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Approved Treatments for Osteoporosis and What’s in the PipelineAlong with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.
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Pearly Pink Chest LesionsCan you identify the 2 slowly expanding growths on the chest of this 68-year-old man?
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Approved Treatments for Osteoporosis and What’s in the PipelineAlong with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.
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Eruptive Vellus Hair Cysts in a 4-year-Old Black GirlAsymptomatic flesh-colored papules were noted on the chest of a healthy 4-year-old black girl. Some of the 1- to 2-mm papules had central, comedo-like crusts. The remainder of the skin was normal.
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A case of pseudo-Meigs syndromeWe present a case of a 52-year oldwoman with exudativepleural effusion. Her workuprevealed an ovarian tumor,and the effusion completely resolvedafter resection of the tumor.Pathology revealed granulosacell tumor, which is anunusual cause of Meigs syndrome.This case shows theimportance of considering abdominopelvicpathology in unsolvedcases of pleural effusion.
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New Once-Weekly Exenatide for Type 2 DiabetesOnce-weekly exenatide, the recently approved GLP-1 receptor agonist, may help improve treatment adherence and outcomes in patients with type 2 diabetes.
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Penicillin- and Carbapenem-Induced Neurotoxicity: How to Reduce the RiskPenicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4
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Young Woman With Abdominal Pain and AnemiaA 27-year-old woman with a 2-dayhistory of nausea, vomiting, andpostprandial abdominal pain is admittedto the hospital. Acute cholecystitisis suspected
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Allergic Contact Dermatitis From Tea Tree OilThe sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.
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Woman With Type 2 Diabetes and AcromegalyA 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.
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Travel Risks: How to Help Parents Protect Infants and Young ChildrenChildren are at greater risk than adults for many travel-related problems, such as barotitis and barotrauma associated with flying, cold and heat injury, drowning, and infection with geohelminths. Most of these problems can be avoided with appropriate measures. Here, a summary of the most important steps.
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Giant Fundic Gland PolypFundic gland polyps are the most common form of gastric polyps. Giant FGPs, however, are extremely rare.
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Recognizing lung disease in patients with rheumatoid arthritis, part 2ABSTRACT: 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)
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Inflammatory Breast CancerA 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.
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Eosinophilic Esophagitis-Related Dysphagia in a Young WomanEoE is a chronic, immune/antigen-mediated esophageal disease. Clinical symptoms reflect esophageal dysfunction; histology is characterized by eosinophil-predominant inflammation.
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A rare diagnosis: Endobronchial schwannomaEndobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.
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HIV-Positive Woman With DyspneaA 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.
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Therapeutic Strategies for Hepatitis CCombination therapy with pegylated interferon alfa-2a or alfa-2b and ribavirin (RBV) results in a greater rate of sustained virologic response (SVR) than that seen with standard interferon alone. Patients infected with hepatitis C virus genotype 1 require higher doses of RBV and a longer duration of therapy than do patients infected with genotype 2 or 3. Closely monitor patients for neuropsychiatric effects, especially depression, and hematologic and other toxicities. Because of the teratogenicity of RBV, strict birth control must be used throughout the course of treatment and for 6 months afterwards. Patients who have not demonstrated a 100-fold reduction in viral load after 12 weeks of therapy are unlikely to achieve SVR; discontinuation of therapy may be considered.
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Double Aortic Arch in an Infant With Persistent StridorDouble aortic arch-a vascular ring anomaly in which both embryonic aortic arches persist and encircle the trachea and esophagus-is rare.
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Woman With Vesicles and Crusts on Her ForeheadFor 3 days, a 60-year-old woman hashad a tender rash on her forehead. Thelesions erupted 2 days after she sustainedminor trauma to the left side ofthe forehead (Figure 1); no scratchesor bleeding were associated with theinjury. She noted a burning sensationand mild tenderness at the site shortlybefore the lesions arose.
