March 6th 2025
The FDA set the Prescription Drug User Fee Act (PDUFA) date for December 16, 2025.
Management of COPD: What's New, What's Next
January 1st 2004Bronchodilators, preferably inhaled, are recommended for all patients with chronic obstructive pulmonary disease; ipratropium, with a 6- to 8-hour duration of action, is effective maintenance therapy. Tiotropium is currently being reviewed by the FDA for release in the United States; its once-daily dosing schedule may facilitate adherence. Criteria for long-term oxygen therapy are severe hypoxemia (PaO2, 55 mm Hg or lower) or a PaO2 of 60 mm Hg or lower with signs of cor pulmonale or secondary polycythemia (hematocrit higher than 55%). When symptoms are disabling despite optimal medical management, referral for pulmonary rehabilitation is the next step. Patients with upper lobe-predominant emphysema and low exercise capacity may benefit most from lung volume reduction surgery. Consider transplantation if the patient has severe lung disease that is refractory to medical therapy and survival is expected to be less than 2 to 3 years.
How to Handle Chronic Cough in Kids:
December 1st 2003ABSTRACT: A cough is considered chronic when it persists for 3 or more weeks. Typically, chronic cough is a lingering manifestation of a viral upper respiratory tract infection; other, more serious causes-such as asthma, sinusitis, or gastro- esophageal reflux-must also be considered. Look to the history for diagnostic clues and order a chest film, which may point to pneumonia, hyperinflation, atelectasis, or cardiac or pulmonary abnormality. Diagnostic test methods will depend, in part, on the child's age; for example, the American Academy of Pediatrics recommends against imaging of the sinuses in children 6 years or younger. Pulmonary function tests can be useful in diagnosing asthma if the child is able to cooperate. Consider ordering a barium swallow for a very young child whose cough may be the result of a vascular anomaly. A pH probe study can help you determine whether cough is secondary to gastroesophageal reflux. Treatment is directed at the underlying cause.
CASE 5: Palmoplantar Psoriasis
June 1st 2003A 63-year-old woman presents withdiffuse hyperkeratosis of the solesand palms. She also has onycholysis-separation of the nail plate fromthe nail bed-and salmon-coloredplaques behind her ears. Biopsy ofone of the plaques confirms the suspecteddiagnosis of psoriasis.
Psoriasis: Update on Therapy for the Various Manifestations
June 1st 2003A middle-aged man with"jock itch" that has failed torespond to antifungal creams.An older woman who has diffusehyperkeratosis of predominantlyweight-bearing surfaces.A young man with mildlypruritic, small, salmon pinkpapules and thick white scaleon his trunk and arms.
CASES 4A AND 4B: Guttate Psoriasis
June 1st 20034A:Small, slightly pruritic, salmonpink papules with thick white scalehave arisen over the past 5 days onthe trunk and arms of a 24-year-oldman. The patient has a history ofvery mild psoriasis vulgaris of the elbows,knees, and scalp; he deniesstreptococcal pharyngitis or other recentinfections. Guttate psoriasis isdiagnosed.
CASE 8: Erythrodermic or Pustular Psoriasis
June 1st 2003A 60-year-old man with a long historyof psoriasis vulgaris required a systemiccorticosteroid for a severe exacerbationof asthma. Soon after theErythrodermic or Pustular Psoriasiscorticosteroid was discontinued, generalizederythema and scaling of theskin developed.
Dermatitis on the Hands and Chest
September 1st 2002A 12-year-old boy with a history of atopy complained of pruritus and severe dryness of the hands. Over-the-counter moisturizers failed to resolve the condition. The patient did not wash his hands frequently and had no hobbies that exposed him to environmental irritants or allergens.
Deep Venous Thrombosis and Pulmonary Embolism
June 1st 2002For 2 months, a 31-year-old woman had had dyspnea anddull, continuous retrosternal pain. She was admitted to thehospital, and a helical CT scan of the thorax identified asaddle pulmonary embolism. An ultrasonogram revealeddeep venous thrombosis (DVT) in the left leg. Intravenousheparin was given; the patient was discharged,and warfarin was prescribed.