Authors
Latest:
A reduction in D l CO may be an early sign Recognizing PAH in patients with systemic sclerosis key words: Pulmonary arterial hypertension, Systemic sclerosis, Sclerodermaabstract: Pulmonary arterial hypertension (PAH) is a common complication in patients with systemic sclerosis and is associated with an increased mortality rate. Patients are often asymptomatic early in the disease, but as the disease progresses, exertional dyspnea and fatigue develop. The workup usually includes chest radiography, pulmonary function tests, and Doppler echocardiography. If the results of Doppler echocardiography are consistent with PAH, the patient should undergo right heart catheterization. Patients with mild PAH who demonstrate considerable vasoreactivity are potential candidates for treatment with oral calcium channel blockers. Other therapies that can reduce symptoms and improve exercise tolerance and hemodynamics include bosentan and epoprostenol.
Latest:
Case In Point: What caused diffuse alveolar hemorrhage in a patient with gout?Allopurinol, 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.
Latest:
Headache Pain, Bipolar Disorder, and Mood ModulatorsA 45-year-old man has a history of migraine that started shortly after puberty. The headaches became more frequent andsevere 3 years ago, when the patient was promoted from metal worker to shift boss.
Latest:
Thyrotoxicosis presenting as pulmonary hypertensionThe authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.
Latest:
Complications of Diabetes Mellitus: Lisfranc Fracture and DislocationA 53-year-old man with a 20-year history of type 2 diabetes mellitus (for which he required insulin) sought evaluation of a hot, swollen right foot that seemed to have become “flat.” He had no pain, fever, or chills. The patient’s metatarsal bones were readily movable, consistent with Charcot joint. Further workup ruled out osteomyelitis. Plain films demonstrated extensive deformity of the tarsal and metatarsal bones with Lisfranc fracture/dislocation through the base aspects of all 5 metatarsals.
Latest:
Creeping Eruption-Cutaneous Larva MigransCutaneous larva migrans (CLM), also known as “creeping eruption,” is the most commonly acquired tropical dermatosis
Latest:
Severe Migraine: Options for Acute Therapy in the Emergency DepartmentA 36-year-old man with a 15-year history of episodic migraine presents to the emergency department (ED) at 5 AM witha right-sided throbbing headache of 4 hours' duration. The headache awakened him, which is typical of his more severemigraine attacks. Unfortunately, the patient forgot to refill his prescription for pain medication and did not "catch" thisheadache in time. He took an over-the-counter combination of aspirin and caffeine, which seemed to help for about 60minutes, but the headache has returned full force. He has vomited twice-another characteristic typical of his migraineattacks
Latest:
Benign Migratory GlossitisThe sharply demarcated, smooth red plaques on this 3-year-old's tongue had been present for several months.
Latest:
Disseminated Echinococcosis Involving the Pulmonary ArteryDisseminated echinococcal disease can present complex management issues that require a multidisciplinary approach to care. We describe a patient with hydatid disease who had multiple cysts in the liver, lungs, and pulmonary artery that were caused by Echinococcus granulosus infection.
Latest:
Case In Point: Peripheral nerve sheath tumor mimicking pulmonary embolismWe describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.
Latest:
Primary synovial sarcoma presenting as an endobronchial massEndobronchial primary synovialsarcoma is an extremelyrare pulmonary tumor. We reportthe case of a 58-yearoldman who presented witha right-sided endobronchialmass, which was diagnosed asprimary synovial sarcoma onthe basis of histological appearanceand immunohistochemicalstaining. To the bestof our knowledge, this is onlythe third case report of endobronchialprimary synovialsarcoma.
Latest:
Recognizing the impact of obstructive sleep apnea in patients with asthmaAbstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)
Latest:
Man With a Potentially Life-Threatening Waterborne InfectionA 79-year-old man presents to theemergency department with a painfullesion on his right forearm. Three daysearlier, he had scratched his arm whileremoving crabs from a trap. Initially,the scratch had bled slightly, and hehad self-treated with an over-the-counterantibiotic ointment and an adhesivebandage.
