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Von Recklinghausen DiseaseA 66-year-old man presented with numerous cutaneous tumors. He had dementia and thus was unable to provide an accurate history.
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Emerging Strategies in HIV PreventionHIV infection continues to exact a devastating toll worldwide.Advances in antiretroviral therapy have helped bring theHIV/AIDS epidemic under control in developed countries.Antiretroviral drugs, however, are not widely available inthose developing countries where HIV poses a catastrophicthreat. Effective strategies for HIV prevention are thereforecrucial to curbing the global epidemic. Vaccination, microbicideuse, and male circumcision are 3 key preventive interventions.Current research is focused on developing effective vaccinesand microbicides and on determining the extent to whichcircumcision helps prevent HIV acquisition and transmission.[Infect Med. 2008;25:63-72]
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Vesicles and Erosions in a Middle-aged Man With DiabetesOver the past 8 years, fragile vesicles,painful ruptured bullae, and erosionshave developed on the sun-exposed skinof a 57-year-old man. Some of the vesicleserupt at sites of minor trauma; othersarise spontaneously. A corticosteroidcream prescribed by another practitionerfor presumed atopic dermatitisfailed to clear the lesions.
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Is There a Medical Explanation?A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
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Orthotopic UreteroceleA 67-year-old woman was admitted to the hospital with fever, chills, unilateral flank pain, dysuria, and urinary frequency and urgency. Her past medical history included several febrile relapses of infection.
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Occupational asthma: Tips on establishing the diagnosisWhen encountering a patient who may have occupational asthma, what is your approach to the initial evaluation? What are the most useful questions to ask?
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Lactic Acidosis in an Infant Receiving HIV ProphylaxisZidovudine is safe and effective in reducing transmission of HIV from mother to infant but rare serious side effects do occur. Is it worth the risk?
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Why patients with asthma should be given a trial of controller therapyAbstract: There is convincing evidence that controller therapies, such as inhaled corticosteroids and leukotriene receptor antagonists, provide many benefits to patients with asthma. These benefits include decreased symptoms, improved lung function, reduced frequency of exacerbations, and improved quality of life. Even patients with mild asthma and normal lung function can benefit from controller therapy. A recent analysis of the burden of asthma suggests that the proportion of patients who have mild intermittent disease is much smaller than previously estimated and that many more patients have persistent asthma. This finding, in combination with the considerable variability of patient responses to therapy and the difficulty in predicting which patients will respond, underscores the importance of considering a trial of controller therapy in patients with asthma.
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Update on Rifampin and Rifabutin Drug InteractionsRifampin is associated with numerousclinically significantdrug interactions.1-4 New interactionswith rifampin-aswell as rifabutin-continue tobe reported in studies and clinical observations.Here we present highlightsof our recent update on the interactionsthat are most relevant toprimary care practice.5
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Breast Cancer:In this article, I review several interventions that have been shown or are postulated to reduce breast cancer risk in women with no history of the disease; these include chemoprevention, physical activity, weight control, diet, alcohol use, and avoidance of specific carcinogens.
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Is There a Medical Explanation?A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
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Worsening Neurological Symptoms in an Older Man With History of Rectal CancerA 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.
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Giant Bullous EmphysemaA 54-year-old man presented to the ED with palpitations identified as atrial flutter and RVR. Medical history included stage IV renal-cell carcinoma, end-stage COPD, NYHA class IV heart failure, and recent pulmonary embolism. A CT scan of the thorax was ordered.
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An HIV-infected patient with bilateral pneumoniaA 43-year-old homeless woman presented with a 2-week history of fever, chills, sweats, generalized pain, and cough that was productive of purulent green-yellow sputum mixed with blood. She reported a 15-lb weight loss over the past 6 weeks.
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Inside the Southeast Michigan ePrescribing InitiativeDespite clear evidence of its benefits, widespread adoption of electronic prescribing (ePrescribing) has been slow. The vast majority of prescriptions are still written by hand, a process plagued with errors and inefficiencies. The Southeast Michigan ePrescribing Initiative (SEMI), a collaborative effort of employers, health plans, physician groups, and others, was launched in 2005 to speed the adoption of ePrescribing. SEMI has accomplished much in 4 years, enrolling more than 3000 physicians who have transmitted nearly 9.5 million electronic prescriptions while improving patient safety and winning over physicians. (Drug Benefit Trends. 2009;21:23-26)
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Woman With Acromegaly Presenting as Unilateral Vision LossA 36-year-old woman presented to the emergency department with loss of vision in the right eye that had initially involved the peripheral field and progressed over 2 months to the central and nasal fields. During this period, she also had headaches, vomiting, and generalized weakness. She had had amenorrhea for 1 year.
