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The 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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Opportunistic fungal infections are increasingly common inpatients who undergo hematopoietic stem cell transplant(HSCT). Voriconazole is frequently used in allogeneicSCT recipients who receive immunosuppressant therapy forgraft versus host disease to prevent invasive aspergillosis.Indications for voriconazole use include invasive aspergillosis,candidemia, Scedosporium apiospermum infection, and fusariosis.We describe a case in which disseminated Fusarium infectiondeveloped in an HSCT recipient who was receiving voriconazoletherapy. [Infect Med. 2008;25:528-530]

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Recognition of a simultaneous viral and bacterial skin infectioncan be challenging. In the case presented here, an immunocompromisedpatient presented with a painful rash on the arm,pustules and papules on the chest, and crusted lesions onthe nares. Culture and immunofluorescent staining revealedStreptococcus and varicella-zoster virus, respectively. Afterappropriate treatment, the rash completely resolved. [InfectMed. 2008;25:240-241]

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Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.

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Cumulative research with animal, normative, and clinical populations over several decades shows that the mechanisms underlying anxiety disorders differ from those of the normal emotion of anxiety. In persons with anxiety disorders, fear and tension are disproportionate to the actual threat and may be present when no real threat exists, thereby generating an expectation of danger and distorted perceptions related to danger and various types of threats. The most common anxiety disorders are social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Persons with SAD can experience a wide range of social fears as well as severe functional consequences, whereas persons with GAD tend to experience emotional, interpersonal, and somatic symptoms of high levels of chronic anxiety. Persons with PTSD have vivid memories of and thoughts about a terrifying event or ordeal that lead to the development of anxiety, depression, and functional impairment. Effective treatment options-pharmacotherapy; psychotherapy, particularly cognitive-behavioral therapy; or a combination-can be discussed openly with the patient to make a collaborative, informed decision. A variety of medications can be used to successfully manage anxiety disorders, of which SSRIs and serotonin-norepinephrine reuptake inhibitors are the most effective. When properly used, medications can enhance a patient's own efforts to master anxiety; overcome fearful avoidance; and address troubling behaviors, patterns, or memories. (Drug Benefit Trends. 2008;20:101-113)

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A 34-year-old man experienced fever and arthralgia several days after appearance of the rash.

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In the metastatic setting, given the limited potential for a cure, treatment is focused on extending patient life, providing symptom relief, and improving quality of life.

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Worsening respiratory symptoms and fatigue of 6 months’ duration brought a 44-year-old woman in for evaluation. Diagnosed with asthma 2 years earlier, she was compliant with, but unresponsive to treatment. Your impressions?

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Generalized muscle weakness, ataxic gait, and numbness and tingling in her hands and feet prompted a 45-year-old woman with a history of heavy alcohol abuse to seek medical attention. Atrophic glossitis and decreased sensation to light, touch, and vibration of the distal extremities were noted.

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A rare finding is a timely lesson for all clinicians who are touched in one way or another by the injectable drug crisis in the US.

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A 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis (A and B). The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits, or urinary symptoms.

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For 6 months, a 69-year-old man has experiencedpain in his right shoulder; hetakes NSAIDs for relief. During the lastmonth, the pain has worsened, weaknessand tingling have developed in his righthand, and the skin on the right side ofhis face has become dry. The patient alsoreports a 1-month history of melanoticstools. He had smoked 1 pack of cigarettesa day for 50 years before quittinglast year

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Abstract: In the assessment of central airway obstruction and disease, no imaging technique is an adequate substitute for bronchoscopy. The indications for rigid bronchoscopy include multiple malignant and benign disorders, with most interventions performed for treatment of complications of lung cancer. The rigid bronchoscope is a useful tool for managing most types of airway stenoses, and it facilitates other endobronchial therapies, including stent placement, argon plasma coagulation, balloon dilatation, electrocautery probes, and laser therapy. Certain patients with benign lesions or postintubation or post-tracheostomy stenosis may benefit from rigid bronchoscopic techniques instead of surgery. Although use of the rigid bronchoscope requires general anesthesia, it provides a stable airway and often results in fast removal of foreign bodies. (J Respir Dis. 2006;27(3):100-113)

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The goals of therapy for patients with inflammatory bowel disorder include inducing and maintaining a steroid-free remission, preventing and treating the complications of the disease, minimizing treatment toxicity, achieving mucosal healing, and enhancing quality of life.

