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Herpes Zoster in Multiple DermatomesA 50-year-old woman had visited 4 health care providers seeking relief from low back pain. The patient likened the pain to an electric shock that started at the left side of the lower back and radiated to the front of the left leg. The area was also numb.
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Apical Ballooning SyndromeAfter a family argument, an 83-year-old woman experienced chest pain, a "racing heart," and a choking sensation and was brought to the emergency department. The chest pain lasted 10 to 15 minutes; was sharp, substernal, and nonradiating; and was associated with dyspnea and a bout of emesis. A sublingual nitroglycerin tablet partially alleviated the pain, but the patient felt syncopal. Her symptoms persisted despite the administration of supplemental oxygen and a second sublingual nitroglycerin tablet. The patient had a history of gastroesophageal reflux disease, allergic rhinitis, and osteoarthritis. Her oral medications included esomeprazole (40 mg/d), aspirin (81 mg/d), and fluticasone nasal spray. She had discontinued valdecoxib 3 weeks earlier.
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Progressive DyspneaA 37-year-old woman presented with progressive dyspnea of 2 weeks' duration, a low-grade fever, and night sweats. She had been a healthy marathon runner until her exercise tolerance recently declined.
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Podcast: Bariatric Surgery Bests Medical Therapy Alone in Obese Patients with DiabetesBariatric surgery nearly cures type 2 diabetes-at least that’s what results of a new study, presented at the recent ACC meeting, seem to imply.
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Adult Intussusception: A Rare Cause of Bowel ObstructionAdult intussusception is a rare entity, accounting only for 1% to 5% of cases of bowel obstruction.
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Scarlet Fever and Group A Streptococci InfectionThis 6-year-old boy was brought to his physician for evaluation of a rash. The child had been running a fever and, for the past 48 hours, had been complaining of a sore throat, headache, and abdominal pain.
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Omega-3 Fatty Acid Therapy: What Comes Next?Omega-3 fatty acids used to treat patients with dysglycemia in the ORIGIN trial failed to reduce cardiovascular death or ischemic events. Follow-up was 6 years.
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How to Handle Chronic Cough in Kids: A Practical Approach to the WorkupThe patient is a 4-year-old boy who hasbeen coughing persistently for the past 2months. The mother reports that aboutthe time the coughing began, the childhad a “cold” with nasal congestion andfever. These symptoms resolved, but acough ensued. The mother tried usingover-the-counter medications, includingcough suppressants, but the cough hasnot abated. It occurs during the day andat night. It is disrupting the child’s sleep,and the teachers at his day-care centerare concerned that he may be infectingother children.
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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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Inhalational anthrax, part 2: Prevention and treatmentWhen untreated, inhalational anthrax typically resultsin a rapidly fatal illness. Evidence suggests that both theanthrax vaccine and prophylaxis with ciprofloxacin or doxycyclineare effective in preventing illness after inhalational anthraxexposure. The current anthrax vaccine appears to have anadverse-effect profile that is similar to that of other adult vaccines.For patients with active infection, the CDC recommendsa multi-antibiotic regimen that should include doxycycline ora fluoroquinolone and 2 additional antibiotics that have proteinor RNA synthesis inhibition, such as rifampin and clindamycin.Monoclonal antibodies directed against anthrax toxinsmay also play a role in treating active infection. (J Respir Dis.2008;29(6):249-254)
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Erythema Multiforme in a 28-Year-Old ManA 28-year-old man presented to the emergency department with a 1-week history of multiple, concentric, erythemic, targetlike plaques over the entire body. Severe necrosis and hemorrhagic crusting were evident on the oral mucosa and lesions were present on the upper lip. The remainder of the physical examination was unremarkable. The patient had no known medical problems, was seronegative for HIV, and denied a history of herpes simplex virus (HSV) infection. He used no medications.
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Case In Point: Fever and a chest wall mass in a young manCoccidioides immitis is a di-morphic fungus that causes pulmonary disease with a variety of clinical and radiographic presentations. Miliary pulmonary disease is very uncommon and is found almost exclusively in immunocompromised patients. The authors describe the case of an immunocompetent patient who had disseminated coccidioidomycosis with a miliary pulmonary disease pattern. Obtaining a careful travel history and considering regional fungal infections was integral to making a prompt diagnosis.
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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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Clostridium subterminale - Infection Secondary to an Open FractureClostridia are anaerobic, spore-forming, gram-positive bacilli that are ubiquitious in nature. They can be isolated from soil and the GI tract of animals and humans.1
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Obesity: Is There Effective Treatment?In this article, we review the factors that contribute to obesity. We then describe effective approaches to weight control, including exercise, dietary modification, drug treatment, and bariatric surgery.
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Obese Young Girl With Acanthosis Nigricans and Vaginal Yeast InfectionA 12-year-old African American girl comes to youroffice for a well-child checkup. She is tall for herage (height above the 95th percentile) and obese(body mass index [BMI] above the 95th percentile).Physical examination reveals acanthosisnigricans on her neck, axilla, and upper abdominalregion (Figure) and a vaginal yeast infection.Routine urinalysis reveals a glucose level ofgreater than 1000 mg/dL, with negative proteinand ketones. A random blood glucose test, obtainedbecause of the glucosuria, is 249 mg/dL.