Latest:
PseudotumorA 45-year-old man with a history of congestive heart failure presented with cough and dyspnea. A chest roentgenogram showed loculated pleural effusion in the horizontal fissure of the right lung, and a CT scan revealed pleural-based density in that lung.
Latest:
Emphysematous Pyelonephritis Caused by Pasteurella multocidaEmphysematous pyelonephritis (EPN) is a rare but life-threatening infection characterized by widespread necrosis and production of gas within the kidney.
Latest:
STEMI With Underlying Paced RhythmAccording to the Sgarbossa criteria, the patient had an acute MI: ECG revealed a greater than 1-mm ST-segment depression in lead V2 and about 5-mm discordant ST-segment elevation in leads II, III, and aVF.
Latest:
Aging Matters: Delirium in Hospitalized Elderly Patients: How You Can HelpAn 83-year-old man presents to the emergency department after he fell down his basement stairs and was unable to walk.
Latest:
With HIV, Location MattersIt turns out that where a patient gets a diagnosis of HIV affects how quickly he or she gets treatment for the infection.
Latest:
Wolff-Parkinson-White Syndrome: What Treatment?A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.
Latest:
Statin-Drug Interactions: Update on the Most Common and Clinically SignificantStatins (HMG-CoA reductase inhibitors) are the most effective drugs in the management of elevated low-density lipoprotein cholesterol (LDL-C) levels. Recent large clinical trials continue to demonstrate the remarkable efficacy of these agents, including improved outcomes.
Latest:
Pulmonary involvement in a patient with lymphocytic colitisMicroscopic colitis is a noninfectiouscolitis that is characterizedby chronic nonbloodydiarrhea and macroscopicallynormal colonic mucosa. Extraintestinalmanifestationsare rarely seen. In this report,we describe a nonspecific interstitialpneumonitis in a patientwith lymphocytic colitis.
Latest:
Restrictive Covenants: What's in Your Contract?Dr Bobby Lazzara spends a Medical News Minute reminding you to pay close attention to all the fine print.
Latest:
Community-acquired pneumonia: An update on therapyAbstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)
Latest:
Back Extension Exercises for Patients With OsteoporosisExercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.
Latest:
The Charcot Foot: A Missed Diagnosis Can Cost a LimbThis enigmatic, destructive, and deforming condition most often affects persons who have diabetes.
Latest:
Acute Low Back Pain in Children:ABSTRACT: Unless the cause of back pain is obvious, order anteroposterior and lateral radiographs of the spine, a complete blood cell count, erythrocyte sedimentation rate, and urinalysis. If you suspect infection, tumor, or bony abnormalities, obtain an MRI or CT scan. MRI has surpassed bone scanning as the gold standard for diagnosing spinal infections, because it confirms a specific anatomic diagnosis. Spondylolysis and spondylolisthesis are 2 of the most common causes of back pain in adolescents; the diagnosis is made with plain radiographs, which show slippage on the later-al view in patients with spondylolisthesis and fracture through the pars interarticularis on the oblique views in those with spondylolysis.
Latest:
Lethargy, Confusion, and Constipation in an Older WomanA 77-year-old woman is brought for evaluation by her family. The patient had previously been alert and active; however, for the past week, she has been difficult to arouse and, when awake, has been delusional and has behaved abnormally. In addition, for the past 2 weeks, she has complained of abdominal discomfort related to constipation.
Latest:
Exercise:An examination of the evidence on the cardioprotective benefits associated with various intensity levels, types, and amounts of physical activity, as well as tips on a beneficial yet realistic exercise program.
Latest:
Hypertension in an African American Man with DiabetesA 54-year-old African American man with a history of type 2 DM, hypertension, and gout presents for diabetes follow-up. What’s the best therapy for his hypertension?
