Case In Point: What caused diffuse alveolar hemorrhage in a patient with gout?
October 1st 2006Allopurinol, commonly used to treat patients with gout, has been known to cause hypersensitivity reactions. We report a case of drug-induced delayed multiorgan hypersensitivity syndrome secondary to allopurinol use. To the best of our knowledge, this is the first reported case of diffuse alveolar hemorrhage in a patient presenting with allopurinol-induced rash with eosinophilia and systemic symptoms.
Case In Point: Unilateral agenesis of the diaphragm
October 1st 2006Unilateral agenesis of the hemidiaphragm is a very rare congenital anomaly. We present the case of an adult who was evaluated for persistent cough. Unilateral agenesis of the diaphragm was an unexpected finding on a chest radiograph.
Exploring the link between nasal allergy and sinus infection
October 1st 2006Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)
Chronic Kidney Disease: Putting Guidelines Into Practice
October 1st 2006During my career, I have been on both sides of the clinical fence. From 1980 until 1992, I was a practicing nephrologist; from 1992 on, I have been a primary care physician (PCP). It should come as no surprise to the readers of CONSULTANT that I have found primary care practice to be much more demanding.
Pap Smear Results: Method for Notifying Patients
October 1st 2006When patients come in for a Pap smear, we have them write their name and address on an envelope, which we file in a box organized by month. Then as results come in, we retrieve the appropriate envelopes from the box and mail them out. Any envelopes left in the folder at the end of the month serve as reminders that those patients haven't been contacted yet.
Curling Iron Burn of the Cornea
October 1st 2006These photographs were taken 1Z\x hours after a 45-year-old woman accidentally dropped a hot curling iron onto her right eye while she was styling her bangs. The images show white coagulation of the superficial corneal epithelium, erythema of the lateral infraorbital area, and a transverse pale area of the superior eyelid. Severe pain occurred immediately after the injury. The vision in her right eye was partially obscured by the white coagulation.
Zero Tolerance Caffeine Policy
October 1st 2006Before you prescribe an anticholinergic for patients with urinary frequency or urge incontinence, advise them to cut out all caffeine. Complete avoidance--rather than just decreased intake--often results in an immediate improvement in symptoms. Also instruct patients to keep their daily fluid intake under 64 oz. Should medication still be needed, these steps can help ensure a good outcome.
Pulse Oximetry: Use the Earlobe
October 1st 2006When using pulse oximetry to evaluate patients with Buerger disease, Raynaud phenomenon, a history of heavy smoking, or other conditions that cause vasoconstriction of the fingers, place the probe on the earlobe. In such patients, this gives a more accurate measurement of arterial hemoglobin saturation than does a digital placement.-- Lynda Sutliff, RN, FNP San Angelo, Tex