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Case In Point: Woman With Cough and DyspneaA 51-year-old woman with chronic obstructive pulmonary disease presents with nonproductive cough and slowly progressive dyspnea of 3 months' duration. She denies fever, chills, and night sweats. Over the past 3 months, she has received several different courses of treatment; the latest was cefixime, a 2-week tapering dose of prednisone, and bronchodilators. These treatments have failed to alleviate her symptoms.
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Purpuric Rash After Upper Respiratory Tract InfectionTwo 7-year-olds show the purpuric rash of the lower body and legs that is typical of Henoch-Schönlein purpura. This disease is a vasculitis that chiefly affects small vessels of the skin, joints, gastrointestinal tract, and kidney.
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Benign Prostatic Hyperplasia:Traditionally, urologists have cared for patients with benign prostatic hyperplasia (BPH). However, because of demographic fluctuations, changes in the health care system, and the development of effective pharmacologic therapy for BPH, primary care physicians are increasingly involved not only in initial patient evaluation but also in continuing management. Here we provide guidelines for treatment of uncomplicated BPH--with special emphasis on medical therapies.
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A practical evidence-based approach to rhinosinusitisAbstract: Rhinosinusitis affects millions of persons annually and has a marked impact on quality of life and work productivity. Chronic rhinosinusitis (CRS) is characterized by symptoms that last at least 12 weeks. The history and physical examination should include a search for underlying conditions, such as allergic or nonallergic rhinitis and nasal polyposis. An evaluation of underlying immunodeficiency is warranted in certain patients, particularly those with severe or difficult-to-treat disease or other recurrent infections. When radiologic evaluation is indicated, coronal sinus CT scanning is the procedure of choice. While antibiotics are indicated for bacte- rial rhinosinusitis, intranasal corticosteroids represent the mainstay of treatment for CRS and are particularly useful when polyp disease is present. Nasal irrigation with a saline solution can be a very beneficial adjunctive therapy. Depending on coexisting conditions, additional treatments may include antihistamines, leukotriene modifiers, and immunotherapy. (J Respir Dis. 2006;27(9):372-379)
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Amiodarone Drug InteractionsAmiodarone, a class III antiarrhythmic, has become the drug of choice for the management of supraventricular and ventricular arrhythmias.1,2 Although not an FDA- approved indication, the use of amiodarone to treat atrial fibrillation is supported by practice guidelines from the American College of Cardiology/ American Heart Association (AHA) and the European Society of Cardiology.
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Epstein Barr Virus and Multiple Sclerosis: Missing Link FoundEpstein Barr virus activates potentially immunopathogenic and neuropathogenic proteins in cells deriving from peripheral blood mononuclear cells and astrocytes.
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Fixed Drug Eruption Caused by AmoxicillinThis lesion appeared on the left outer thigh of a 28-year-old man after he took amoxicillin. The antibiotic had been prescribed for an upper respiratory tract infection with fever. Two years earlier, a lesion had appeared in the same anatomical region after ingestion of amoxicillin. A skin biopsy of the current lesion confirmed the diagnosis.
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Endobronchial SarcoidosisA 40-year-old man was being treated as an outpatient with inhaled corticosteroids and bronchodilators for a presumed diagnosis of bronchial asthma. Worsening episodes of shortness of breath during the past few months sent him to the emergency department for a second opinion.
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Bilateral Staghorn CalculiA roentgenogram of the kidneys, ureter, and bladder of a 58-year-old man shows bilateral stones in the renal pelvis and the renal calyces. The patient had a history of recurrent urinary tract infections caused by Proteus mirabilis. A ureteral catheter (pigtail) had been placed in the pelvis of the left kidney to facilitate drainage.
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Infection of the Cutaneous Apocrine GlandsHidradenitis suppurativa is a chronic acneiform infection of the cutaneous apocrine glands.
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Prompt diagnosis and therapy are keys to reducing mortality Extrapulmonary tuberculosis, part 5: Pericardial involvement key words: Tuberculosis, Pericarditis, Pericardial effusionabstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)
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Woman With Edema, Vomiting, and DiarrheaA 22-year-old woman has had chronic nausea, emesis with green vomitus, and diarrhea for the past 10 months. The diarrhea is frequent (about 3 to 8 times daily) and does not resolve with starvation.
