Authors


R. Chris Rathbun, PharmD

Latest:

New Advances in Antiretroviral Therapy

It 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.


R. John Presutti, DO

Latest:

Apical Ballooning Syndrome

After 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.


R. Matthew Bloebaum, MD

Latest:

Managing Allergic Rhinitis: The Role of Pharmacotherapy

While 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.


R. Nicholas Carleton, PhD

Latest:

Understanding Uncertainty Can Ease Anxiety Disorders

If physicians know how well their patients tolerate uncertainty about health before providing feedback during a consultation, they can improve their patients' care dramatically.


Rabab Mohamed Radwan, MD

Latest:

Punctate Keratoderma

Since 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.


Rabiya Tuma, Ph.D.

Latest:

ESMO: Cisplatin-Navelbine Duo Shows Survival Edge in NSCLC

ISTANBUL, Turkey -- Cisplatin-Navelbine (vinorelbine) reduced mortality in fully resected non-small cell lung cancer (NSCLC), according to a meta-analysis reported here.


Rachel Epstein, DO

Latest:

Four Types of Kaposi Sarcoma

A 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.


Rachel Stark MD, MPH

Latest:

Slow Medicine: MOC in the Middle

The 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.


Rachelle Scott, MD

Latest:

Bacterial Arthritides

Gonococcal infection is the leading cause of bacterial arthritis in adults.


Rachmel Cherner, MD

Latest:

Diabetes: 11 Treatment Pitfalls-and How to Avoid Them

Here: a look at the many possible causes of poorly controlled blood glucose levels, and steps to overcome them.



Rafael I. Ilyayev, MD

Latest:

Sliding Hiatal Hernia and T-Cell Lymphoblastic Lymphoma

Clinical Images to Help You Hone Your Diagnoses


Rafael L. Perez, MD

Latest:

Case In Point: Polydipsia, polyuria, and pneumothorax in a young woman with diffuse cystic lung lesions

A 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.


Ragheb Assaly, MD

Latest:

Case In Point: Acute eosinophilic pneumonia in a 19-year-old man

The 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.


Rahi Kapur, MD

Latest:

Young Woman With Atypical Presentation of Fitz-Hugh-Curtis Syndrome

A 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.


Rahul Gupta, MD

Latest:

Aortic Dissection

A 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.


Rahul Verma, MD

Latest:

Epiphrenic Diverticulum

Increasingly 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.


Raj K. Jain, MD

Latest:

Adenocarcinoma of the Lung in a 50-Year-Old Woman

During 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.


Raja Mouallem, MD

Latest:

Juvenile Polyp

A 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.


Rajani Katta, MD

Latest:

Post-Trauma Lesions

A 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.


Rajat Mukherji, MD

Latest:

Sliding Hiatal Hernia and T-Cell Lymphoblastic Lymphoma

Clinical Images to Help You Hone Your Diagnoses


Rajbala Thakur, MD

Latest:

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.


Rajesh Kabadi, MD

Latest:

Pericardial tamponade caused by Actinomyces after bronchoscopy

Actinomyces 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.


Rajesh L. Gade, MD

Latest:

Multiple Aorto-Cavitary Fistulas

Infective 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


Rajesh Rajan, MD

Latest:

Snapshots of Neurosyphilis

A 38-year-old man presented with a 2-week history of mental status changes and impaired memory. He also had a rash on both hands and feet that had been getting worse for the past few months.


Rajiv Arora, MD

Latest:

Idiopathic Cold Urticaria

For 6 months, a 19-year-old woman had had sensitivity to cold. When outside in cold weather, she noticed swelling, erythema, and pruritus of her uncovered hands. After she held a cold drink on her arm for about 5 minutes, urticarial lesions developed on the skin in contact with the drink. The symptoms resolved about 20 minutes after the cold source was removed. She denied angioedema, respiratory symptoms, light-headedness, and tachycardia.


Rakesh Patel, MD

Latest:

Case In Point: Persistent left superior vena cava in an elderly man with pneumonia

The authors report the incidental finding of a persistent left superior vena cava (PLSVC) during the routine placement of a left subclavian central line in an elderly man with acute renal failure.


Rakesh Shah, MD

Latest:

Case In Point: Coexisting Hodgkin disease and lung cancer in a patient with AIDS

The patient was a 41-year-old manwith a history of HIV infection diagnosed10 years before admission.He had been noncompliant withtreatment, and therapy with tenofovir,efavirenz, and lamivudinehad not been started until 2 monthsbefore admission, when he presentedto another hospital. At thetime, his CD4+ cell count was156/µL and his viral load was45,743 copies/mL. He also had ahistory of incarceration; had usedinjection drugs, cocaine, alcohol,and marijuana; and had a 20-packyeartobacco history.


Rakesh Shrivastava, MD

Latest:

Superior Mesenteric Vein Thrombosis

A 65-year-old woman with metastatic adenocarcinoma of the colon was undergoing chemotherapy following a colectomy and a hepatic wedge resection. The physical examination and laboratory data were unremarkable.


Rakesh V. Alva, MD

Latest:

Chronic cough: Seeking the cause and the solution

The major causes of chronic cough include upper airwaycough syndrome (UACS, formerly known as postnasal dripsyndrome), asthma, nonasthmatic eosinophilic bronchitis, andgastroesophageal reflux disease. In fact, one or more of these isthe cause of cough in the vast majority of nonsmokers who arenot receiving angiotensin-converting enzyme inhibitors andwho have no evidence of active disease on chest radiographs. Ahigh index of suspicion is required, because each of these conditionsmay present with cough as the sole symptom. BecauseUACS may be the most common cause, it appears reasonableto try empiric UACS therapy in patients in whom other causesare not evident at initial evaluation. In many cases, the combinationof a first-generation antihistamine and a decongestantmay be most effective. (J Respir Dis. 2008;29(3):113-122)

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