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Heterozygous Familial HypercholesterolemiaA 56-year-old woman was referred for management of severe hyperlipidemia. Her family history included hypercholesterolemia and premature coronary artery disease.
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Eosinophilic Granuloma of the VulvaA 46-year-old woman sought treatment of vaginal pruritus of 6 months' duration. She also was bothered by generalized skeletal aching that was most prominent in her legs. The patient had a history of hypertension.
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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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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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Calcification of the Mediastinum in an Asymptomatic WomanA 72-year-old woman presented for her annual physical examination. She had been treated for tuberculosis 20 years earlier. The patient did not smoke cigarettes; she denied fever, chills, and rigors.
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Acute Poisoning:We live in a world of toxins and potential toxins, and thus we are often just a misstep away from a toxic exposure and its consequences. Even that which is meant to cure can kill. All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy; exposure to the wrong dose of a medication (whether accidental or not) remains a common form of toxic exposure.
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Nonarteritic Anterior Ischemic Optic NeuropathyA 43-year-old white man presented to the emergency department with dyspnea, abdominal bloating, fever with chills, night sweats, decreased oral intake, and myalgia of 1 week's duration. He was found to have heart failure caused by systolic dysfunction. Viral myocarditis was the presumptive diagnosis after investigation for other causes.
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Multiple Myeloma Presenting With CHFDyspnea, orthopnea, and weight loss sent a 40-year-old woman for medical consultation. Fifteen years earlier, the patient had been nephrectomized because of left kidney lithiasis. There was no history of other symptoms or diseases.
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Multiple Myeloma Presenting With CHFDyspnea, orthopnea, and weight loss sent a 40-year-old woman for medical consultation. Fifteen years earlier, the patient had been nephrectomized because of left kidney lithiasis. There was no history of other symptoms or diseases.
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Inflammatory Breast CancerA 40-year-old woman was concerned about an area of redness and tenderness on her left breast. Despite antibiotic therapy prescribed by another physician, the rash had progressed during the past month to erythema and nodules that involved the anterior chest and right breast.
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Pellagra I a 45-Year-Old Man#onc_figure_border{ width: 175px; float:right; display:block;clear:right; border-left: 1px solid #a5a5a5; padding: 2px 0px 10px 10px; margin: 0px 0px 0px 10px;}
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Pulmonary Embolism and Deep Venous ThrombosisFor 2 months, a 31-year-old woman had had dyspnea and dull, continuous retrosternal pain. She was admitted to the hospital, and a helical CT scan of the thorax identified a saddle pulmonary embolism. An ultrasonogram revealed deep venous thrombosis (DVT) in the left leg. Intravenous heparin was given; the patient was discharged, and warfarin was prescribed.
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Extrapulmonary tuberculosis, part 4: Skeletal involvementAbstract: Spinal tuberculosis is the most common form of osteoarticular involvement in patients with tuberculosis. Localized pain is a common presenting symptom. In patients who do not present until vertebral wedging and collapse have occurred, a localized knuckle kyphosis is obvious, especially in the dorsal spine. In some patients, a retropharyngeal abscess develops, causing dysphagia, dyspnea, and/or hoarseness. Peripheral joint tuberculosis is characterized by an insidious onset of slowly progressive, painful, and swollen monoarthropathy, most commonly affecting the hip or knee. The radiologic features include juxta-articular osteoporosis, peripheral osseous erosion, and gradual narrowing of the interosseous space. Treatment involves antituberculosis drugs; the indications for surgery are relatively limited. (J Respir Dis. 2005; 26(12):543-546)
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Wheezing in a 52-Year-Old Woman With a History of Colon CancerA 52-year-old woman was admitted tothe hospital with progressive shortnessof breath of 2 days’ duration. Bronchialasthma had been diagnosed 6 monthsearlier; inhaled corticosteroids, bronchodilators,and leukotriene antagonistswere prescribed. Despite aggressivetreatment, the patient’s dyspneaand wheezing worsened.
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Sleep Disturbances Up Alzheimer Disease Risk in MenThe older the age at which self-reported sleep disturbance was indicated, a Swedish study found, the higher the risk of Alzheimer dementia.
