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Bilateral Mandibular FracturesA 20-year-old man sustained a 2- to 3-cm soft-tissue laceration in the middle of the chin when he fell, face forward, onto pavement.
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Anal Atresia in a NeonateA newborn male is seen with anal atresia. Isolated finding? Or, first clue?
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BRCA: A Primary Care Concern?October is Ovarian Cancer Awareness Month. Find out in this podcast with Harvard professor Richard Penson, MD, what traits in your female patients should prompt testing.
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Intoxication with street drugs: Cocaine and amphetaminesCocaine and amphetamine intoxication continue to be common causes of emergency department and hospital admissions.
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Woman With Daily Headaches That Have Become Refractory to TriptansA 30-year-old woman complains that her headaches no longer respond to triptans; instead, they have increased in frequencyand severity. The pain interferes with her ability to work part-time and to take care of her 16-month-old daughter.
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Case In Point: A case of bilateral hilar lymphadenopathyThe authors describe a rare cause of diffuse thoracic lymphadenopathy--Cogan syndrome. This case was remarkable for the temporal development of extensive lymphadenopathy independent of other hallmark symptoms and signs of this syndrome. In the appropriate clinical setting, Cogan syndrome should be considered in the differential diagnosis of thoracic lymphadenopathy.
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Zosteriform Lentiginous NevusA 17-year-old girl sought evaluation of multiple face and neck nevi. The lesions had been present at birth and were becoming darker as the teen grew older. She reported no family or personal history of skin cancer or dysplastic nevi.
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Are Guns a Health Issue?Confirmation of President Obama's nominee for Surgeon General is suspended as the debate over an answer to this question continues.
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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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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]
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Renal Artery Stenosis Complicating Essential HypertensionA 73-year-old man who had a history of long-standing essential hypertension, congestive heart failure, mild renal insufficiency, atrial fibrillation, and a mitral valve replacement presented with refractory hypertension. His medications included labetalol, irbesartan, and furosemide.
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Questions Physicians Often Ask About Allergens That Trigger AsthmaAbstract: Because of the impact of allergen exposure on asthma control, all patients with asthma should be evaluated for allergic sensitization. Such patients can be referred to an allergist for evaluation, or radioallergosorbent tests can be ordered by the primary care provider. The major groups of aeroallergens that can trigger asthma attacks include furred-pet, dust mite, cockroach, rodent, mold, and pollen allergens. When assessing a patient's exposure history, remember that furred-pet allergens are found not just in the home, but in other settings, such as schools, and these allergens are passively transferred from one environment to another. Allergen avoidance measures are essential to the management of asthma in sensitized patients and can significantly improve asthma control. First-line dust mite control measures include installing allergen-proof mattress and pillow encasements, washing all bedding every 1 to 2 weeks in hot water, removing stuffed toys, vacuuming and dusting regularly, and reducing indoor relative humidity. (J Respir Dis. 2006;27(12):511-526)
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Dermatoses of Childhood: 7 Photoclinic CasesCan you diagnose these 7 cases of dermatoses? Scroll through our Photoclinic to find out.
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Chronic Plaque PsoriasisChronic plaque psoriasis in this 37-year-old man was treated with systemic corticosteroids after topical medications proved ineffective. The corticosteroids provided initial relief, but the psoriasis recurred once the medication was discontinued. This patient had been in a county jail for about 18 months; during his confinement, he was not exposed to sunlight.
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Recognizing the impact of obstructive sleep apnea in patients with asthmaAbstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)
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State-of-the-art airway imaging with CT: Part 3Abstract: A significant advance in CT imaging is the use of 3-dimensional (3D) reconstruction techniques. A 3D reconstruction, for example, permits a volumetric evaluation of the contours of the airways and displays areas of stricture, or narrowing, more effectively than do routine axial images. External 3D rendering, also called CT bronchography, helps reveal complex airway abnormalities and improves the detection of subtle airway stenoses. Although it is primarily an investigational tool, internal 3D rendering (virtual bronchoscopy) has several potential applications, including assessing airway stenoses, guiding transbronchial biopsy procedures, and screening for lung cancer. Multiplanar reformation imaging methods can aid in the assessment of airway stenoses, airway stents, tracheomalacia, and extrinsic airway compression. A review of multiplanar images can also aid in the planning of stent placement or surgery. (J Respir Dis. 2006;27(8):348-352)
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Anal Pain: Office Diagnosis and TreatmentPatients almost always believe that their anorectal problems are caused by hemorrhoids, regardless of the nature of their symptoms. They are often dismayed when we insist that they must come to the office for an examination before we can prescribe any treatment.
