Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.
The development of an enzyme-linked immunosorbent assay (ELISA) that detects the glycoprotein galactomannan represents an important advance in the diagnosis of invasive aspergillosis. Foy and associates found evidence that the galactomannan ELISA is a highly specific diagnostic tool when used to screen patients who are undergoing hematopoietic stem cell transplantation (HSCT).
At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.
Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.
Guest Commentary
Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).
Young children are prone to scrapes and bruises. I recommend to their parents keeping a tray of miniature party-type ice cubes in the freezer.
Photo quiz
When patients' deep tendon reflexes in the ankle and knee are diminished, have them clasp their hands together and pull outward with both arms.
The next time you need to perform a routine oral examination in a patient with a severe gag reflex, try this: have the patient use the tongue blade to depress his or her own tongue while you shine the light. For some reason, the exam goes more smoothly when the patient is involved.
Clinical Images to Help You Hone Your Diagnoses
This 33-year-old Guatemalan man presented to a medical mission camp with generalized bilateral knee pain and inability to extend his leg without pain. The 4-ft 11-in patient had mild scoliosis, increased elbow carrying angles, and hypoplastic patellae. He had had dysplasia of the nails with triangular lunulae since birth. The fingernails were absent on the first and second digits of both hands. His mother had had similar physical findings. He had not had regular medical care.
An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.
ROCKVILLE, Md. -- Veggie Booty snack food, sold in all 50 states and Canada, may be contaminated with Salmonella wandsworth, and consumers should throw away any of the product they have on hand, the FDA advised.
STOCKHOLM -- Breast cancer prognosis may be inherited along with the propensity for breast cancer, researchers found.
ROCHESTER, Minn. -- Women with atypical hyperplasia in three or more places in the breast have a sharply increased risk of developing breast cancer, researchers here said.
BOSTON -- Excess deaths from the heat of global warming will not be counteracted by a corresponding drop in cold-related mortality, investigators here estimated.
NEWCASTLE UPON TYNE, England -- Cerebral palsy does not impair children's perception of their quality of life unless they are in pain, researchers found.
INNSBRUCK, Austria -- A novel treatment to relieve stress incontinence in women, strengthening the urinary rhabdosphincter with cultured autologous tissue, has panned out.
PORTLAND, Ore. -- Non-smokers who worked in bars and restaurants where smoking was allowed had significantly higher levels of a tobacco-specific carcinogen than those who worked where the air wasn't tainted.
