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Podcast: The Practice of Nonsuicidal Self-injury in Adolescents Part 2In Part 2 of this podcast series, Dr Smith continues his discussion of the practice of nonsuicidal self-injury in adolescents.
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Linear Verrucous Epidermal NevusA 7-year-old boy with a history of atopic dermatitis presented with an intensely pruritic linear rash on his upper extremity. His mother reports that the rash has been “growing” despite use of topical corticosteroid creams.
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Gastrointestinal Involvement of Systemic AmyloidosisThe authors present a case of AL amyloidosis with rare GI involvement and an equally rare presenting symptom.
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Creeping Eruption-Cutaneous Larva MigransCutaneous larva migrans (CLM), also known as “creeping eruption,” is the most commonly acquired tropical dermatosis
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Larsen SyndromeAn abnormality of both first proximal interphalangeal joints was noted in a 54-year-old woman who had recently undergone an elective total hip arthroplasty to treat post-traumatic osteoarthritis. She had had worsening hip pain following an intertrochanteric fracture and open reduction internal fixation several years earlier.
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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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COX-2 Inhibitor–Induced RashA 63-year-old man was given oral celecoxib, 100 mg bid, for shoulder pain. Three days later, a pruritic rash appeared on his back, then spread to the chest, lower legs, and face. He stopped the celecoxib on his own and self-administered diphenhydramine for the pruritus. The rash and itch persisted, which prompted the patient to seek medical care. He had no respiratory symptoms.
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Images in HIV/AIDS: HIV-Associated Lymphogranuloma Venereum ProctitisImages in HIV/AIDS: HIV-Associated Lymphogranuloma Venereum Proctitis
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Right Shoulder Pain in an Older ManFor 6 months, a 69-year-old man has experiencedpain in his right shoulder; hetakes NSAIDs for relief. During the lastmonth, the pain has worsened, weaknessand tingling have developed in his righthand, and the skin on the right side ofhis face has become dry. The patient alsoreports a 1-month history of melanoticstools. He had smoked 1 pack of cigarettesa day for 50 years before quittinglast year
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A Rare Finding of Lymphangiomatosis: Case ReportPatient was hemoccult positive with anemia but colonoscopy and EGD were negative. What test would you order next?
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Herpes Encephalitis in Monoclonal GammopathyNinety percent of adult cases of encephalitis are caused by herpes simplex virus (HSV) type 1, and HSV type 2 encephalitis is clinically indistinguishable from HSV-1 encephalitis.
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Greenfield Filter MigrationAn 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.
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Bilateral Parotid Swellings in an HIV-Positive PatientA large minority of persons with HIV infection have head and neck symptoms; parotid swellings have been noted in approximately 5% to 10% of patients with HIV-1 infection.
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MAC Infection in a Man With Pectus ExcavatumFor 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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A Differential Diagnosis of Drug-Induced Aseptic MeningitisDrug-induced aseptic meningitis should be included in thedifferential diagnosis of viral/aseptic meningitis. Cliniciansshould use historical clues in patients presenting with signs andsymptoms of viral meningitis to aid in the differentiation ofdrug-induced aseptic meningitis from other causes of asepticmeningitis. Viruses are the most common cause of asepticmeningitis, with enteroviruses being the most common amongviruses in cases presenting as aseptic meningitis. Ibuprofen iscurrently the most common cause of drug-induced asepticmeningitis. Drug-induced aseptic meningitis is a benign conditionwithout long-term sequelae. The diagnosis of druginducedaseptic meningitis is made by establishing a causalrelationship between the use of the drug and the onset of signsand symptoms, supported by negative tests for infectiouscauses of symptoms and rapidity of resolution after the drugis discontinued. [Infect Med. 2008;25:331-334]
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Cocaine-Induced StrokeBrain infarcts among crack cocaine users may be secondary to large cerebral artery vasospasm with secondary intravascular thrombosis (with or without distal embolization).
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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.
