niven, MD


Making the most of pulmonary function testing in the diagnosis of asthma

Although the results of a thorough history and physicalexamination often suggest the diagnosis of asthma, confirmatorytesting is required and may be helpful in more subtlecases. Spirometry before and after bronchodilator administrationis the first step for the initial diagnosis; it also is an importantcomponent of the long-term assessment of asthma control.When the results of spirometry are normal in a patient in whomasthma is suspected, bronchoprovocation challenge testingwith methacholine is generally considered the next diagnosticstep. Numerous alternative methods of bronchoprovocationtesting have been developed, such as the challenge with adenosine5'-monophosphate. Novel methods such as the forced oscillationtechnique and the measurement of exhaled nitric oxidehold promise for more effective diagnosis and monitoringof asthma in the future. (J Respir Dis. 2008;29(4):157-169)

Alexander V. Ng, PhD


Wellness Program Improves Self-Efficacy in Multiple Sclerosis

Here: more evidence that with the proper tools and motivation, health and wellness are attainable goals-even within the constraints of MS.

Alexandra Flamm, MD


Metastatic Carcinoma

A 60-year-old Caucasian man with a history of invasive squamous cell carcinoma of the lung presents with the lesions shown. Metastases to the skin can be a clinical finding in many malignancies.

Alexandria Bachert


Poor Sleep May Hike Mortality in Metabolic Syndrome

In the context of metabolic syndrome, sleep is thought to be an added and modifiable risk factor.

Alexandria Bachert, MPH


Coffee: No Harm, No Foul If Only 4 Cups Daily

Newest news on coffee, from BMJ: "...more likely to benefit health than to harm it..." High vs low intake reduces risk of diabetes and  Alzheimer disease. Plus, more. 

Alexey Amchentsev, MD


Septic Pulmonary Emboli

A51-year-old man who was an active injection drug user was admitted to the ICU with septic shock and severe respiratory distress. Notable findings were fever, multiple opacities on a chest radiograph, and an elevated white blood cell count.

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