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One week earlier, these asymptomatic linear brown streaks had appeared on the dorsal aspect of a 28-year-old woman's right thumb. When Ted Rosen, MD, of Houston questioned the patient about her recent activities, she said that she had just returned from a vacation in the Caribbean. During the trip, she had squeezed fresh limes into various beverages.

Right lower leg pain prompted a 15-year-old boy to seek medical attention. An hour earlier, he had fallen on the leg during a football game and on standing had heard a "pop." No gross abnormality was noted. Jack-Ky Wang, MD, and Laurie Meng, PA-C, of Palos Heights, Ill, report that radiographs revealed a transversing pathologic fracture through an expansile lytic lesion of the right fibula.

Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)

A staff nurse calls the physician to see "something really bizarre-we have no idea what this is": the plastic of a urine collection bag of an 81-year-old woman has turned purple, although the urine within is more orange-brown and distinctly less odd looking.

SEATTLE ? The stereotypic image of alcohol abusers denying their problems, and showing no inclination to change their ways, is wrong in most cases, according to researchers here.

ATLANTA ? Botox (botulinum toxin type A) injected directly into the bladder's detrusor muscle not only tamed an overactive organ but kept the bladder calm for almost a year, according to Swiss researchers.

ATLANTA ? Relief came to interstitial cystitis patients after 30 sessions in a hyperbaric oxygen chamber over five weeks, according to a small study.

HOBART, Australia - The data suggesting that a high-fat diet increases the risk of skin cancer were never too substantial, and now they are even thinner, according to Australian researchers.

FRESNO, Calif. - Neonatal and maternal mortality rates did not improve despite an increase in repeat cesarean deliveries, apparently engendered by revised ACOG guidelines, researchers here reported.

MADISON, Wis. - Asymptomatic emphysema can be revealed by a new magnetic resonance imaging technique that is more sensitive to lung changes than computed tomography, investigators here reported.

SUMMIT, N.J. - The FDA has approved Thalomid (thalidomide) in combination with Decadron (dexamethasone) for the treatment of newly diagnosed multiple myeloma.

Since gout can precipitate olecranon bursitis, should I routinely order a crystalanalysis for patients who present with this bursitis?

In Dr David Kaplan’s Dermclinic case of a teenager with aphthous stomatitis(CONSULTANT, April 15, 2001, page 665), the patient wears braces in the photograph(Figure).

A 20-year-old college student presents with frequent heart palpitations. Hehas been in excellent health.

For the past few weeks, pruriticpatches have been erupting on a38-year-old man’s extremities. He recallsthat similar lesions occurredduring the last 2 winters. The patienthas a history of seasonal allergies;he owns a cat and 2 dogs.

A 6-year-old girl presents witha several-month history ofgenital discomfort that includesitching, irritation, andoccasional bleeding. Themother reports that there isblood on the toilet paper afterthe child wipes herself. Therehas also been some spottingin the child’s underwear. Thepatient seems to be grabbingat her crotch frequently.

Diabetes is epidemic! The numbersare truly alarming. In 1997, official datashowed that 16 million people in theUnited States had diabetes. Approximately1 million had type 1 disease,and 10.4 million had type 2 disease; theremainder had undiagnosed diabetes.1If these numbers are projected outagainst an annual increase in diseaseprevalence of about 3.5%, it means thatby the year 2028, 50 million people willhave diabetes. However, the actual rateis closer to 7% each year. As such, approximately100 million Americans-roughly 1 of every 4-will have diabetesby 2028.

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