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When is it time to refer your patient with low back pain to a specialist for possible spine surgery? How long should you give conservative measures a try? What symptoms signal the need for urgent care? In this video, Raymond Haroun, MD addresses these and other pressing questions.

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This 27-year-old man complained that a facial rash of several years' duration had worsened during the past few months. Hypopigmented macules with scale were especially prominent on the eyebrows and in the nasolabial folds; a moderate amount of scale was noted on the scalp. The patient was seropositive for HIV.

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ABSTRACT: The most common errors in measuring blood pressure (BP) are using the incorrect cuff size, not having the patient relax for 5 minutes before the measurement, and deflating the cuff too quickly. Observer bias may compound technical errors. When patients use the proper procedure, home BP measurements may be more reproducible than office measurements. Brachial artery-based monitors are more accurate than finger- or wrist-based instruments. To ensure that patients measure their BP correctly, observe their technique with their own monitors. Counsel patients to measure their BP at predetermined times and to have their monitors validated periodically.

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Should acute infection with hepatitis C virus (HCV) be treated? If yes, what is the recommended treatment?

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A 41-year-old man presented with a 3-month history of itchy, scaly feet and right hand. The left hand was unaffected.

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Topical corticosteroids remain the mainstay of treatment, especially in patients with erythematous, acutely inflamed psoriatic plaques. The topical immunomodulators tacrolimus and pimecrolimus are used to treat psoriasis, although neither has FDA approval for this indication. Unlike corticosteroids, immunomodulators do not cause skin atrophy, irreversible striae, acne, or tachyphylaxis. Newer topical vehicles of delivery (eg, foam clobetasol propionate) and newer drug combinations (eg, once-daily calcipotriene/betamethasone dipropionate ointment) may improve efficacy and reduce side effects. Reserve systemic therapy for patients with moderate to severe psoriasis. Until more long-term safety data become available, be cautious about prescribing biologic agents for patients at risk for infection (particularly tuberculosis) and malignancy.

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The initial complaint of a 79-year-old woman was of mild headache, neck pain, and sore throat. She had a history of hypertension, diabetes mellitus, and heavy cigarette smoking. Examination by an otolaryngologist, which included laryngoscopy, revealed no abnormalities. Three weeks later, the patient's throat and neck pain became more severe. She had no arthralgias, visual loss, fever, or worsening head pain.

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Use this short test to gauge how much you’ve learned about a condition that needs more primary care involvement.

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Fluoroquinolone antibiotics have activity against a wide range of gram-positive, gramnegative, and atypical bacteria.

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What is the cause of this erythematous rash that appeared suddenly and spread rapidly on the child's trunk and extremities?

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A 49-year-old white man, in whom HIV infection had been newly diagnosed (CD4+ cell count, 25/µL; HIV-1 RNA level, 274,000 copies/mL), was transferred to our hospital for further workup and treatment of multiple neurologic deficits. He had presented to another hospital with a 4-day history of left-sided weakness and numbness, left-sided facial droop, dysphonia, and dysphagia that led to the initial diagnosis of an acute stroke.

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A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.

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This newborn has Cornelia de Lange syndrome, a disorder characterized by prenatal growth retardation (this child weighed 2240 g at birth and measured 46 cm in length), microbrachycephaly, bushy eyebrows, long eyelashes, short neck, low posterior hair line, depressed nasal bridge, anteverted nares, long philtrum, thin upper lip, downturned corners of mouth, micrognathia, a single umbilical artery, phocomelia, micromelia, and oligodactyly.

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An 82-year-old woman who had recentlyarrived from Japan presented to theemergency department with a 3-dayhistory of abdominal pain that beganimmediately after she swallowed severalpills with a small amount of water.The severe, intermittent pain radiatedto the patient’s back and worsened withmeals. The patient denied chills, nausea,vomiting, coughing, diarrhea, andconstipation. She had well-controlledtype 2 diabetes mellitus and hypercholesterolemia,and had undergone anappendectomy 50 years earlier.