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Women and Heart Disease: Incidence, Prevalence, Progress, and the FutureFemale CV mortality lags behind male mortality; lifetime risk assessment, not 10-year risk, is a better estimation tool for women
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Graves Disease with Exopthalmos and Pretibial MyexdemaThis 17-year-old presented with a 1-month history of weight loss, increased appetite, mild insomnia, hand tremor, palpitations, sweating, heat intolerance, and quick loss of temper. The number of daily bowel movements had increased from 1 to 2. There was no family history of thyroid disorders.
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Antimicrobial Resistance Update: Klebsiella pneumoniae CarbapenemasesThe rapid spread of Klebsiella pneumoniae carbapenemases (KPCs) is limiting the effectiveness of carbapenems in the treatment of multidrug-resistant infections. The resistance genes found in KPCs have been identified in other organisms as well and have properties that have raised concerns regarding their transmissibility and epidemic potential.
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Wilms Tumor: A Rare Finding in an AdultA 43-year-old woman was admitted to the hospital with left flank pain. The physical examination revealed a left abdominal mass. Laboratory test results identified normochromic-normocytic anemia (hematocrit, 33%; hemoglobin, 10.8 g/dL; and mean corpuscular volume, 88 fL) and microscopic hematuria (10 red blood cells per high-power field).
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Under what circumstances is outpatient therapy possible? Using low molecular weight heparins to treat venous thromboembolism key words: Deep venous thrombosis, Pulmonary embolism, Heparin, Anticoagulant therapyabstract: Low molecular weight heparins (LMWHs) have proved to be as safe and effective as unfractionated heparin for the treatment of venous thromboembolism. They have the advantage of not requiring frequent measurement of activated partial thromboplastin time and subsequent dosage adjustments. Patients who have deep venous thrombosis can be treated with once- or twice-daily subcutaneous doses. Hospital admission is necessary for patients with risk factors for major bleeding complications, for those with symptomatic pulmonary embolism, or when noncompliance is likely. Symptomatic proximal deep venous thrombosis and asymptomatic pulmonary embolism may be managed on an outpatient basis if there are no contraindications. Although heparin-induced thrombocytopenia occurs less frequently with LMWHs than with unfractionated heparin, the platelet count must still be monitored during therapy. (J Respir Dis. 2007;28(4):132-138)
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Bronchoalveolar CarcinomaA 52-year-old woman (a nonsmoker) was hospitalized after experiencing a low-grade fever and dyspnea for a month. No abnormalities were noted on physical examination, but the chest film showed multiple nodules, both well- and ill-defined. Lung biopsy confirmed the diagnosis of bronchoalveolar carcinoma.
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“Snakeskin” Gastric MucosaCirrhosis and ascites developed in a 52-year-old man with a history of chronic hepatitis C and alcohol abuse. He was hospitalized because of bleeding esophageal varices, which were successfully treated with elastic band ligation.
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Teenager With Small Red Papules on Her Arms and Thighs17-Year-old girl with a 7-month history of small, red papules on her arms and thighs. Rash is not painful or itchy. Otherwise in good health.
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Tuberculous ArthritisA 72-year-old woman was hospitalized after 8 years of pain and swelling of the right metatarsophalangeal joint. (In this film, the dark area over the distal joint of the large toe is an artifact.) Results of a purified protein derivative tuberculin test were positive, and a chest film revealed apical changes compatible with old tuberculosis (TB).
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Research Focus: Recent Developments in HIV TherapeuticsResearch Focus: Recent Developments in HIV Therapeutics
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An Uncommon ECG Finding in a Man With Acute MIA 49-year-old man presented to the emergency department (ED) with substernal chest pain that had started an hour earlier. The pain radiated to the left arm, was constant, and was associated with diaphoresis, nausea, and dyspnea. A similar episode 4 days earlier had spontaneously resolved. He denied fever or chills, pleuritic chest pain, vomiting, and diarrhea.
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Surgical Treatment of Obesity: Questions Physicians Often Ask About Laparoscopic Adjustable Gastric BandingBecause bariatric surgery has traditionally been associated with a high incidence of complications, it has been used primarily for superobese patients. A large body of evidence suggests that laparoscopic adjustable gastric banding is a much safer procedure that is also very effective. This procedure offers an additional option to patients who might benefit from bariatric surgery when diet, exercise, and pharmacologic approaches have failed. Here we address questions primary care physicians often ask about the procedure.
