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Acute Suppurative Thyroiditis in a Patient With Aplastic AnemiaAcute suppurative thyroiditis (AST) is a rare inflammatorycomplication in patients with hematological malignancy.Infection spreads to the thyroid from a distant site throughthe bloodstream or the lymphatics. Defects such as persistentthyroglossal duct and pyriform sinus fistula are associatedwith the development of AST. Ultrasonography, bariumswallow testing, CT, and fine-needle aspiration are usedfor diagnosis. Treatment includes the administration ofparenteral antibiotics, drainage, and excision. We describea patient with aplastic anemia and bacteremic AST.[Infect Med. 2008;25:339-342]
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Leprosy (Hansen Disease)Leprosy, or Hansen disease, had recently been diagnosed in a 39-year-old man. He presented to the tropical disease unit of Harare Hospital, Zimbabwe, for follow-up.
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Inferior Myocardial Infarction With Right Ventricular InvolvementRight Ventricular involvement in acute inferior MI is an independent predictor of major complications and in-hospital death, as this case demonstrates. While in-hospital prognosis after left ventricular infarction is directly related to the postinfarct LV ejection fraction, involvement of the right ventricle drastically alters that linear relationship.
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Lhermitte-Duclos DiseaseLhermitte-Duclos disease is a rare, slow-growing, benign lesion of the cerebellum and is considered a hamartomatous tumor of the cerebellar cortex.
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How to differentiate from restrictive cardiomyopathy Recognizing constrictive pericarditis as a cause of shortness of breath key words: Constrictive pericarditis, Pericardial calcificationabstract: In the past, constrictive pericarditis was most often caused by tuberculosis. Today, however, it is more likely to be preceded by injury or trauma, infection, or previous cardiac surgery. Most patients with constrictive pericarditis present with dyspnea and have elevated jugular venous pressure. Other potential symptoms and signs include peripheral edema, abdominal fullness, hepatomegaly, ascites, and chest pain. Electrocardiography demonstrates nonspecific ST-segment and T-wave changes and generalized T-wave inversion or flattening. In many cases, chest radiography and CT reveal pericardial calcification, and echocardiography shows increased pericardial thickness and calcification. Treatment may include NSAIDs, corticosteroids, antibiotics, angiotensin-converting enzyme inhibitors, and diuretics. Surgery is the treatment of choice for chronic disease, and pericardiectomy is typically effective. (J Respir Dis. 2007;28(2):49-56)
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Catscratch Disease Presenting as Acute Respiratory DistressSuperficial adenopathy is the most common symptom ofcatscratch disease (CSD) attributed to Bartonella henselaeinfection. More complicated adenopathy with pulmonaryinvolvement can occur. We report a case of a 15-year-oldboy with pleural symptoms related to B henselae–associatedCSD. [Infect Med. 2008;25:248-250]
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Pressure AlopeciaA 50-year-old man had been hospitalized for 27 days, 12 of which he spent comatose, lying on his back. A few days after discharge, he noticed a bald spot on the back of his head. The 2.5 × 3-cm area of alopecia was in the occiput, and the affected portion of the scalp was mildly erythematous.
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Acute Suppurative Thyroiditis in a Patient With Aplastic AnemiaAcute suppurative thyroiditis (AST) is a rare inflammatorycomplication in patients with hematological malignancy.Infection spreads to the thyroid from a distant site throughthe bloodstream or the lymphatics. Defects such as persistentthyroglossal duct and pyriform sinus fistula are associatedwith the development of AST. Ultrasonography, bariumswallow testing, CT, and fine-needle aspiration are usedfor diagnosis. Treatment includes the administration ofparenteral antibiotics, drainage, and excision. We describea patient with aplastic anemia and bacteremic AST.[Infect Med. 2008;25:339-342]
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Myocardial Infarction: New Meaning, Same NameIn 2000, MI was defined as any necrosis in the setting of myocardial ischemia. The 2007 update to this definition recognized that different conditions can lead to myocardial necrosis and 5 types of myocardial infarctions were defined.
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Medication Nonadherence and the Risks of Hospitalization, Emergency Department Visits, and Death Among Medicare Part D Enrollees With DiabetesThe authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.