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A case of pseudo-Meigs syndromeWe present a case of a 52-year oldwoman with exudativepleural effusion. Her workuprevealed an ovarian tumor,and the effusion completely resolvedafter resection of the tumor.Pathology revealed granulosacell tumor, which is anunusual cause of Meigs syndrome.This case shows theimportance of considering abdominopelvicpathology in unsolvedcases of pleural effusion.
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Case In Point: Massive, fatal hemoptysis in a patientwith AIDS and B-cell lymphomaA 49-year-old man presented to theemergency department (ED) andcomplained of fever and cough thatproduced bloody sputum for 1 day.He had AIDS and recently receiveda diagnosis of large B-cell lymphoma.His most recent CD4+ cellcount was 24/µL. He had optedagainst receiving highly active antiretroviraltherapy and prophylaxisfor opportunistic infection.
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Case In Point: Acute eosinophilic pneumonia in a 19-year-old manThe authors describe a case of acute eosinophilic pneumonia (AEP) that occurred in a previously healthy young man. The presentation was similar to that of acute respiratory distress syndrome (ARDS), and the diagnosis was established by bronchoalveolar lavage (BAL). The authors note that it is important to recognize the subset of patients with AEP who present with an ARDS-like picture, especially since corticosteroids are very effective in this setting.
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A Comparison of the Clinical Effectiveness and Cost-Effectiveness of Treatments for Moderate to Severe PsoriasisThis study investigated the clinical effectiveness and cost-effectiveness of treatments for moderate to severe psoriasis from a managed health care systems perspective. An analysis was conducted of randomized clinical trials evaluating biologic and oral systemic medications and phototherapy for patients with moderate to severe psoriasis.
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OrfA 32-year-old man who had no significant medical history complained of “something growing on the knuckles of my right hand.” He reported that a “bump” was forming on the site of a cut he sustained while slaughtering sheep 3 weeks earlier. There was no blister, discharge, or pain. The patient denied any fever, cough, or malaise. He also did not recall seeing any lesions or “bumps” on the sheep.
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Endophthalmitis Caused by Rhizobium radiobacterPostsurgical endophthalmitis caused by Rhizobium radiobacterdeveloped in a 62-year-old man. The patient was treatedwith empiric intraocular therapy. On identifying the causativeorganism, systemic ciprofloxacin was added to the treatmentregimen. Therapy resulted in complete resolution of visualchanges caused by the infection. [Infect Med. 2008;25:274-276]
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Tuberous XanthomasDuring a routine physical examination, flesh-colored papules were noted on a 36-year-old man’s elbows, knees, and interphalangeal joints. The patient reported that they had been present for a long time, were nonpruritic, and had remained the same color and size. He had not self-treated with any over-the-counter medications. His only other concern was acid reflux for which he regularly took antacids. He had no significant medical or surgical history and no medication allergy. He smoked 1 pack of cigarettes per day, drank alcohol socially, and consumed caffeine-containing drinks daily.
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Colorectal Cancer Screening: Old Obstacles, New TestsColorectal cancer (CRC) is highly preventable; however, it remains a significant cause of morbidity and mortality in Western countries. CRC develops in more than 125,000 Americans each year, and about 50,000 die of it.
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Disseminated Fusariosis Following Cutaneous Injury From Contact With a Palm TreeOpportunistic fungal infections are increasingly common inpatients who undergo hematopoietic stem cell transplant(HSCT). Voriconazole is frequently used in allogeneicSCT recipients who receive immunosuppressant therapy forgraft versus host disease to prevent invasive aspergillosis.Indications for voriconazole use include invasive aspergillosis,candidemia, Scedosporium apiospermum infection, and fusariosis.We describe a case in which disseminated Fusarium infectiondeveloped in an HSCT recipient who was receiving voriconazoletherapy. [Infect Med. 2008;25:528-530]
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Nonspecific symptoms are among the obstacles to diagnosis Pulmonary alveolar proteinosis: An easy-to-miss diagnosis key words: Alveolar proteinosis, Surfactant, Whole lung lavageabstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)
