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To minimize pain when repacking anabscess, remove the old packing, thensquirt 1 mL of 1% lidocaine into theopen wound with a syringe (no needlenecessary). Wait 1 to 2 minutes andrepack the abscess.

Which treatment approaches are effective in a woman who has persistent or refractory vaginal trichomoniasis? Should the male sex partner of a patient who has recurrent vulvovaginal candidiasis be treated? Answers to these and other questions can be found in the recently updated CDC guidelines on managing sexually transmitted diseases

Prevention of and therapy for osteoporotic disorders in men have been virtually unexplored. Although osteoporosis in men is associated with significant morbidity and mortality, many clinical decisions must be based on extrapolation from data on osteoporosis in women.

ABSTRACT: In patients with renal colic, the location of the urinary tract obstruction largely determines the nature of the symptoms (eg, an obstruction in the distal ureter typically produces boring pain that radiates to ipsilateral groin, testicle, or labium). The initial evaluation includes urinalysis, a complete blood cell count, and a renal function panel. A full metabolic evaluation is warranted if the patient has risk factors for or a family history of stone disease, a history of bilateral stone disease, or chronic recurrent urinary tract infection, or if nephrocalcinosis is found on radiographic studies. Noncontrast CT is the imaging study of choice; it is nearly 100% accurate for detecting stone disease. Analgesia and volume expansion are the mainstays of management.

Patients with mycotic toenails whoare unable to take oral antifungalagents may find relief with this oldremedy. Instruct them to fill a bastingpan with warm water, add 2 or 3 capfulsof chlorine bleach, and soak bothfeet in this solution for 10 to 15 minutestwice a day for 2 weeks.

Because of the potential harm they pose to patients, prescribing errors continue to be a focus of attention in the medical literature.1-4 Indeed, the primary impetus for the creation of this column was to help prevent these errors.

Q:Should I avoid angiotensin-converting enzyme (ACE) inhibitors in mypatients with progressive renal insufficiency?

Q:Many of my patients appear to have white-coathypertension: their pressure is elevated whenmeasured in my office-but normal when measured athome. Am I ignoring significant hypertension if I do nottreat these patients? Or am I overtreating if I do treat?

An otherwise healthy 18-month-old boy presented with palpable purpura over the legs, arms, and buttocks; his face, neck, and trunk were spared. The patient was otherwise asymptomatic, alert, and playful. His mother reported that the child had a “stuffy nose and cough” 1 month earlier.

Recently the CDC updated its guidelines for treating sexually transmitted diseases (STDs). This article focuses on genital herpes simplex virus (HSV) infection and human papillomavirus (HPV) infection.

Highly pruritic, 2- to 4-mm, papular lesions with central ulceration erupted on the back of a 66-year-old woman. She had had 2 similar outbreaks in the past. The patient was taking conjugated estrogens, alprazolam, and alendronate.

A 76-year-old woman had a 40-year history of rheumatoid arthritis (RA). She had repeatedly refused treatment with disease-modifying drugs, including methotrexate. Nodules began to develop 15 years after the initial diagnosis; they recurred after surgical removal.

Affected infants present shortly afterbirth with a large bowel obstructionsecondary to transient dysmotility inthe descending colon. Although thecause is unknown, immaturity of thecolonic myenteric plexuses has beendemonstrated in some cases. Morethan 50% of affected infants are bornto mothers with diabetes. Other predisposingfactors include hypoglycemiaand sepsis.

The extent of mucosal or transmural intestinal necrosis varies. Pneumatosis progresses from the submucosa through the muscular layer to the subserosa. The distal ileum and proximal colon are most frequently involved.

This condition, which accounts forabout 30% of cases of intestinal obstructionamong neonates, is characterizedby the inspissation of thick,tenacious meconium in the bowel.The most common cause is cystic fibrosis;approximately 6% to 20% of infantswith cystic fibrosis have meconiumileus. Hyperviscous mucus secretedby abnormal intestinal glands,an abnormal concentrating processin the proximal small intestine, and adeficiency of pancreatic enzymeshave been implicated in the pathogenesis.The histologic hallmark is distention of the gobletcells in the intestinal mucosa.

Inspissated, sticky, immobile meconiumcauses this transient form of distalcolonic or rectal obstruction in newborns.The incidence has been estimatedat 1 in 500 to 1000 live births.The condition is thought to resultfrom dehydration of the meconium.

A 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.

Syndrome The mother of a 7-year-old boy with cardiofaciocutaneous syndrome sought treatment for the cutaneous aspects of her son’s disease. Dry skin and keratosis pilaris of the upper outer arms were noted. Cardiofaciocutaneous syndrome- a rare autosomal dominant genetic disorder-had been diagnosed when the child was 3 years old.