A previously healthy 40-year-old man presents with a 2-hour history of excruciating colicky pain of acute onset that emanates from the right flank and radiates to the groin. He rates the severity of the pain at 9 on a scale of 1 to 10. Before arriving at the emergency department, the patient experienced nausea and 2 episodes of nonbilious, nonbloody vomiting.
A 34-year-old woman presented with a blistering, intensely pruritic rash that had erupted 3 days earlier. Multiple papular lesions were densely clustered on areas of exposed skin. Excoriations were present, but there was no evidence of bacterial infection.
These pinpoint pustules, some with excoriations, and surrounding erythema appeared on the posterior trunk and outer arms of a 15-year-old boy after he had wrapped his upper body in a wool blanket. These lesions were occasionally pruritic, especially on the arms, where most of the excoriations were noted.
A 70-year-old man was hospitalized after he fell and was unable to rise because of weakness. He denied dyspnea, chest pain, palpitations, vertigo, light-headedness, preceding aura, hematemesis, hematochezia, and melena. For the past year, the patient had had intermittent low-volume, watery diarrhea that had recently begun to occur daily; he had also lost 13.5 kg (30 lb) during the past 6 months. Shortly after he was admitted, scrotal edema, discoloration, bullae, and erythema of the upper left thigh developed.
The use of analgesics, specifically acetaminophen, has been proposed as one of the mechanisms for the rise in asthma prevalence in the last 30 to 40 years.1 Acetaminophen, approved by the FDA in 1951, is one of the most commonly used analgesics in adults and children. The association between asthma and acetaminophen has been reported in case reports, in the setting of oral challenge tests, and in larger clinical studies.2
These sinuses are lined by a membrane. When this membrane becomes inflamed--usually as a result of an infection or obstruction--you can get sinusitis. Sinusitis can be acute, recurrent, or chronic. Acute sinusitis responds well to treatment within a few weeks. Recurrent sinusitis is characterized by episodes that repeat at least 4 times a year. Sinusitis is considered to be chronic when symptoms persist for at least 12 weeks after treatment of acute sinusitis has ended.
A 24-year-old Korean woman, who was 20 weeks' pregnant, was referred to an allergist for an elimination diet and evaluation of the risk of allergies to her unborn child. She had a several-year history of perennial allergic rhinitis with seasonal exacerbations.
Abstract: Many patients with sarcoidosis are asymptomatic at presentation and have bilateral hilar adenopathy on a chest radiograph obtained for other reasons. Symptomatic patients usually present with chronic cough, dyspnea, or noncardiac chest pain. Extrapulmonary organ involvement is not uncommon. Lung biopsy shows well-formed noncaseating granulomas in a bronchovascular distribution. Interstitial lung disease also may result from collagen vascular disease, such as systemic lupus erythematosus and Sjögren syndrome. In patients with acute hypersensitivity pneumonitis, cough, dyspnea, and flu-like symptoms occur within 12 hours of exposure to the inciting antigen, such as pigeon stool or moldy hay. Some patients have a subacute or chronic course, probably as a result of continued exposure to the offending antigen. In acute hypersensitivity pneumonitis, the chest radiograph may show diffuse small nodules, whereas in chronic disease, reticular lines or fibrosis may be seen. (J Respir Dis. 2005;26(10):443-448)
Abstract: Chronic rhinosinusitis can be caused or aggravated by a number of factors, including bacterial, viral, and fungal infections; asthma; allergies; and obstruction caused by nasal polyps or a deviated nasal septum. The diagnosis can usually be established clinically. Imaging studies are not routinely necessary, but a CT scan of the sinuses should be obtained if the patient has significant ocular or orbital symptoms or if sinus surgery is planned. Treatment consists of antibiotics, with consideration of a change in the regimen if the patient has already received a full course of a first-line agent. The course of treatment may need to extend to 4 weeks. Also consider adjunctive therapy, such as intranasal corticosteroids and decongestants. Patients who have allergic rhinitis may also benefit from an antihistamine and/or a leukotriene modifier. Sinus surgery is reserved for patients who do not respond to medical therapy. (J Respir Dis. 2005;26(10):415-422)
Influenza vaccinationcontinues to be the primarymethod of preventinginfluenza and its lifethreateningcomplications.In preparation forthis year’s influenza season,the Advisory Committeeon ImmunizationPractices (ACIP) has publishedits recommendationsfor the preventionand control of influenza.1
A 4-year-old boy is admitted with a 2-week history of high fever with rigors; profuse night sweats; progressive dull, aching, nonradiating right upper quadrant pain; and watery, foul-smelling diarrhea that contains no blood or mucus.
A 24-year-old woman complains of a severe, throbbing headache that is present when she is upright and is relieved when she lies down. When she is upright, she also experiences dizziness, blurred vision, light sensitivity, nausea, and occasional diplopia.
In patients with underlying disease, a preoperative evaluation and targeted perioperative management strategies can minimize surgical complications and maximize healing. This article focuses on how to identify surgery patients at risk for complications caused by diabetes, chronic obstructive pulmonary disease (COPD), and other medical conditions; I also describe strategies to minimize such risk.
A 68-year-old man with a prosthetic mitral valve presents to the emergency department with acute abdominal pain, nausea, vomiting, and constipation. Surgical evaluation is performed; the results suggest a complete bowel obstruction. Urgent celiotomy is recommended.
An acneiform eruption, pruritic papules on the extremities, pustular scalp lesions--can you identify the disorders pictured here?
Skin signs of systemic disease: sarcoidosis, rheumatoid nodules, Muir-Torre syndrome, diabetic vasculopathy, hyperlipidemic nodules, zinc deficiency, and Sister Mary Joseph nodule.
Following a complicated vaginal delivery 4 months earlier, a 22-year-old mother of a healthy 9.5-lb infant girl experienced stool incontinence and leakage. An infection had occurred at the site of the episiotomy shortly after the delivery; fecal and flatus incontinence developed about 2 weeks later.
For 3 days, a 10-year-old girl had redness and vesicles on her right volar wrist. She had not had any pain, fever, or other systemic symptoms.
Asthma is one of the most common chronic diseases worldwide, and its prevalence--particularly among children--is increasing in many countries.1,2 In 1997, an estimated 9.6% of persons in the United States had asthma (Table 1).3
A menagerie of zoonotic diseases.
A 10-year-old girl has had a worsening rash for 1 week. The mildly pruritic, nontender eruption initially appeared on the child's thighs and then spread to the arms and face. The child's right hand, feet, and ankles have been swollen for the past 4 days, which has made ambulation intermittently painful.
A verrucous birthmark, a rash at the commissure of the lips, proximalnail changes--can you identify the disorders pictured here?
The patient is a 12-year-old Hispanic boy with hemophilia A (factor VIII deficiency) and high Bethesda unit factor VIII inhibitor who presented to a clinic after 4 days of abdominal pain and clear, nonbilious vomiting. Viral gastroenteritis had been diagnosed, and the boy was given rabeprazole and promethazine, which failed to resolve symptoms. The patient was hospitalized when he became unable to tolerate oral fluids; his urinary output decreased. He denied fever, diarrhea, hematemesis, hematochezia, and melena.
An enlarging mass was noted on the dorsum of the right fifth toe of a 2-month-old boy during a well-child examination. The firm, immobile mass measured approximately 1 cm in diameter. A congenital abnormality was suspected; the patient was referred to a plastic surgeon for consultation.
A 51-year-old man presented with red, mildly pruritic papulonodules that had erupted on his face approximately 5 weeks earlier. The clinical appearance suggested cutaneous lymphoid hyperplasia.
