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Crossed Renal Ectopia With FusionFrequent urinary tract infections and unexplained hypertension (160/100 mm Hg) occurred in a 38-year-old man with no significant medical history. The heart and chest were normal; a right lower quadrant mass was detected in the abdomen. Red blood cells were found in the urine. An abdominal CT scan demonstrated that the left kidney was fused to the lower pole of the right kidney with the left pelvicaliceal system to the left of the midline; these findings are consistent with crossed fused renal ectopia. Cystographic and cystoscopic examinations were normal.
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After Metformin: Which Class Would you Choose?In this older patient with T2DM, HFpEF, and other comorbidities, which class of medication is most appropriate--and guideline-recommended?
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Woman With Acromegaly Presenting as Unilateral Vision LossA 36-year-old woman presented to the emergency department with loss of vision in the right eye that had initially involved the peripheral field and progressed over 2 months to the central and nasal fields. During this period, she also had headaches, vomiting, and generalized weakness. She had had amenorrhea for 1 year.
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AHA: Study Finds Celebrex Safe for HeartResults of the PRECISION study are embraced by some and soundly criticized by others. What would you tell your osteoarthritis patients?
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Pitfalls in Prescribing: Macrolide-Drug Interactions: Update on the Most Common and Clinically SignificantMacrolides are commonlyused to treat avariety of infections.Erythromycin haslong been recognizedas having numerous highly importantdrug interactions.1 Althoughclarithromycin generally has somewhatless of an effect on the clearanceof other drugs, it also has severalclinically relevant interactions.1-3
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Intraductal PapillomasSolitary intraductal papillomas are tumors of the major lactiferous ducts. They occur most frequently in women 30 to 40 years of age, and frequently present with nipple discharge.
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A patient with hemoptysis, anemia, and renal failureMicroscopic polyangiitis is a potentially fatal disease if it is notrecognized and treated early. In the case described here, what initiallypresented as a postinfectious residual cough was actuallyactive pulmonary hemorrhage, severe anemia, and a crescenticglomerulonephritis. Significant improvement was achieved withhemodialysis and aggressive treatment with corticosteroids andcyclophosphamide. This case exemplifies a classic presentationof microscopic polyangiitis and demonstrates the importance ofan expeditious diagnostic evaluation and early treatment to preventrapid deterioration. Early recognition and highly aggressiveimmunosuppressive treatment achieved significant suppressionof the disease.
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Mites and HTLV-1 at the Crux of a 10-Year Itch and Plaque-Like LesionsImmunosuppression that is associated with human T-cell lymphotropic virus 1 (HTLV-1) infection predisposes to hyperinfective strongyloidiasis.1,2
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Diagnosis of isolated axillary neuropathy in athletes: Case studiesCase studies of athletes with isolated axillary neuropathy provide an overview of this injury's anatomy and function, which are key to definitive diagnosis and appropriate treatment.
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Rhabdomyolysis Secondary to Urinary Tract Infection With E coliRhabdomyolysis is linked to infection in up to 31% of cases. However, only 19 cases of rhabdomyolysis related to E coli infection have been reported.
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Using ultrasonography in the diagnosis and management of pleural diseaseABSTRACT: The increasing availability of bedside ultrasonographyallows for more timely diagnosis and treatment of pleuraleffusion while limiting the patient's exposure to radiation. Thedynamic signs characteristic of pleural effusions includerespirophasic changes in the shape of the fluid collection, floatingmovements of atelectatic lung, and the plankton sign. Ultrasonographyalso is an efficient means of excluding pneumothoraxwhen rapid diagnosis is needed or after interventionssuch as central line placement, lung or pleural biopsy, or thoracentesis.The diagnosis of a pneumothorax relies on the absenceof dynamic signs such as "lung sliding." Static signs, suchas the comet tail artifact, or consolidated lung parenchyma orlung tissue that contains a solid mass, also can be useful in excludingpneumothorax. Ultrasonography can be used to guidefine-needle aspiration and core biopsies of pleural nodules,pleural thickening, and subpleural lung masses. (J Respir Dis.2008;29(5):200-207)
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Angiosarcoma of the FaceThe patient reported that he had noticed the facial eruption a couple of months earlier. On examination, the lesion appeared more plaque-like and dense than is typical of rosacea. The differential diagnosis included lupus, mycosis fungoides, rosacea, and angiosarcoma.
