Authors
Latest:
Nonspecific symptoms are among the obstacles to diagnosis Pulmonary alveolar proteinosis: An easy-to-miss diagnosis key words: Alveolar proteinosis, Surfactant, Whole lung lavageabstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)
Latest:
Continued Cytological Monitoring for Cervical Cancer Despite Prior VaccinationThe human papilloma viruses (HPVs) are among the widespread sexually transmitted pathogens infecting women. Like HIV, HPV–s
Latest:
Pyoderma Gangrenosum Surrounding Colostomy Stoma in a 64-Year-Old Woman With Crohn DiseaseA painful skin eruption surrounding her colostomy stoma had appeared several months ago and was slowly increasing in size, complained a 64-year-old woman with Crohn's disease. The lesion consisted of several coalescent ulcers with a yellow, fibrinoid base and a violaceous, undermined border.
Latest:
A Man With Transient Dyspnea After Taking TadalafilA 26-year-old man presented with sudden onset of palpitations and shortness of breath after incidentally taking tadalafil. He had no other symptoms and no history of illnesses during childhood. He drank socially but denied smoking and use of illicit drugs.
Latest:
What's The "Take Home"? Severe Elbow Pain in an Elderly ManA 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.
Latest:
Will the latest therapies prove beneficial? Reviewing the clinical aspects of HIV- associated pulmonary hypertensionabstract: Pulmonary hypertension is an increasingly recognized complication of HIV disease. Echocardiography is the most useful imaging modality for an early diagnosis; the most frequent findings are systolic flattening of the interventricular septum, right atrial and right ventricular enlargement, and tricuspid regurgitation. Other components of the workup include comprehensive laboratory tests (complete blood cell count, measurement of prothombin time and partial thromboplastin time, hepatic profile, etc), chest radiography, pulmonary function tests with arterial blood gas analysis, ventilation-perfusion lung scanning, and spiral CT scanning. The treatment of this condition is complex and controversial, and the drug of choice has not yet been established. The therapies currently used include antiretroviral agents, bosentan, calcium channel blockers, epoprostenol, and sildenafil.
Latest:
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
Latest:
Tuberculosis:Cutaneous lesions can develop in anumber of pulmonary diseases, suchas tuberculosis and sarcoidosis, as wellas in other diseases that may have pulmonaryinvolvement, such as Wegenergranulomatosis, collagen vasculardiseases, varicella, and pneumococcalinfections. In many cases, knowledgeof the clinical and histologic characteristicsof the skin lesions associatedwith these diseases can greatly facilitatediagnosis.
Latest:
Treatment of Psychiatric Disorders in Patients With HIV/AIDSMental illness is a risk factor for HIV infection. It brings a number of behavioral correlates that put patients at risk for getting infected. As HIV infection worsens, it begins to affect the brain, and cyclical relationship between the disease and mental illness begins.
Latest:
A "Slightly High" PSA:ABSTRACT: Although the widespread use of prostate-specific antigen (PSA) testing has led to an increase in the number of cancers detected, controversies about the benefits of screening persist. No conclusive evidence has yet emerged that PSA screening reduces the mortality associated with prostate cancer. Thus, mass screening is not universally endorsed. The American Urologic Association and the American Cancer Society recommend that digital rectal examination and PSA testing be offered annually to men 50 years and older with an estimated life expec- tancy of 10 years or more. High-risk patients (those with a positive family history or those of African American descent) are advised to begin screening at age 45. The decision to screen is based on the patient's preference following a thorough discussion of the benefits and limitations of PSA testing. Refer to a urologist any patient with a PSA greater than 4.0 ng/mL. Also, be alert for high PSA velocity changes in patients undergoing annual screening, and refer those with a PSA velocity of more than 0.75 ng/mL/y.
Latest:
High BMI Tied to T2D, but Not to Heart TroublesA Swedish study in twins has drawn criticism for limitations but the results reinforce the strong link between obesity and type 2 diabetes.
Latest:
Clinical Consultation: Tai Chi for COPDTai Chi (also known as T'ai Chi Chuan, Taijiquan) is a form of mind-body exercise that has its roots in ancient Chinese martial arts. Throughout Asia, it is often practiced for preventive health, especially among the elderly. In recent years, Tai Chi has become popular in the West among all age groups and has been studied as a therapy for various medical conditions.
Latest:
Hemorrhagic Pituitary Apoplexy in Pregnancy: A Retrospective Radiologic DiagnosisA 38-year-old woman became pregnant during the time she was undergoing evaluation for a pituitary adenoma. Here, see the case unfold.
Latest:
A Pregnant Woman With Lax Joints and SkinA 25-year-old woman presents for a prenatal visit. She has an unremarkable medical history except for hypermobility of the joints and a tendency to bruise easily. Her mother and sister also have very lax joints.
Latest:
Contact Dermatitis to CopperPain and pruritus of the neck and upper chest began to bother a 43-year-old woman several hours after she put on a new copper necklace. Vigorous scratching of the affected area caused excoriation of the skin, which can mask the eruption and complicate diagnosis.
