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CollagenomasDuring a skin cancer screening, a 45-year-old male soldier was noted to have bilateral subcutaneous nodules on the dorsa of his feet. The patient reported that the nodules had remained unchanged since they first appeared in his early 20s and were asymptomatic. He had no other lesions.
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Clinical Observations on West Nile Virus InfectionsIn 2004, 391 cases of West Nile virus (WNV) infection werereported in Arizona. This represented an epidemic thatchallenged area clinicians. We treated 34 patients with WNVinfection and reviewed their medical records. They werehospitalized at 3 community hospitals during the epidemic.These patients represented 9% of all WNV infection casesreported in Arizona. Meningitis was diagnosed in 13 patients,encephalitis in 12, fever of unknown origin in 5, transversemyelitis in 3, and carditis in 1. Respiratory failure requiringmechanical ventilation developed in 6 patients. Five of thesickest patients were empirically treated with interferon alfa 2band ribavirin. The epidemic and associated clinical challengesprompted evaluation of the available diagnostic and treatmentstrategies to optimize care of very ill patients. The consensusamong clinicians was that they were poorly prepared todiagnose and treat WNV infection in hospitalized patients.All patients survived hospitalization, although 4 patientsdied after discharge because of factors attributable to WNVinfection. [Infect Med. 2008;25:430-434]
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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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Metallic Corneal Foreign Body With Rust RingTwo days after "heading" a soccer ball, a 17-year-old boy presented to the emergency department with progressive pain and a foreign-body sensation in his left eye. Visual acuity was 20/20 in the right eye and 20/25 in the left eye. The pupils were equally round and reactive; full extraocular movements of both eyes were noted. The left eye had conjunctival injection and a 1-mm foreign body on the medial cornea with a surrounding halo of discoloration--typical of a metallic corneal foreign body. A Seidel test (which demonstrates streaming of fluorescein dye from the aqueous humor when illuminated with UV light) revealed no evidence of corneal perforation; there were noareas of fluorescein dye uptake.
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The Right Amount of Exercise Is ...... any amount at all. A new American College of Cardiology report says even minimal exercise helps lower risk of cardiovascular disease.
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Pearls From Steven Nissen, MD: On Statin Denial and Cult DietsDr Steven Nissen says statins and climate change share similar public opinion problems and suggests counter tactics.
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Elevated Hematocrit in Man Receiving HemodialysisA 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.
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Diabetic Myonecrosis: A Rare Complication of Type 2 DiabetesA 50-year-old African American woman with type 2 diabetes mellitus and hypertension was admitted with constant bilateral knee and thigh pain and swelling of both knees, all of 1 week’s duration. The pain was not relieved with hydrocodone/acetaminophen and had caused weakness and subsequent falls.
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FOOSH Injury of the ElbowFOOSH injuries associated with acute onset of pain at the elbow suggest fracture of the radial head, proximal ulna, or humeral condyle or soft tissue injury.
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Vertebral Compression Fracture and OsteoporosisNo double-blind, randomized controlled studies of the effectiveness of vertebroplasty have been performed. However, this reflects less the effectiveness or safety of the procedure than it does the difficulty involved in conducting randomized controlled trials of any treatment for a pain disorder.
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Pulmonary hypertension in the elderly, part 2: TreatmentABSTRACT: The treatment of pulmonary arterial hypertension(PAH) is directed at the underlying cause, such as diastolicheart failure or chronic thromboembolic disease. Patients withidiopathic PAH or PAH associated with connective-tissue diseasewho have World Health Organization (WHO) functionalclass II or III PAH should receive a trial of oral bosentan, ambrisentan,and/or sildenafil; inhaled iloprost is an alternative oran additive agent. If patients fail to respond to these interventionsor if they have WHO functional class IV PAH, considersubcutaneous or intravenous treprostinil or epoprostenol. Theuse of these latter agents is much more complicated and maybe difficult to initiate in elderly patients. (J Respir Dis. 2008;29(12):468-474)
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Older Woman With Recent Abdominal Pain and FullnessOn her eighth day in the hospital for acute pulmonaryembolism, an 88-year-old woman complains of nauseaand abdominal pain and fullness of 12 hours’ duration.The pain is localized to the mid epigastric area and radiatesinto the right lower quadrant. The patient deniesvomiting, melena, and dysuria; she has refused to eat allday.
