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An Unusual Presentation of Septic HipEmphysematous cholecystitis is a rare condition that is the result of infection with Clostridium perfringens and other gas-producing organisms including Escherichia coli, Bacteroides fragilis, and Klebsiella species.
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Scrotal Calcinosis in Normocalcemic Primary HyperparathyroidismA 32-year-old man with no significant medical history presents with multiple scrotal lesions that he claims have been present for 2 years. They are non-tender and he reports no overt symptoms. The full case, here.
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Emerging Mold Infections: HyalohyphomycosisFilamentous fungi (molds) can be divided into 2 broad morphologically distinct groups: those that produce aseptate hyphae and those that produce aseptate (or rarely septated) hyphae. Identification of aseptate hyphae in tissue is virtually pathognomonic of zygomycosis (mucormycosis)-disease caused by fungi of the class Zygomycetes (order Mucorales). The discovery of septate hyphae in tissue is less diagnostic; septate hyphae may be caused by fungi that typically grow as yeasts (eg, Candida and Trichosporon) or a vast number of species of molds. The septate molds are often divided into those with darkly pigmented hyphae (phaeohyphomycetes) and those with pale or colorless (hyaline) hyphae (hyalohyphomycetes).
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Snake Bite: A Small Puncture Can Create a Large ProblemAn 8-year-old boy from southern Ohio was outside playing when he saw a snake lying in the driveway. The boy picked up the snake to show his father and then dropped it. He picked it up again and was bitten. He sustained a tiny puncture wound to the palmar aspect of his distal left ring finger and a scratch to the distal long finger.
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Atypical Tuberculin Skin Test ResponsesTuberculin-type hypersensitivity is characterized by marked spongiotic dermatitis with intraepidermal and subepidermal vesiculation and scattered eosinophils.
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Long-Term Efficacy and Safety of Tipranavir Boosted With RitonavirCritical ViewsinInfectiousDiseaseMedicine A
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Hemolytic Uremic SyndromeFor 24 hours, a 62-year-old woman had had severe weakness, abdominal pain, and watery diarrhea that had become bloody in the past 12 hours.She had no significant medical history.
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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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COLONIC DISEASEAs the population ages, physicians are seeing a greaternumber of patients with colorectal disorders. This book combinesan up-to-date survey of the latest basic and clinicalresearch in the field with practical advice for the day-to-daycare of patients with colonic diseases. The first section ofthe book covers current knowledge of normal colorectal physiology.Section 2 discusses the basic disease mechanismsinvolved in colonic disorders and reviews the uses of suchinvestigational tools as colonoscopy, colonic biopsy, anorectalmanometry, ultrasonography, motility measurement,defecography, CT, and MRI. The third section offers a fulldiscussion of the diagnosis and treatment of commoncolonic disorders, including colorectal neoplasia, inflammatorybowel disease, ulcerative colitis, diverticular disease,Crohn disease, constipation, and irritable bowel syndrome.In addition to currently recommended approaches to evaluationand treatment, chapters in this section include discussionof advanced and investigational therapies.
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Bilateral Alien Hand SyndromeA 68-year-old woman was hospitalized because of confusion and agitation of sudden onset. Her history included dementia and multiple infarcts of both cerebellar hemispheres, bilateral basal ganglia, bilateral parietal lobes, and the right occipital lobe.
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Gastric Kaposi's SarcomaHIV infection was diagnosed in a 34-year-old man 3 years before he was hospitalized. The patient had a 2-week history of nausea; vomiting; and diffuse, intermittent, poorly localized abdominal pain. He had received radiotherapy and chemotherapy for Kaposi's sarcoma (KS) of the upper and lower extremities, which had been diagnosed 8 months earlier.
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Dog Bite in a 2-Year-Old BoyThe 2-year-old boy shown here had been bitten on the left cheek by a medium-sized dog while at the home of his day-care provider. Immediately after the incident, the child was examined by his pediatrician and given a presciption for amoxicillin clavulanate. The next day, he presented to the emergency department with worsening cellulitis of the left cheek.
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Ruptured Aortic AneurysmSevere abdominal pain radiating to the back prompted a 72-year-old man to go to the emergency department (ED). The patient had experienced similar pain 2 days earlier and was treated at another hospital for renal colic on the basis of concomitant microscopic hematuria. He had a history of poorly controlled hypertension.
