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On January 15, 2010, top congressional Democrats reported that they were “close” to an agreement with the White House on cost and coverage issues and that a draft would soon be sent to the Congressional Budget Office, the official authority on the cost and extent of coverage that any new legislation would provide. However, the outcome of the Massachusetts Senate race has created a significant obstacle to passing a health care reform bill for the Democrats in the Senate.

A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. He denied respiratory complaints or recent weight loss.

A 26-year-old woman at 30 weeks’ gestation presented to the emergency department with a throbbing frontal headache of 1 month’s duration. She had also had peripheral blurred vision for the past 2 weeks. Acetaminophen initially decreased her pain but was no longer effective. She had had a previous miscarriage.

Both of the disorders presented in Cases 1 and 2 typically have the face as the primary site of involvement, and both are benign processes

Malignant thymoma is an indolent tumor arising from the thymic epithelial cells located in the anterior mediastinum. These tumor cells spread via regional metastasis or invade surrounding structures, including the pleural space.

To obtain a general idea of intestinaltransit time when doing a workupfor chronic constipation or shortbowelsyndrome, I use this simpletest:

Patients with kidney stones areoften sent home with a bulky plasticfilter cup and told to use it to straintheir urine.

Recurrent or persistent vaginal itching is a common problem. If antifungals have not been effective, ask the patient, while she is in the stirrups, to point to the pruritic spot or touch it with her finger.

Editor’s note: In a recent issue (CONSULTANT, November 2009, page 676), Dr Gregory Rutecki made the case for diagnosing dehydration on the basis of physical findings rather than relying solely on elevated blood urea nitrogen (BUN) and creatinine levels.

A 79-year-old man admitted for mental status changes, with neuroimaging that reveals lacunar brain infarct.

Endobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.

The 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.

A 60-year-old laboratory technician complained of a pruritic rash on and around her left ear. It had appeared a few days earlier, shortly after she cleaned her telephone receiver with a disinfectant. A tentative diagnosis of contact dermatitis was made, and treatment with a hydrocortisone cream was initiated.

Dr Rutecki’s thoughtful note, “Diagnosing Dehydration: What Would Osler Do?” resonated strongly with me.

A 33-year-old man from the Ivory Coast (who had been living in the United States for the past 8 years) received a diagnosis of AIDS when he presented with Pneumocystis jiroveci pneumonia. His CD4+ cell count was 6/µL, and his HIV RNA level was 575,000 copies/mL. He also presented with altered sensorium and seizure activity and was found to have obstructive hydrocephalus and ring-enhancing lesions in both cerebellar hemispheres and basal ganglia. Results of polymerase chain reaction testing of cerebrospinal fluid for Toxoplasma gondii were positive, and treatment for toxoplasmosis was started. A ventricular-peritoneal shunt was placed.

The US House of Representatives and the US Senate versions of the health care reform bill have grown further apart. Although a bill containing a public option has passed in the House, Senate Democrats announced that they have agreed on a package of provisions to replace the public option.

For 1 month, a 60-year-old white man has had increasing fatigue, generalized weakness, and exertional dyspnea. He becomes short of breath after he walks only 100 to 150 yards on level ground or climbs only 1 flight of stairs. In addition, he has unintentionally lost 12 lb in the past month and has experienced intermittent dysphagia with solid foods. He attributes this last symptom to long-standing gastroesophageal reflux disease (GERD), for which he regularly takes over-the-counter omeprazole.