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Streptococcal Toxic Shock SyndromeA 44-year-old man presented to the emergency department (ED) with pain and swelling of the left ankle and a petechial rash in the pretibial area that developed the night before. He also reported "fluttering" in his chest.
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PreventionHIV can be transmitted from an infected mother to her child during pregnancy or labor and postnatally through breast milk. Nearly 25 years after the first documented case of HIV infection, the decrease in perinatal HIV infections in the United States represents a major success in public health.
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Occular Irritation in a Child: An Eye-opening TrickWhen young children have an irritant in their eyes, to reduce the stinging and make opening the eyes easier, try putting a drop of an ocular anesthetic in each medial canthus while the child is supine; be sure to wait for it to seep in.
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Cullen Sign in PancreatitisA 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.
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Consultant Health Guide: Keys to Successful Weight LossExcess weight increases the risk of having a heart attack, stroke, high blood pressure, arthritis, diabetes, depression, fatigue, and certain types of cancer. Losing weight and keeping it off are very difficult for most persons who are overweight. Here are some suggestions to help you lose pounds and keep your weight down.
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Traumatic HemothoraxTraumatic hemothorax usually results from penetrating or contused thoracic injuries that lead to rib fracture and damage of intercostal or pulmonary vessels. Hemorrhagic shock can occur with massive blood loss into the pleural space. The shock state may be exacerbated by decreased venous return.
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PylephlebitisAcute abdominal pain, fever, and chills prompted a 51-year-old man to visit his local hospital twice in one week. On both visits, a clinical and laboratory workup was negative. He then presented to a tertiary care center with worsening symptoms. His history included hypertension and tobacco and alcohol use.
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Cerebellar Hemorrhage in Woman With History of HypertensionA 65-year-old woman with a long history of hypertension treated with metoprolol and felodipine complained of dizziness, headache, nausea, and vomiting of acute onset. Her blood pressure was 220/110 mm Hg. She was drowsy and unable to stand or walk.
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Astrocytoma in PregnancyHeadache and vomiting suddenly developed in a 41-year-old woman who was 16 weeks pregnant. The next day, she suffered an episode of tonic-clonic seizures associated with a 15-minute loss of consciousness.
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120: The New Normal?Podcast: Hypertension expert Daichi Shimbo, MD, offers tips on putting SPRINT results into clinical practice.
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Rectus Sheath Rupture With Hematoma FormationThe authors present a case of rupture of the rectus abdominis muscle with subsequent rectus sheath hematoma-an uncommon and often misdiagnosed cause of acute abdominal pain.
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patient education guide Questions and Answers About Chronic SinusitisThese sinuses are lined by a membrane. When this membrane becomes inflamed--usually as a result of an infection or obstruction--you can get sinusitis. Sinusitis can be acute, recurrent, or chronic. Acute sinusitis responds well to treatment within a few weeks. Recurrent sinusitis is characterized by episodes that repeat at least 4 times a year. Sinusitis is considered to be chronic when symptoms persist for at least 12 weeks after treatment of acute sinusitis has ended.
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End-of-Life Discussions: The Art of Delivering Bad NewsAn 84-year-old woman with progressive stenosis of the cervical spinal canal, type 2 diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, hypertension, and stable angina presents to her primary care physician after an appointment with the orthopedist who is monitoring her chronic degenerative joint disease.
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Man With Headache, Diplopia, Nausea, and VomitingA 68-year-old man presents to the emergency department with diplopia and headache of acute onset accompanied by nausea and vomiting.
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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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Cerebral air embolism resulting from an airplane flightThe authors describe a case of air embolism that developed during a plane flight in a woman who had a congenital cystic adenomatoid malformation. They review the pathophysiological mechanisms, risk factors, clinical features, and treatment of air embolism.
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Unusually Severe Pharyngitis in a 19-Year-Old WomanA previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.
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Complications of Body ArtPrimary care providers are seeingan increasing number ofpatients who have snakes orbarbwire coiling around theirarms or gold rings danglingfrom their eyebrows and navels. Tattooingand body piercing are particularlypopular among adolescents andyoung adults-many of whom may notbe aware of the possible medical complicationsof these ancient practices.