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NSAID Nephrotoxicity Revisited:Selective COX-2 InhibitorsFor over 25 years, NSAIDs have been used to treat a variety of pain syndromesand inflammatory diseases. More than 50 million Americanstake these drugs. Unfortunately, control of pain and inflammation is notachieved without an associated cost-namely, GI complications and, to a lesserextent, nephrotoxicity.In an attempt to reduce drug-related toxicity, a new class of selectiveNSAIDs-the COX-2 inhibitors-was introduced in 1999. These selectiveNSAIDs are as effective as and pose less risk of gastric toxicity than nonselectiveNSAIDs.1,2The COX-2 inhibitors are thought to reduce end-organ injury, such as GIulceration, by sparing homeostatic or “constitutive” COX-1 enzyme function.1,2 Incontrast, therapeutic effects result from the inhibition of the “inducible” COX-2enzyme.1,2 Such drug effects target the production of proinflammatory prostaglandinsby COX-2 without interrupting normal cell function mediated by COX-1.2,3
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Drug-induced lung diseases: A state-of-the-art reviewp>Drug-induced lung disease (DILD) can be caused by a variety of agents, including chemotherapeutic drugs, antiarrhythmic agents, antibiotics, and NSAIDs. The clinical syndromes associated with DILD include alveolar hypoventilation, acute bronchospasm, organizing pneumonia, and hypersensitivity reactions. Amiodarone lung toxicity often manifests as a chronic fibrosing alveolitis, characterized by an insidious onset of cough, dyspnea, and weight loss. Important components of the workup include chest radiography, pulmonary function testing, and bronchoscopy with bronchoalveolar lavage (BAL). BAL is particularly helpful in identifying eosinophilic pneumonia and diffuse alveolar hemorrhage and in ruling out infectious causes. Management includes drug withdrawal and, in some cases, corticosteroid therapy. Before starting corticosteroids, it is important to rule out infectious causes of lung disease, particularly in patients receiving chemotherapy. (J Respir Dis. 2009;30(1))
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Renal Cell Carcinoma Metastases to the LungA 2-month history of cough sent a 62-year-old woman for medical evaluation. The patient denied fever, chills, and rigors but reported seeing streaks of blood in her sputum during the past month. The patient had undergone a right nephrectomy 4 years earlier for renal cell carcinoma.
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High-Calorie Diet Tied to Ca Risk for Some WomenAuthors of a new study were surprised to find that this relationship was exclusive to women of normal weight.
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Postpartum pulmonary arterial hypertensionPatients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.
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ECG Changes in Polymorphic Ventricular TachycardiaTorsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.
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What are the pulmonary effects of smoking marijuana?Marijuana is the most commonly used illicit drug in the United States. The prevalence of marijuana use has remained stable over the past several years, with 14.6 million persons older than 12 years reporting past-month use in 2005. Given the prevalence of illicit use and interest in the medicinal use of marijuana, an understanding of the potential negative health consequences of marijuana smoking is needed. While tobacco smoking is clearly associated with numerous adverse respiratory complications, including increased cough and wheeze, the development of chronic obstructive pulmonary disease (COPD), lung cancer, and an increased incidence of infections,1-3 the relationship between marijuana and pulmonary disease is controversial, despite similarities in many compounds found in marijuana and tobacco smoke.
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Lowering the Bar: Patient or Addict?Of the [ADHD] drug's effects he said, "It was instant; it fixed everything...All these problems that had ailed me my whole life were gone."
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Social Anxiety Disorder: A Short Guide to Dx and Rx in Primary CareMany patients clearly would benefit from help from clinicians, but two-thirds of patients have never sought medical care for this disorder.
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Underarm Eruption in a Teenaged BoyTopical steroids and antifungals have not only failed to resolve the bilateral rash; the teen says they’ve made it worse. Your Dx?
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AANP: Weight Control Problems May Be a Matter of BiochemistryINDIANAPOLIS -- Each person metabolizes food differently, so the diet that works for one person won't work for another.
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Visceral LeishmaniasisAfter 5 weeks of undulating fever, weight loss, and night sweats, a 22-year-old man presented to the emergency department. He reported no significant medical history. The patient had recently completed a course of tetracycline followed by another of azithromycin for a presumed upper respiratory tract infection.
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Case In Point: Young Woman With Abdominal Pain and FullnessA 23-year-old woman presents withweight loss, epigastric pain, abdominalfullness, and mild nausea. Shereports that she has had a slow-growingmass on her upper middle abdomen.She denies vomiting and doesnot have evidence of jaundice. Theonly significant finding in her medicalhistory is a myringotomy performedmany years earlier. She currentlytakes an oral contraceptive.
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Scurvy, Pellagra, and Beri BeriA 38-year-old woman presented with bruising and pain of the lower extremities and dyspnea on exertion. She had had these symptoms for 3 weeks. She denied hematuria, melena, hematemesis, fever, or abdominal pain. Results of routine blood work showed a hemoglobin level of 6.4 g/dL (19 months earlier, this level was 15.8 g/dL).
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Sweet SyndromeA 66-year-old woman was hospitalized because of severe anemia secondary to myelodysplastic syndrome. She had had associated fatigue and throbbing pain in both legs for several days.