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Dyslipidemia: Effective Statin Treatment for Cardiovascular Disease PreventionDyslipidemia plays a dominant role in atherosclerotic plaque formation and as a modifiable risk factor for cardiovascular events.
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Using elastic compression stockings to prevent post-thrombotic syndromeThe reported incidence of postthrombotic syndrome (PTS) after a first episode of deep venous thrombosis (DVT) is quite variable, depending on the measurement scale used and the severity. Most studies suggest that the rate is 20% to 50%, with symptoms ranging from minor skin discoloration to chronic swelling and ulceration.1 However, the incidence of symptomatic PTS was less than 5% in a population of patients who underwent orthopedic hip and knee arthroplasty, regardless of whether they experienced symptomatic postoperative DVT.2
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Posaconazole: A New Triazole AntifungalPosaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
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“Mad Cow Disease”:What You-and Your Patients-Need to Know NowWhat is bovine spongiform encephalopathy(BSE), or “mad cow disease,” and how is itthought to infect cattle?
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Oropharyngeal candidiasis: Diagnostic clues, treatment tipsThe most common manifestation of oropharyngealcandidiasis (OPC) is pseudomembranous candidiasis, commonlyknown as "thrush," which appears as a whitish yellow,curdlike discharge on the mucosal surfaces. Other forms ofOPC include denture stomatitis, angular cheilitis, and glossitis.Patients with denture stomatitis are usually asymptomatic, butthe tissue beneath the denture is typically red and hyperplastic.Patients with angular cheilitis may complain of a burning sensationat the margins of the lips. Candidiasis involving thetongue can be exuberant and is usually associated with complaintsof a white tongue, taste alterations, and a burning sensationof the tongue. The diagnosis of OPC can be establishedby identifying typical fungal elements on potassium hydroxidepreparation or Gram stain of scraped material. Treatment optionsinclude clotrimazole, fluconazole, itraconazole, and nystatin.(J Respir Dis. 2008;29(3):128-135)
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ST-Segment Elevation Myocardial Infarction:What Role for Anticoagulants and Antiplatelet Agents?The goal of treatment in acute coronary syndromes is the restoration and maintenance of myocardial perfusion. To this end, numerous pharmacological agents are available, as well as percutaneous coronary intervention (PCI).
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Lipoprotein(a): A New Treatment Target?Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).
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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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Bronze Skin in HemochromatosisA 60-year-old white man was evaluated for dyspnea on exertion. Hepatomegaly and abnormal skin pigmentation were noted, particularly in the upper extremities.
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Disseminated Intravascular Coagulation as an Unusual Presentation of Acute Retroviral SyndromeMultiple atypical presentations of acute retroviral syndromehave been reported in the literature, but rarely has acute retroviralsyndrome been associated with disseminated intravascularcoagulation (DIC). We detail a case of a 19-year-old manadmitted to the hospital with initially unexplained severe DICthat on workup was found to be secondary to acute retroviralsyndrome. [Infect Med. 2008;25:24-28]
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Biologics Are Changing the Face of Psoriasis TreatmentAs dermatologists' use of biologic drugs for psoriasis grows, MCOs must take an increasingly active role in managing the near-term utilization of these high-cost agents while also taking into account that some of the "payback" for these drugs comes in the form of long-term costs avoided. Meanwhile, physicians, insurers, and employers continue to wrestle with issues such as step-down dosing; step therapy; patient-administration versus physician-administration; and whether biologic drugs should be covered under a plan's pharmacy benefit, medical benefit, or some combination. (Drug Benefit Trends. 2008;20:143-147).
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Patient Goals Should Figure Prominently in Tx DiscussionsWanted: Physicians who will interact with patients the way a good financial counselor would.
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Chronic cough: Seeking the cause and the solutionThe 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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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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Unilateral Scleral Jaundice in an Elderly Man: An Odd FindingLeft scleral icterus is the only prominent physical finding in the 86-year-old who presented with transient aphasia, ataxia, and general asthenia. Can you dx?
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What Cause of Persistent Diarrhea and Weight Loss?A 28-year-old woman presents with a 4-month history of diarrhea and a 15-lb weight loss. She reports starting “another new diet” a few months ago but was in good health until these symptoms began. There is no family history of GI disease and no sick contacts. She denies recent travel.
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Man With Abdominal Bruit of Unusual OriginA 52-year-old man with a 29-year history of type 1 diabetes mellitus and mild diabetic retinopathy and nephropathy presents for a regular checkup.