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Economic Evaluation of a Prior Authorization Program for Biologic Response ModifiersSpecialty medications constitute the fastest-growing segment of drug spending under the pharmacy benefit. This study evaluated the impact of a specialty pharmacy prior authorization (PA) program on prescription drug costs for biologic response modifiers (BRMs) used in the treatment of persons with rheumatoid arthritis, juvenile rheumatoid arthritis, Crohn disease, ankylosing spondylitis, psoriatic arthritis, psoriasis, and other spondyloarthropathies. A retrospective, case-control, one-to-one matching approach based on patient age, sex, and client characteristics was used. Case clients were enrolled in the specialty pharmacy PA program from January 1 through December 31, 2005. The control group consisted of clients who were not enrolled in the program during this time. The average costs per eligible member per month (PMPM), for the total, plan, and member were $1.32, $1.29, and $0.03, respectively, in the case group, and $1.44, $1.41, and $0.03, respectively, in the control group. Clients who implemented the specialty pharmacy PA program for BRMs saved an estimated total cost of $0.12 PMPM. Implementing a specialty pharmacy PA program reduced BRM costs. (Drug Benefit Trends. 2008;20:26-31)
Latest:
Acute Suppurative Thyroiditis in a Patient With Aplastic AnemiaAcute suppurative thyroiditis (AST) is a rare inflammatorycomplication in patients with hematological malignancy.Infection spreads to the thyroid from a distant site throughthe bloodstream or the lymphatics. Defects such as persistentthyroglossal duct and pyriform sinus fistula are associatedwith the development of AST. Ultrasonography, bariumswallow testing, CT, and fine-needle aspiration are usedfor diagnosis. Treatment includes the administration ofparenteral antibiotics, drainage, and excision. We describea patient with aplastic anemia and bacteremic AST.[Infect Med. 2008;25:339-342]
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Nasal HemangiomaA 21-year-old woman had suffered recurrent nosebleeds and pain in her nose for the previous 2 months. Physical examination revealed an extremely vascular, slowly enlarging intranasal growth on the anterior surface of the septum.
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Case In Point: Acute eosinophilic pneumonia in a 19-year-old manThe authors describe a case of acute eosinophilic pneumonia (AEP) that occurred in a previously healthy young man. The presentation was similar to that of acute respiratory distress syndrome (ARDS), and the diagnosis was established by bronchoalveolar lavage (BAL). The authors note that it is important to recognize the subset of patients with AEP who present with an ARDS-like picture, especially since corticosteroids are very effective in this setting.
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Emphysematous Pyelonephritis Caused by Pasteurella multocidaEmphysematous pyelonephritis (EPN) is a rare but life-threatening infection characterized by widespread necrosis and production of gas within the kidney.
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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.
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Crusty Scalp LesionAn 89-year-old woman is seen for an erosion on the frontal area of the scalp. History is positive for actinic keratosis. What's your Dx?
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Bacterial ArthritidesGonococcal infection is the leading cause of bacterial arthritis in adults.
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Arterial and Venous Thrombosis From a Patent Foramen Ovale (With Video)A 59-year-old man presented with painful paraparesis of acute onset, severe low back pain, and shortness of breath. On initial examination, he had 0/5 strength and numbness in his lower extremities. The skin from below his umbilicus to his lower legs was pale.
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New Orleans Now -- Few Doctors in the HouseA Multimedia Special ReportThis special report from Zach Wise, a MedPageToday contributing photographer, presents the sights and sounds of New Orleans medicine a year after Hurricane Katrina.
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Case In Point: Peripheral nerve sheath tumor mimicking pulmonary embolismWe describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.
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Wellens SyndromeA 72-year-old obese man with chronic atrial fibrillation, hypertension, hyperlipidemia, and a history of tobacco use presented for a routine office visit. A year earlier, he began to experience recurrent chest pain, but an ECG had shown normal T waves.
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Pretibial MyxedemaThe persistent effects of Graves disease were evident in a 48-year-old woman who had recently emigrated from Haiti to the United States. Thyrotoxicosis had developed several years before she sought treatment in her native country. The patient's obstructive goiter was removed and treatment with thyroxine was begun.
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Abnormal Liver Function Tests:ABSTRACT: Serum levels of aspartate aminotransferase and alanine aminotransferase that exceed 1000 IU/L indicate acute viral hepatitis (A, B and, rarely, C), acute drug toxicity (eg, acetaminophen overdose or isoniazid hepatotoxicity), or ischemic liver injury. In chronic hepatitis (ie, hepatitis B or C or autoimmune), values range from mildly elevated to usually less than 400 IU/L. Elevated levels of alkaline phosphatase and gamma;-glutamyltransferase (GGT) are consistent with cholestatic disease: primary biliary cirrhosis, primary sclerosing cholangitis, idiosyncratic drug reactions, or mechanical biliary obstruction (eg, biliary stones or tumor). Elevation in the GGT level can also be induced by alcohol consumption or medications (eg, phenytoin). Isolated unconjugated hyperbilirubinemia suggests Gilbert syndrome or a hematologic disorder; conjugated hyperbilirubinemia reflects impaired hepatic excretion. Serum bilirubin and albumin and INR have prognostic significance in chronic liver disease; bilirubin and INR are more useful in acute liver failure because albumin has a long half-life.
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Hip Pain, Irregular Skin Lesions in a 12-year-old GirlA symptom and a sign from a triad that is pathognomonic for this patient's condition. What's your Dx?
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Pediatric and Adolescent Migraine: Update on Treatment OptionsIf the goal of headache therapy for adolescent migraineurs is a pain-free adult life, here's a road map.