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Sleep Disorders in Young Children May Lead to Special Education NeedsSleep-disordered breathing and behavioral sleep disturbance in young children may lead to learning disabilities.
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Green Nail SyndromeGreen discoloration of the fingernailsdeveloped 6 weeks after a 29-year-oldwoman had artificial nails placed duringa manicure. The patient was a doctorof pharmacy degree candidate whowas married and had 2 children.
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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]
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Diabetes and Mental Illness: Factors to Keep in MindPersons with severe mental illnesses (SMI), such as schizophrenia, are at increased risk for comorbid conditions- including type 2 diabetes-independent of therapy. SMI sufferers especially at risk for type 2 diabetes are women, African Americans, and persons older than 45 years. Among the possible causes of increased susceptibility to type 2 diabetes are such schizophrenia-associated conditions as impaired glucose tolerance, overweight, obesity, inadequate nutrition, lack of exercise, and inadequate self-care. Other obstacles to good health care among patients with schizophrenia include impaired communication ability, denial of illness, social withdrawal, and undertreatment because of comorbid conditions. Different antipsychotic medications may also contribute to preexisting insulin resistance or glucose intolerance. Clinicians can optimize care by understanding the most significant barriers for each patient and incorporating this knowledge into an active treatment plan.
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Obesity Hypoventilation Syndrome: Simple to Diagnose, Potentially Deadly if OverlookedObesity hypoventilation syndrome (OHS) shares clinical symptoms with obstructive sleep apnea (OSA) such as daytime sleepiness, headaches, and memory problems. Both the symptoms and their sequelae, however, can be much more severe in OHS. Here, guidance on what to look for and how to manage OHS.
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Crack ThumbA 41-year-old man complaining of left-sided chest pain for 2 hours was examined in the emergency department (ED). On arrival, his blood pressure was 160/100 mm Hg; heart rate, 90 beats per minute; respiratory rate, 18 breaths per minute; oxygen saturation, 99%; and temperature, 37.2°C (99°F).
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Varicella-Zoster Virus InfectionAre these tender, vesicular erythematous lesions symptomatic of HIV/AIDS? Of Ramsay Hunt syndrome? Of herpes simplex or varicella-zoster virus? What's your diagnosis?
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Lifestyle Medicine: AHA's Statement Calling for Lifestyle Counseling TrainingPatients take lifestyle recommendations seriously, but not many physicians offer them. Why not? Do you?
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Herpes Zoster: Pain Now, Rash LaterA 5-year-old boy was brought for evaluation of left leg pain. He had awoken with the pain 2 days earlier.
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A man with sudden-onset dyspnea, chest pain, and pneumothoraxUnilateral cystic lung anomalies are uncommon. We report a case of placental transmogrification of the lung in an adult, a condition with a peculiar histological pattern characterized by formation of placental, villus-like structures in the lung parenchyma.
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Further Evidence That HTLV Protects Against HIV ProgressionPrevious case reports have suggested an association betweenhuman T-cell lymphotropic virus (HTLV) types 1 and 2infection and chronic nonprogressive HIV infection. Evidenceis lacking about the specifics of how the two are related. Wereport 2 cases of chronic nonprogressive HIV infection (of9 and 13 years' duration, respectively) in women in whomHTLV coinfection was diagnosed. These cases provide clinicalsupport that HTLV coinfection may serve as a protective factoragainst progression of HIV infection. Possible reasons for thisrelationship and potential future research are discussed.[Infect Med. 2008;25:416-420]
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Bloody Diarrhea Caused by Infection With Klebsiella oxytoca in a Burn PatientClostridium difficile infections account for most cases of antibiotic-associated colitis.1 However, there is increasing evidence that Klebsiella oxytoca infection contributes to the development of C difficile–negative antibiotic-associated hemorrhagic colitis. Most cases have been reported in France,2-12
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Pruritic Urticarial Papules and Plaques of PregnancyThis tongue-twister of a dermatosis is the most common type seen during pregnancy and primarily occurs in women carrying twins or triplets.
