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Eye on Ocular Disorders: Isolated Abducent Nerve PalsyA 65-year-old woman presented withdouble vision of 2 days’ duration.The diplopia mainly occurred whenshe looked toward her right. She deniednausea, vomiting, vision loss,headache, change in mental status,facial pain, weakness in the extremities,and sinus infection. She had nohistory of head trauma or systemicmalignancy.
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Right Bundle-Branch Block After Pacemaker ImplantationThe morning after an 88-year-old woman with symptomatic second-degree type I (Wenckebach) atrioventricular block underwent placement of a dual chamber pacemaker without complication, she awoke with uncomfortable pulsations in her abdomen. The pacing thresholds and impedance had remained unchanged since implantation.
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Pitfalls In Prescribing: Metronidazole Dosing in Patients With Hepatic DysfunctionMetronidazole, the prototype nitroimidazole, was originally released in 1959 for the treatment of Trichomonas vaginalis infections. It has since been used to treat a variety of infections caused by anaerobic and facultative anaerobic bacteria and protozoa. Here we discuss the need for dosing adjustments in patients with hepatic disease.
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New Advances in Antiretroviral TherapyIt is estimated that approximately 33.2 million persons worldwide were living with HIV infection in 2007.1 With the development of effective antiretroviral treatment strategies, HIV infection has now become a manageable chronic disease.2 Despite advances in treatment, drug resistance, long-term adverse effects, and high adherence requirements represent ongoing challenges to durable viral suppression.
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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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Managing Allergic Rhinitis: The Role of PharmacotherapyWhile avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.
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Understanding Uncertainty Can Ease Anxiety DisordersIf physicians know how well their patients tolerate uncertainty about health before providing feedback during a consultation, they can improve their patients' care dramatically.
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Punctate KeratodermaSince his twenties, a 71-year-old man had had multiple tiny, pinhead, whitish yellow papules on his palms. They were asymptomatic but made his skin feel like sandpaper. Other members of his family had similar lesions.
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ESMO: Cisplatin-Navelbine Duo Shows Survival Edge in NSCLCISTANBUL, Turkey -- Cisplatin-Navelbine (vinorelbine) reduced mortality in fully resected non-small cell lung cancer (NSCLC), according to a meta-analysis reported here.
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Four Types of Kaposi SarcomaA 46-year-old man with AIDS (CD4+ cell count, 150/μL) presented with a painful nodular lesion on the plantar surface of his right foot. The lesion had appeared 1 month earlier as a painless, 1-cm, raised, reddish purple nodule and had progressively enlarged to 5 cm. Six months earlier, the patient had cryosurgery to remove a similar, larger lesion on the posterior aspect of his right midcalf.
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Slow Medicine: MOC in the MiddleThe ABIM has certainly lapsed from its self-defined mission of “accountability to both the profession of medicine and to the public.” It will take significant work to gain back the trust of its diplomats.
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Bacterial ArthritidesGonococcal infection is the leading cause of bacterial arthritis in adults.
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Diabetes: 11 Treatment Pitfalls-and How to Avoid ThemHere: a look at the many possible causes of poorly controlled blood glucose levels, and steps to overcome them.
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Sliding Hiatal Hernia and T-Cell Lymphoblastic LymphomaClinical Images to Help You Hone Your Diagnoses
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Case In Point: Polydipsia, polyuria, and pneumothorax in a young woman with diffuse cystic lung lesionsA 23-year-old woman was referred to our interstitial lung disease (ILD) clinic with a diagnosis of LAM, a progressive cystic ILD that affects women of childbearing age. The patient had been a smoker since the age of 16, but she quit smoking about 2 months before the clinic visit, when she had a pneumothorax. At that time, she complained of sudden onset right-sided chest pain with shortness of breath for which she was admitted to her hometown hospital.
