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ABSTRACT: Patients with rheumatoid arthritis (RA) often havepulmonary manifestations, such as interstitial lung disease.The most common cause of upper airway obstruction is cricoarytenoidarthritis. Patients often complain of a pharyngeal foreign-body sensation or hoarseness, but some present with severestridor. Bronchiolitis obliterans is characterized by a rapidonset of dyspnea and dry cough, with inspiratory rales andsqueaks on examination. This presentation, particularly in middle-aged women with seropositive disease, distinguishes bronchiolitisobliterans from other pulmonary manifestations ofRA. High-resolution CT may be more sensitive than pulmonaryfunction tests for detecting small-airways disease, and it frequentlyshows moderate to severe air trapping on expiratoryimages. (J Respir Dis. 2008;29(8):318-324)

We describe a case of sulfasalazine-induced pneumonitis ina complex medical patient.This case illustrates the potentialfor drug-induced pulmonarydisease and the vigilanceneeded in evaluating patientswith subacute respiratory decompensation.Proper recognitionand treatment mostlikely prevented the progressionof acute respiratory failureand, possibly, irreversiblelung injury or death.

A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.

ABSTRACT: The most common causes of chylothorax are neoplasm-particularly lymphoma-and trauma. The usual presentingsymptom is dyspnea resulting from the accumulationof pleural fluid. The diagnosis of chylothorax is established bymeasuring triglyceride levels in the pleural fluid; a triglyceridelevel of greater than 110 mg/dL supports the diagnosis. The initialapproach to management involves chest tube drainage ofthe pleural space. The administration of medium-chain triglyceridesas a source of fat is often useful. If drainage remains unchanged,parenteral alimentation should be started. Surgicalintervention is indicated if conservative management is notsuccessful or if nutritional deterioration is imminent. If chylothoraxpersists after ligation of the thoracic duct, options mayinclude percutaneous embolization, pleuroperitoneal shunt,and pleurodesis. (J Respir Dis. 2008;29(8):325-333)

I have seen conflicting recommendations concerning the use of throat cultures and empirical antibiotic therapy in patients with pharyngitis. When do you consider throat cultures to be indicated? Are your recommendations different for children than for adults?

What's Your Diagnosis - Continuing Medical Education Credit

Despite the availability of good clinical tools for identifying patients at risk for fracture, osteoporosis is underdiagnosed in clinical practice. This is the case even in patients who have already sustained a fragility fracture and are at very high risk for future fracture.

A 68-year-old woman was hospitalized because of confusion and agitation of sudden onset. Her history included dementia and multiple infarcts of both cerebellar hemispheres, bilateral basal ganglia, bilateral parietal lobes, and the right occipital lobe.

Infants who receive 3 additional months of treatment with the drug nevirapine are less likely to be infected with HIV by their mothers through breast-feeding (Emery G. Reuters. June 4, 2008).

Five years ago, the International Agency for Research on Cancer (IARC) conducted a case-control study in 9 sites (Italy, Spain, Northern Ireland, Poland, India, Cuba, Canada, Australia, and Sudan) of 1415 participants with cancer of the oral cavity and 255 with oropharyngeal carcinoma.1 Markers for human papillomavirus (HPV) infection were evaluated, including antibodies against HPV16 E6 and E7 proteins, which are common in cervical cancer, and HPV DNA in biopsy samples, detected by polymerase chain reaction assay.

Cerebrovascular disease (CVD) in HIV may be associated with multiple concurrent etiologies and with varying presentations, from chronic asymptomatic microvascular calcifications or vascular anomalies to intracerebral hemorrhage to thrombotic stroke.

In September 2006, the CDC recommended that the interpretation of "general consent" for medical care include HIV screening, which eliminated the need for a separate, written consent.

A previously healthy 26-year-old woman was hospitalized for melena. She denied prior episodes of GI bleeding, fatigue, or dyspnea.

We present the case of an HIV-infected patient with cirrhosis in whom severe neuropsychiatric signs and symptoms developed in the setting of a significantly elevated plasma efavirenz level.

A 40-year-old homosexual man with CDC class B3 HIV infection presented to our clinic complaining of worsening right hip pain. HIV infection had been diagnosed in 1995. His most recent CD4+ cell count was 167/µL, and his HIV RNA level was suppressed while he was receiving antiretroviral therapy consisting of emtricitabine/tenofovir fixed-dose combination, efavirenz, and ritonavir-boosted atazanavir.

A case-control study was conducted that involved a retrospective chart review of 181 HIV-infected women in whom cervical dysplasia had been diagnosed to examine the association between patient adherence to highly active antiretroviral therapy and the regression or stabilization of cervical dysplasia.

In the 2-part series, “Chronic Pain Syndromes: How to Break the Cycle” by David A. Provenzano, MD, and Morris Levin, MD (CONSULTANT, April 1, 2008, page 297, and April 15, 2008, page 371), greater emphasis should have been given to physical therapy.

Fewer people are smoking than in past decades; as a result, the number of lung cancers should decrease. Because of widespread use of screening mammography, more cases of breast cancer are detected and treated at an early stage, and survival has improved. What about a similar success story for the most common cancer?