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Autosomal Dominant Polycystic Kidney Disease in a 38-Year-Old WomanAutosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.
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Primary Biliary CirrhosisA 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.
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Double Aortic Arch in an Infant With Persistent StridorDouble aortic arch-a vascular ring anomaly in which both embryonic aortic arches persist and encircle the trachea and esophagus-is rare.
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Erythema ab Igne in a 66-Year-Old Black WomanThis 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.
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Bilateral Painless Swelling of the Neck in a 40-Year-Old ManOn palpation, the swelling was non-tender, soft, and mobile but did not feel fluid-filled. Here, view ultrasound findings and propose your diagnosis.
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Vulvar MelanosisDuring a routine examination, macular dermatitis with irregular borders was noted on the genitalia of an otherwise healthy 41-year-old woman. The right labia minora featured a 7-cm dark pigmented macular area; a similar area measuring 10 cm was observed on the left upper labia minora.
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Gastrointestinal Involvement of Systemic AmyloidosisThe authors present a case of AL amyloidosis with rare GI involvement and an equally rare presenting symptom.
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Medication Nonadherence and the Risks of Hospitalization, Emergency Department Visits, and Death Among Medicare Part D Enrollees With DiabetesThe authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.
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Back Extension Exercises for Patients With OsteoporosisExercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.
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The 10 Most Common Prescribing Errors: Tips on Avoiding the PitfallsNumerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.
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AIDS-Related PsoriasisA 29-year-old man presented with a complaint of venereal warts and a long history of mild psoriasis, which he had treated with fluocinolone. He returned 3 months later complaining of chest congestion of 10 days' duration; it had been treated with ciprofloxacin at an urgent care facility.
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Rebound Headache: Keys to Effective TherapyWhich of these scenarios is familiarto you? •A local pharmacist calls to say thatyour patient wants another refill for thecombination analgesic containing aspirin,caffeine, and butalbital that youprescribed last week. Pharmacy recordsindicate that this patient has received250 tablets of this medication inthe last 34 days.
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Osteoarthritis of the Knee and Hip:For patients with osteoarthritis, nonpharmacologic treatment can be an effective adjunct to drug therapy. Patient education is essential; both community-based and independent self-care programs are available. Weight loss can improve function and alleviate symptoms; however, it is more effective when dietary modification is accompanied by increased physical activity.
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Podcast: Measles Shows Its Spots-AgainMeasles is making a comeback . . . yet again . . . in the United States.
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Desmoplastic MelanomaA minute, nonpigmented, innocuous-appearing papule on the nose of a 60-year-old man did not seem cause for alarm. However, a simple, 3-mm punch biopsy saved this patient's life.
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Primary synovial sarcoma presenting as an endobronchial massEndobronchial primary synovialsarcoma is an extremelyrare pulmonary tumor. We reportthe case of a 58-yearoldman who presented witha right-sided endobronchialmass, which was diagnosed asprimary synovial sarcoma onthe basis of histological appearanceand immunohistochemicalstaining. To the bestof our knowledge, this is onlythe third case report of endobronchialprimary synovialsarcoma.
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EncephaloceleThis 3-year-old child was brought to our ear, nose, and throat clinic for evaluation of the nasal mass that had developed over the previous few months, reports Dr Paul E. Lomeo of Muskegon, Mich. The youngster was known to have congenital problems, including cardiac, renal, and craniofacial anomalies. There was no identified syndrome associated with his health.
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Considering the role of NPPV, PEEP, and other interventions Managing acute severe asthma: What therapies to try, part 2 key words: Asthma, Leukotriene modifiers, Mechanical ventilationabstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)
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Antiretroviral TherapyTenofovir disoproxil fumarate is approved to treat HIV infection in combination with other antiretroviral agents. Although tenofovir is generally well tolerated, the potential for nephrotoxicity exists based on preclinical data, case reports, and observational studies.
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Preschooler With Slowly Progressing Rash on One ArmDuring the past week, a rash on theright thumb and forefinger of a 4-yearoldboy has progressed to involve theentire arm.
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Matters of the Heart: Pericardial TamponadeA 70-year-old woman with no previousmedical problems had had progressivedyspnea and generalized weaknessfor the past several days. She washypotensive (73/31 mm Hg), tachycardic(120 beats per minute), andtachypneic (28 breaths per minute);oxygen saturation (room air) via pulseoximetry was 84%.
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Pseudomembranous ColitisFollowing mechanical bowel preparation and prophylactic antibiotic therapy, a 59-year-old man underwent transanal excision of a villous adenoma of the distal rectum. Two weeks after discharge, he returned with a temperature of 38.9°C (102°F), abdominal pain, and diarrhea.
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Cutaneous Mycobacterium InfectionThis rash, which covered a 68-year-old woman's body, was noted to have worsened during the past 2 months. A cephalosporin antibiotic had failed to clear the condition. The patient, a nursing home resident, suffered from emphysema, asthma, and heart disease. She had been receiving oxygen therapy and prednisone for 1 year.
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Herpes ZosterApproximately 1 million cases of herpes zoster are diagnosed in the United States every year. Here, a refresher on the virus and a good look at the rash.
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What Is This Intensely Pruritic Rash?A 71-year-old woman presents to the emergency department for evaluation of a blistering, intensely pruritic generalized rash that started 5 days earlier. Multiple ruptured and intact hemorrhagic bullae are obvious on the hands, arm, neck, chest, back, and abdomen and to a lesser extent on the lower extremities. The mucous membranes are spared. The Nikolsky sign is absent. The patient reports recent use of furosemide for periodic leg swelling.
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Preventive measures are still the best strategy Aspiration syndromes: Pneumonia and pneumonitis key words: Aspiration, Pneumonitis, Pneumoniaabstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)
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Polymicrobial Wound Infection and Nerve Injury Secondary to a Nonhuman Primate BiteNonhuman primate bites in the United States are rare. Mostphysicians have no experience managing them. The lesionsare initially treated in much the same way as human bites,although consultation with an infectious diseases specialist,surgeon, and veterinarian are recommended, especially formicrobial infection control and management. Of particularconcern is animal-to-human transmission of herpes B virus,which can be fatal. We report a case of polymicrobial simianbite wound infection with associated nerve injury in a12-year-old boy. [Infect Med. 2008;25:120-122]