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Tympanic Membrane Perforation:An Unusual Complication of Varicella-Zoster Virus InfectionOtological complications associated with varicella-zostervirus infection are common; however, tympanic membraneinvolvement is rarely reported. We describe a patient withherpes zoster in whom hemorrhagic otitis media with tympanicmembrane perforation developed. To our knowledge,this is the first report of an HIV-infected patient with thisunusual presentation. [Infect Med. 2008;25:561-562]
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Catastrophic Antiphospholipid Syndrome in Secondary SyphilisCatastrophic antiphospholipid syndrome (CAPS), first described by Asherson and colleagues1 in 1992, refers to a clinical scenario in which multiple vascular occlusive events involving small vessels that supply blood to organs occur over a short period.
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Mediastinal Abscess From Laryngeal Mask AirwayThe laryngeal mask airway (LMA) has become a popularalternative to endotracheal intubation. Many cliniciansconsider it a safe procedure, but complications do occur.Although uncommon, retropharyngeal perforation withmediastinal abscess can become a life-threatening event. Wereport a case of mediastinal abscess in an 84-year-old womanwho received LMA ventilation during a surgical procedurefor total knee replacement. [Infect Med. 2008;25:180-185]
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Book Review: The Fifteen Minute Hour: Therapeutic Talk in Primary CareStress affects daily activities, influences the way symptoms are perceived, and detracts from quality of life; it plays a role in everyone’s life and is a component of every illness. The responsibility of the primary care physician is to help manage the stress and recognize when specific therapeutic measures are needed. The fourth edition of The Fifteen Minute Hour presents biopsychosocial approach concepts from the earlier editions of the book and provides new material to make the principles and techniques more useful to primary care health professionals.
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Healthful Eating Habits, Cancer, and Heart DiseaseThe authors of the Women’s HealthInitiative (WHI) study involving50,000 postmenopausal women concluded thata low-fat diet (goal: 20% of total calories) had no significant effect on the incidence of breast cancer, coloncancer, or heart disease. What should we be telling our patients?
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Sports Concussion: Implications of the Exam After Head InjuryAs many as 300,000 sportsrelatedconcussions arediagnosed each year inthe United States.1 Thisfigure underestimatesthe true incidence, however, becausemany concussive injuries are notrecognized by the injured persons,trainers, or physicians. A recentstudy found that 4 of 5 professionalfootball players with concussionwere unaware that they had sufferedthis injury.2
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Podcast: A Practical Long-Term Approach to Diabetes CareHow does the chronic care model of diabetes care differ from the acute care model-and how might this approach work for you and your patients?
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Emerging Strategies in HIV PreventionHIV infection continues to exact a devastating toll worldwide.Advances in antiretroviral therapy have helped bring theHIV/AIDS epidemic under control in developed countries.Antiretroviral drugs, however, are not widely available inthose developing countries where HIV poses a catastrophicthreat. Effective strategies for HIV prevention are thereforecrucial to curbing the global epidemic. Vaccination, microbicideuse, and male circumcision are 3 key preventive interventions.Current research is focused on developing effective vaccinesand microbicides and on determining the extent to whichcircumcision helps prevent HIV acquisition and transmission.[Infect Med. 2008;25:63-72]
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Lipid-lowering Injectable Antibodies: The Next Big Thing?PCSK-9 inhibition in patients with recalcitrant hypercholesterolemia has reaped reductions in LDL-C of up to 85% after the first week of therapy.
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Liver AbscessThree weeks after undergoing gastric bypass surgery for obesity, a 64-year-old woman presented with fatigue, chills, and abdominal pain of 2 days' duration. She denied shortness of breath, nausea, vomiting, changes in bowel habits, melena, and hematochezia. The patient had no significant past medical history.
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Chest Pain: 10 Common Myths and MistakesABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.
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Hospitals May Overfeed Newly Born Babies With FormulaWINNIPEG, Manitoba -- Physiologically appropriate infant weight loss is less for babies fed formula in the hospital than for those who are breastfed, suggesting that hospitals feed too much, researchers said.
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Photo Dx: Achilles Tendon Rupture? Tendonitis? Bursitis? Something Else?Does an Achille’s tendon rupture, tendonitis, bursitis, or something else underlie sudden heel and lower leg pain?
