November 22nd 2024
Your daily dose of the clinical news you may have missed.
Young Man With Fever, Headache, and Seizures
November 1st 2006A 28-year-old man is hospitalized because of highfever with rigors and chills and rapid weight loss(5.4 kg [12 lb] in 2 weeks). During the past 48 hours,generalized throbbing headache, intermittent vomiting,blurry vision, and seizures have developed. The progressiveseizures started in the left hand and have becomegeneralized grand mal.
Pulmonary arterial hypertension: Classification, diagnosis, and prognosis
November 1st 2006Abstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)
Pulmonary Pearls: A 61-year-old woman with insidious onset of dyspnea
November 1st 2006A 61-year-old woman presented with progressive dyspnea of 5 months' duration. She first noticed dyspnea while engaged in her usual daily activities, and it gradually progressed in severity. A primary care physician prescribed bronchodilators without relief. She was subsequently referred for a pulmonary evaluation.
Celiac Disease: Could You Be Missing This Diagnosis?
November 1st 2006ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.
How Relevant Is Evidence-Based Medicine to Your Practice?
November 1st 2006In his recent editorial "Why We Need to Know the Limitations of Evidence-Based Medicine", Dr Gregory Rutecki questioned whether the findings of randomized controlled trials (RCTs) can be extrapolated to patients in primary care practices, who often have multiple comorbidities.
Pleomorphic Adenoma of the Parotid Gland in a 20-Year-Old Woman
November 1st 2006A 20-year-old woman presented with a painless left facial mass that had slowly enlarged over the previous 2 years. There was no facial numbness or weakness. Her medical history was unremarkable, and there was no recent weight loss.
Risk Factors Identified for Complications After Sleep Apnea Surgery
October 16th 2006SEATTLE -- Surgery to correct obstructive sleep apnea (uvulopalatopharyngoplasty) is more likely to have complications if the condition is severe, a concurrent retrolingual procedure is done, BMI is high, or there are medical comorbidities, found a VA study.
65-year-old man with nonpruritic yellowish lesions on his eyelids
October 10th 2006A 65-year-old man consults his primary care physician because of concern about nonpruritic yellowish lesions on his eyelids. He says they have been present for the past few years but have recently become more numerous.