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Epidermoid Cysts Treated With Phosphatidylcholine InjectionsEpidermoid cysts may be treated with intralesional injections of phosphatidylcholine to avoid potential recurrence, eliminate scarring, and reduce cost.
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Can “Moderate” Drinking Damage Aging Hearts?A new imaging study finds that more than one cocktail a day for seniors aged >75 years may do more harm than good.
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Cough and Cold Treatments for Children: Does Anything Work?Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."
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Diagnostic Images, Treatment IssuesA39-year-old man is brought to theemergency department (ED)after his car struck a tree. He experienceda transient loss of consciousnesswith a 3-minute episode of retrogradeamnesia at the scene of the accident,despite wearing a seat belt andshoulder harness. He was disorientedto date and place.
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Dike Drummond, MD - Brief BioDike Drummond, MD, is a Mayo-trained family doctor, professional coach, author, speaker and trainer whose sole professional focus is addressing the modern burnout epidemic in physicians.
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Paget's DiseaseA 74-year-old man, who had been aware of a gradual increase in hat size over the past 3 years, complained of a mild headache and backache. His serum phosphatase level was 1,475 U/L (upper normal limit, 120 U/L). Skull films showed calvarial enlargement caused by thickening of the cortical tables, radiolucency in the frontal and occipital regions, and patchy osteosclerosis that produced a cotton-wool appearance.
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Acid-Base Problem SolvingA 34-year-old man has had Crohn disease for 12years. He presented initially with ileitis and has had 3surgeries for obstructive complications. Ileum resectionhas resulted in bile salt and fat malabsorption. Recently,the Crohn disease has spread to the large bowel. For thelast 2 years, he has also had seronegative spondyloarthropathy-another complication of Crohn disease.
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Chest Pain: Is It Life-Threatening, or Benign?Ruling out coronary artery disease is the first step in assessing chest pain.
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Case In Point: Recognizing allergic bronchopulmonary aspergillosisA 28-year-old man presented with chest pain, hemoptysis, and wheezing. He had a history of intermittent shortness of breath that occurred at least 3 times a year in the past 3 years; fever; and loss of appetite associated with headache, vomiting, and weakness. His medical history also included asthma, chronic gastritis, and more than 5 episodes of pneumonia since 1996. A test for hepatitis C virus (HCV) had yielded positive results.
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Man With Reflux Symptomsand Esophageal Papular LesionsA 51-year-old man with a 12.5-pack-year smoking history had symptomssuggestive of gastroesophageal reflux disease for 6 weeks.
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Subcutaneous Emphysema After ThoracoscopyA 38-year-old woman with a history of injection drug use presented with progressive pain in the left arm and neck and fever (temperature, up to 38.8°C [102°F]) of 9 days' duration. Physical findings included subcutaneous crepitus, erythema, and swelling of the left arm, chest, and neck. White blood cell count was 27,000/µL with 91% neutrophils. Chest radiographs showed gas in the subcutaneous and soft tissue of the neck, arm, and chest . Necrotizing fasciitis was suspected.
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Case In Point: Does this woman with cough and dyspnea really have CHF?A 47-year-old African American woman presented to the hospital after a 5-day history of cough and shortness of breath. The patient also described worsening cough with yellow sputum production over that same time but denied any fevers, chills, nausea, vomiting, abdominal pain, and urinary symptoms. Her condition began to rapidly deteriorate on arrival to the emergency department (ED).
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Primary Adrenal InsufficiencyFor 2 weeks, a 43-year-old white female had worsening nausea and multiple episodes of vomiting. Her symptoms began with increased malaise and decreased appetite. The emesis was unrelated to meals and was sometimes accompanied by mild abdominal distention. She had occasional fevers but denied any recent contact with ill persons. She also reported a 12-lb weight loss, decreased energy level, and an increased tan complexion over the past several months.
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The Dyslipidemia of Type 2 Diabetes: When and How to TreatABSTRACT: Low-density lipoproteins are the most common atherogenic particles in diabetic dyslipidemia; therefore statins, which dramatically reduce low-density lipoprotein (LDL) cholesterol, are first-line therapy for patients with diabetes. These agents produce equivalent relative risk reductions in those with and without diabetes but confer greater absolute risk reduction because of the increased incidence of ischemic cardiovascular events in those with diabetes. The LDL cholesterol goal for patients with diabetes who do not have coronary heart disease is below 100 mg/dL. For secondary prevention, the goal is below 70 mg/dL. High-dose statin therapy may be required to achieve these goals. Fibric acids are a reasonable initial option for patients with triglyceride levels above 200 mg/dL and high-density lipoprotein (HDL) cholesterol levels below 40 mg/dL; in such patients they reduce risk as effectively as statins. Intermediate-release niacin raises HDL cholesterol levels; the effect is enhanced when niacin is combined with a statin.