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Case In Point: Acute eosinophilic pneumonia in a 19-year-old manThe authors describe a case of acute eosinophilic pneumonia (AEP) that occurred in a previously healthy young man. The presentation was similar to that of acute respiratory distress syndrome (ARDS), and the diagnosis was established by bronchoalveolar lavage (BAL). The authors note that it is important to recognize the subset of patients with AEP who present with an ARDS-like picture, especially since corticosteroids are very effective in this setting.
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Young Woman With Atypical Presentation of Fitz-Hugh-Curtis SyndromeA 22-year-old woman presented to her primary care physician’s office with right lower quadrant and suprapubic abdominal pain. She stated that the pain had begun earlier that day; she had no symptoms on awakening that morning.
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Aortic DissectionA 67-year-old woman presented to the emergency department (ED) with severe, sharp, central chest pain of sudden onset and mild shortness of breath. The pain had been present for 15 minutes. The patient was obese; her medical history included hypertension, myocardial infarction, and osteoarthritis.
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Epiphrenic DiverticulumIncreasingly severe dysphagia had bothered a 77-year-old woman for several months. By the time she sought medical attention, both food and liquids were sticking in the lower esophagus, leading to vomiting and weight loss.
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Adenocarcinoma of the Lung in a 50-Year-Old WomanDuring the past few months, a 50-year-old woman had experienced cough, dyspnea, mild hemoptysis, and a 30-lb weight loss. She had no fever, chills, or rigors. The patient had smoked cigarettes for 30 years.
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Juvenile PolypA 2-year-old girl presents to the pediatric emergency department (ED) for evaluation of a fleshy mass protruding from her rectum. The mass, which had been present for 1 day, protruded spontaneously and not during defecation. There is no history of cough, constipation, diarrhea, vomiting, weight loss, or parasitic or chronic disease. However, the child has been having episodic, painless bleeding during the past month. There is no family history of GI disease.
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Post-Trauma LesionsA 16-year-old boy removed a small sliver of wood from the palm of his hand with a pocket knife. However, the fledgling “surgeon” created a small puncture wound during this operation. Over the next month, a small, moist, friable papule grew at the site.
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Sliding Hiatal Hernia and T-Cell Lymphoblastic LymphomaClinical Images to Help You Hone Your Diagnoses
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Tension and Cervicogenic Headaches:ABSTRACT: A thorough history and physical examination can establish the diagnosis of tension headache; further evaluation is generally unnecessary. In contrast, the workup of cervicogenic headache includes standard radiographs, 3-dimensional CT, MRI, and possibly electromyography; nerve blocks may also be used to confirm the diagnosis. Episodic tension headache can be treated effectively by trigger avoidance, behavioral modalities, and structured use of analgesics. Reserve opioids for patients with intractable headaches. Chronic tension headache is treated primarily by prophylactic measures, such as antidepressants and anticonvulsants, and behavioral and physical therapy. Treatment options for cervicogenic headache include analgesics; invasive procedures, such as trigger point injections, greater or lesser occipital nerve blocks, facet joint blocks, segmental nerve root blocks, and diskography; spinal manipulation; and behavioral approaches.
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Pericardial tamponade caused by Actinomyces after bronchoscopyActinomyces odontolyticus isa rare cause of pleuropericardialinfection, with only 1 caseidentified in the literature. Inthat instance, the infectionwas believed to be secondaryto gastric surgery. We present apatient with pericarditis andpericardial tamponade causedby A odontolyticus. The infectionoccurred after an ultrasound-guided subcarinalbronchoscopic needle biopsyperformed for a suspicious mediastinalmass found on a CTscan of the chest. We describethe case presentation, the microbiologyand treatment of Aodontolyticus infection, andthe classic features of pericarditisand cardiac tamponade.
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Multiple Aorto-Cavitary FistulasInfective endocarditis (IE) starts as a vegetation on the valvular structures. The infection can extend to the adjacent periannular areas and erode into nearby cardiac chambers, leading to an aorto-cavitary fistula (ACF).1,2
