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Pulmonary nocardiosis mimicking empyema necessitatisNocardia asteroides is a rarecause of pulmonary or disseminatedinfection in immunocompetentpersons. Pleuralcompromise is common, butempyema necessitatis is veryrare. The authors describe anapparently immunocompetentpatient with N asteroides infectionwho had chest wallcompromise mimicking empyemanecessitatis.
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Atrial Fibrillation:When - and How - to Convert to Sinus RhythmYour patient with atrial fibrillation (AF)is hemodynamically stable and youhave successfully established rate control.Your next step is to weigh therisks and benefits of attempting to restoresinus rhythm. In up to one half ofpatients, AF of recent onset convertsspontaneously to normal sinus rhythmwithin 24 hours. Thus, in some cases,the most appropriate approach maybe to control the ventricular response,identify and treat comorbid conditions,initiate anticoagulation, and closelymonitor the patient.
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The technique of adult flexible bronchoscopy: Part 1ABSTRACT: Flexible bronchoscopy was clinically introduced byShigeto Ikeda in 1968 and is now used widely for diagnosticand therapeutic interventions. A combination of advancingtechnology and ingenuity has fostered the development of anexpanded array of devices and applications. The newer videobronchoscopes offer higher-resolution images than fiberopticbronchoscopes. The advantages of fiberoptic technology arelower cost and greater technical ease of adapting to smallerdiameterbronchoscopes. Hybrid bronchoscopes have an imaginglens and fiberoptic bundles that transmit the viewingimage to a charge couple device (CCD) chip in the body of theoperator end of the bronchoscope. The digital image is transmittedfrom the CCD chip to the external processor for viewingon a monitor, for digital storage, or for printing. (J Respir Dis.2008;29(11):423-428)
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Dislocated Septal CartilageDislocation of the triangular cartilage of the nasal septum is caused by pressure on the nose before and during delivery. It should not be confused with the transient flattening of the nose during birth.
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Focus on the Needs of Individual Patients- Not of Society as a WholeAny discussion of theutility and reliabilityof mammography mustfocus on what is good forindividual patients-not onwhat the results of a Europeanpublic health researchproject have determined isgood for society as a whole.What is good for most patientsis annual screeningmammography beginningat age 40 years (and for patientsat very high risk forbreast cancer, mammogramsbeginning much earlier,and possibly performedmore frequentlythan once a year).1
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Diagnosis of Atrial Fibrillation: A Guideline ToplineThis AF guideline topline offers an at-a-glance look at the most recent ACC/AHA guidance on diagnosis of the arrhythmia.
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Human and Animal Bites:Each year almost 5 million Americans sustain an animal or human bite. Dog bites alone represent 0.4% to 1% of all emergency department (ED) visits and can range from trivial to life-threatening.
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React to CVD Risk Factors: A Preventive Cardiology Guideline ToplineBased on guidance from the American Society of Preventive Cardiology, this topline summarizes risk factors and interventions to reduce the risk of major adverse CV events.
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Pearly Pink Chest LesionsCan you identify the 2 slowly expanding growths on the chest of this 68-year-old man?
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LeukoplakiaA 39-year-old man was concerned that his history of long-termnicotine exposure placed him at increased risk forthroat cancer. He had used about 2 cans of “dip” each weekfor many years. The patient habitually placed the tobaccoin the right lower lip area; to avoid spitting, he always swallowedthe spent wad. The patient did not smoke; he usedalcohol occasionally.
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Takotsubo Syndrome in an African American Woman With Typical PresentationAlso known as “broken-heart syndrome,” Takotsubo syndrome is a stress-induced cardiomyopathy.
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What’s New in the Treatment of Osteoporosis?That’s the question we put to Dr. Kenneth Saag. In the next few minutes, Dr. Saag, will summarize the latest developments in osteoporosis therapy.
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Complications of Body ArtPrimary care providers are seeingan increasing number ofpatients who have snakes orbarbwire coiling around theirarms or gold rings danglingfrom their eyebrows and navels. Tattooingand body piercing are particularlypopular among adolescents andyoung adults-many of whom may notbe aware of the possible medical complicationsof these ancient practices.
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Takotsubo Cardiomyopathy in a Man With a Gunshot WoundA 48-year-old African American man with no significant medical history sustained a gunshot wound to the face and shoulder.
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Incomplete LV Rupture Secondary to MI: A Case of Intramyocardial DissectionMyocardial rupture is the most feared and often lethal complication of acute MI. It was a potential diagnosis for this patient who presented with sinus tachycardia, ST-segment elevation from V1 to V4, II, III, and aVF with associated Q waves. Follow the workup and outcome here.
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Follow-up of Childhood Cancer Survivors: The Role of the Primary Care PhysicianA 16-year-old boy with a history of leukemia at age 12 years complains of right hip pain of several months' duration. A 34-year-old woman who had Hodgkin lymphoma at age 14 years comes in for a routine physical.