Latest:
An Intriguing DiagnosisA 12-month-old previously healthy boypresented to the pediatric emergencydepartment (ED) with a 10-day historyof fever, irritability, and anorexia.The patient’s mother had originallynoted the development of 3 erythematouspapules on the patient’s back, leftaxilla, and chest; these were followedby the onset of daily fevers, with temperaturesranging from 38.8°C to41.1°C (102°F to 106°F). The lesionsgrew progressively larger and erythematous,and became ulceratedwith central eschars.
Latest:
Lymphomatoid granulomatosis with muscular involvementA 74-year-old woman with a history of breast cancer and cutaneous sarcoidosis was admitted after a fall from bed that resulted in a left hip fracture.
Latest:
ACP 2015: "Still, Do No Harm"I’ll admit I was a little nervous to attend the annual American College of Physicians (ACP) meeting this year, what with the MOC snafu and the fall out.
Latest:
The Weekly Dose: How Medicaid Policies Impact Postpartum Depression CareAt ACOG 2025, Elizabeth Mollard, PhD, discussed her research on Medicaid PPD screening and coverage policies on PPD diagnosis.
Latest:
Research Focus: Recent Developments in HIV TherapeuticsResearch Focus: Recent Developments in HIV Therapeutics
Latest:
Multimedia: AMA House of DelegatesCHICAGO -- This special report from Greg Laub, MedPageToday videographer, gives a sense of the proceedings at the 2007 Annual Meeting of the AMA House of Delegates, with a debate regarding the sale of physician data from AMA's Physician Masterfile to pharmaceutical companies that use the data to compile physician prescribing data.
Latest:
Tympanic Membrane Perforation:An Unusual Complication of Varicella-Zoster Virus InfectionOtological complications associated with varicella-zostervirus infection are common; however, tympanic membraneinvolvement is rarely reported. We describe a patient withherpes zoster in whom hemorrhagic otitis media with tympanicmembrane perforation developed. To our knowledge,this is the first report of an HIV-infected patient with thisunusual presentation. [Infect Med. 2008;25:561-562]
Latest:
Middle-Aged Woman With Epistaxis, Facial Pain and Swelling, and OtalgiaFor 2 weeks, a 49-year-old woman has had mild, intermittent epistaxis with left-sided facial pain, swelling, and otalgia; the severity of the bleeding has increased during the past 24 hours. She also has congestion of the left naris of 1 month's duration.
Latest:
Treating Sepsis: An Update on the Latest Therapies, Part 1A milestone has been reached in the treatment of sepsis-the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to obtain cultures rapidly and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (Infect Med. 2009;26):134-143)
Latest:
Colorectal Cancer Screening: Old Obstacles, New TestsColorectal cancer (CRC) is highly preventable; however, it remains a significant cause of morbidity and mortality in Western countries. CRC develops in more than 125,000 Americans each year, and about 50,000 die of it.1 Screening and early intervention significantly reduce morbidity and mortality, and a number of organizations have published screening recommendations (Table). Nevertheless, only 1 of every 3 eligible adults elects to be screened.2
Latest:
Editor's CommentaryThere's a curse frequently attributed to the Chinese, "May you live in interesting times." It seems that we find ourselves living in interesting times right now. The Department of Homeland Security recently heightened our threat levelfrom code yellow to code orange. Duct tape, plastic wrap, and flashlights are in short supply at local hardware stores. There’s been more talk about smallpox and the smallpox vaccine, and parents and colleagues are eager for more information.
Latest:
Respiratory symptoms may develop years after IBD diagnosis What are the pulmonary manifestations of inflammatory bowel disease? key words: Inflammatory bowel disease, Ulcerative colitis, Crohn disease, Bronchiectasis, BOOP, Interstitial pneumonitisabstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)
Latest:
Health care–associated pneumonia: Meeting the clinical challengesABSTRACT: The risk factors for health care–associated pneumonia(HCAP) include hospitalization for 2 or more days withinthe past 90 days, residence in a nursing home or extended-carefacility, home infusion therapy, and long-term dialysis withinthe past 30 days. Distinguishing between community-acquiredpneumonia (CAP) and HCAP is important because of the implicationsfor therapy. Compared with CAP, HCAP is morelikely to be caused by multidrug-resistant organisms and is associatedwith a higher mortality rate. The management ofHCAP requires antimicrobial coverage of Pseudomonas aeruginosa,Acinetobacter species, extended-spectrum ß-lactamase–producing Enterobacteriaceae, and methicillin-resistant Staphylococcusaureus. Empirical narrowing of therapy is probablysafe in patients with culture-negative HCAP who have improvedwith broad-spectrum therapy. (J Respir Dis. 2008;29(5):208-213)
Latest:
Case In Point: What caused diffuse alveolar hemorrhage in a patient with gout?Allopurinol, commonly used to treat patients with gout, has been known to cause hypersensitivity reactions. We report a case of drug-induced delayed multiorgan hypersensitivity syndrome secondary to allopurinol use. To the best of our knowledge, this is the first reported case of diffuse alveolar hemorrhage in a patient presenting with allopurinol-induced rash with eosinophilia and systemic symptoms.
Latest:
Inverted DiverticulumColonoscopy revealed diverticulosis in a 47-year-old man who had presented with rectal bleeding. A polypoid lesion was noted in the sigmoid colon.