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Post-Test on Rheumatoid Arthritis in Primary CareUse this short test to gauge how much you’ve learned about a condition that needs more primary care involvement.
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The 10 Most Common Prescribing Errors: Tips on Avoiding the PitfallsNumerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.
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Thyrotoxicosis presenting as pulmonary hypertensionThe authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.
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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.
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Pulmonary hypertension in the elderly, part 2: TreatmentABSTRACT: The treatment of pulmonary arterial hypertension(PAH) is directed at the underlying cause, such as diastolicheart failure or chronic thromboembolic disease. Patients withidiopathic PAH or PAH associated with connective-tissue diseasewho have World Health Organization (WHO) functionalclass II or III PAH should receive a trial of oral bosentan, ambrisentan,and/or sildenafil; inhaled iloprost is an alternative oran additive agent. If patients fail to respond to these interventionsor if they have WHO functional class IV PAH, considersubcutaneous or intravenous treprostinil or epoprostenol. Theuse of these latter agents is much more complicated and maybe difficult to initiate in elderly patients. (J Respir Dis. 2008;29(12):468-474)
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Mesenteric Venous ThrombosisA 63-year-old man with a history of hypertension and gastroesophageal reflux disease presented with progressive, sharp mid-abdominal pain of 3 weeks' duration.
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Erythema ab Igne After Frequent Heating Pad UseA 62-year-old woman presented with a rash and intermittent pain of the right upper quadrant. The reticular, brown hyperpigmentation was also seen on her right flank and around the umbilicus. The patient reported that she often applied heating pads to these areas for pain relief.
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CARDIAC DRUG THERAPY (ed 6)In this compact clinical guide, the author presents detailed prescribing advice forall types of cardiac patients. The first chapters are devoted to the principal classesof cardiac drugs: β-blockers, angiotensin-converting enzyme inhibitors, angiotensinII receptor blockers, calcium antagonists, and diuretics. These chapterscover such topics as indications, contraindications, adverse effects, interactions,dosages, differences between the available agents in a given class, and how tochoose the most appropriate agent from a class for a particular patient. Chapterson the management of the various cardiac disorders-hypertension, angina, acutemyocardial infarction, heart failure, arrhythmias, cardiac arrest, infective endocarditis,and hyperlipidemia-comprise the core of the book. There are also chapterson antiplatelet agents, anticoagulants, and thrombin inhibitors; and the use ofcardiac drugs during pregnancy and lactation. The sixth edition features a newchapter on recent clinical trials, new American Heart Association cardiac arresttreatment algorithms, current hypertension management guidelines, and expandeddrug administration and dosage tables. Numerous tables, charts, algorithms,and graphs accompany the text.
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Osteomyelitis in a 75-Year-Old Heroin UserPresenting complaints were fever, nausea, and lower abdominal pain that worsened with walking. Osteomyelitis is not commonly included in a differential for abdominal pain. This case is different.
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Ophthalmic ZosterSeveral days earlier, a 69-year-old man had a mild headache, fatigue, and tingling and prickly facial sensations. Shortly afterward, this painful, “weepy” rash developed on his forehead, upper cheek, and nasolabial folds and vision in the right eye became blurry. The patient’s history included type 2 diabetes mellitus, hypertension, and childhood varicella.
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Bilateral Painless Swelling of the Neck in a 40-Year-Old ManOn palpation, the swelling was non-tender, soft, and mobile but did not feel fluid-filled. Here, view ultrasound findings and propose your diagnosis.
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Aquagenic UrticariaSwelling of the wrists and ankles of 3 months' duration prompted a 33-year-old man to seek medical attention. The swelling was highly migratory, with periods of regression that lasted several days at a time. The patient also had a 3-year history of "breaking out" after contact with water. He had no personal or family history of asthma, allergies, or other atopic disorders. He was not taking any medications.
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Asthma Disease Burden and Formulary Decision Making: MCO and Employer PerspectivesAsthma affects approximately 22 million adults and children in the United States and poses a significant economic burden on the health care system and on employers. According to the National Heart, Lung, and Blood Institute, direct and indirect costs for all forms of asthma totaled $19.7 billion in 2007. Prescription drugs represented the largest single direct cost at $6.2 billion.
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Fever and Rash: Infection or Kawasaki Syndrome?Kawasaki syndrome (KS) is a common and serious disorderthat most often affects children aged 1 to 8 years but mimicsa range of other diseases of childhood. Diagnosis of KS isbased on physical examination findings coupled with theexclusion of other causes. To provide optimal care for patients,it is important to be aware of the differential diagnosis of KS.We report a case of a 4-year-old boy who presented withpersistent fever and cervical lymphadenitis; later, mucousmembrane changes, rash, and conjunctival injectioncharacteristic of KS developed. [Infect Med. 2008;25:320-322]
