September 20th 2024
FluMist is the first influenza vaccine that does not have to be given by a health care professional.
Antiretroviral Suppression of HIV in the Context of Persistently Low CD4 Counts: New Insights
January 1st 2007Shortly after the introduction of combination antiretroviral therapy, it was noted that a significant fraction of patients, from 8% to 17%, had poor CD4+ T-cell recovery despite suppression of HIV RNA to undetectable levels for at least 6 to 12 months.1
Acute lymphoblastic leukemia presenting with an acute fibrinous and organizing pneumonia
January 1st 2007The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.
Profoundly Impaired Woman With Bilateral Unexplained Upper-Thigh Bruises
January 1st 2007Asked to evaluate bilateral unexplained upper-thigh bruises on a profoundly impaired woman newly admitted to our rehabilitation unit 2 weeks after an intracerebral hemorrhage. Patient received high-dose dexamethasone to reduce perihemorrhage edema.
Irritable Bowel Syndrome: Rational Therapy
January 1st 2007ABSTRACT: Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort, bloating, and constipation or diarrhea; the pain is typically relieved by defecation. The diagnosis is not one of exclusion; it can be made based on the answers to a few key questions and the absence of "alarm" symptoms. Fiber therapy, the elimination of particular foods, and regulation of bowel function can help relieve symptoms. Tegaserod or polyethylene glycol can be used to treat IBS with constipation. Loperamide and alosetron are of benefit in IBS with diarrhea (although the latter carries a small risk of ischemic colitis). Low-dose tricyclic antidepressants may be used to treat the abdominal pain associated with IBS. Probiotic therapy or rifaximin may help reduce bloating. Psychological therapies seem to improve well-being in patients with IBS.
What to Do When One Bacterial Scourge Begets Another
January 1st 2007With the significant rise in methicillin-resistant Staphylococcus aureus (MRSA) infections, a small rise in the number of cases of Clostridium difficile colitis appears to be an unfortunate but unpreventable consequence of using the few effective antibiotics remaining that can be prescribed in the outpatient setting.
An Unusual Injury to the Mouth
January 1st 2007A 2-year-old boy was brought to the emergency department by his mother after he slipped and fell in the bathtub. The boy's father, who had been bathing the child when the injury occurred, reported that he had briefly turned his back while the child was attempting to drink from the hook-shaped faucet. The child had jerked his head upward when he fell, thus causing the sharp edge of the faucet tip to lodge in the soft floor of the mouth beneath the tongue. The father, in desperation, wrenched the faucet from its base and then was able to remove the tip from the child's mouth. During the removal process, the child reached up and also cut his finger on the sharp edge of the faucet.
Cough, Chest Pain, and Dyspnea in a Woman With Rheumatoid Arthritis
January 1st 2007A 40-year-old Hispanic homemaker is admitted with a 3-week history of high fever, chest pain, and a dry, irritating cough. Her illness began insidiously with increasing right upper chest pain that is sharp, pleuritic, and rates a 6 on a pain scale of 1 to 10. The pain is associated with temperatures of up to 38.8°C (102°F) and chills, rigors, and profuse sweating that increase in the evening. Worsening dyspnea has been accompanied by a drop in effort tolerance.
Epiglottitis in a 68-Year-Old Woman With Type 2 Diabetes Mellitus
January 1st 2007A 68-year-old woman with type 2 diabetes mellitus presented with a sore throat of 3 days' duration and progressively worsening dysphagia to both solids and liquids, including her own saliva. She denied consumption of steak or fish with bones. Attempts to swallow caused her to grimace. Her voice was normal and her airway was clear, but tenderness was noted when the larynx was moved side to side.
Avian Flu: Do You Need to Be Prepared?
January 1st 2007Avian influenza primarily affects wild birds and domesticated poultry. Humans acquire avian influenza viruses chiefly through direct contact of the mucous membranes with secretions or excreta from infected birds or contaminated poultry products. The upper respiratory tract and conjunctivae appear to be the main portals of entry. Influenza pandemics occur when new virus subtypes emerge and become readily transmissible among humans. On average, pandemics occur about 3 or 4 times per century. Avian influenza is not a pandemic influenza. It is not easily transmitted among humans, and it has not been found in the United States. Therefore, at present, the risk to persons in this country is considered low.
Bronchoalveolar Carcinoma in a 58-Year-Old Man
January 1st 2007A 58-year-old man presents with exertionaldyspnea of 6 weeks’ duration, adry cough for 2 weeks, and decreasedappetite. He denies fever, chills, sputumproduction, hemoptysis, cigarette smoking,and significant weight loss. Thepatient, a retired electrician, was exposedto asbestos 20 years earlier.
Man With Weakness, Dyspnea, and Ataxia
January 1st 2007For 3 months, a 66-year-old retired man has had increasingweakness of the lower legs with stiffness,tingling, and numbness; worsening ataxia; anergia; andexertional dyspnea of insidious onset. He has lost 8 lb,and his appetite is poor. He denies fever, cough, chest orabdominal pain, paroxysmal nocturnal dyspnea, orthopnea,ankle swelling, bleeding disorders, hematemesis,melena, headache, vision problems, sciatica, joint pain,bladder or bowel dysfunction, and GI symptoms. He hasnocturia attributable to benign prostatic hypertrophy.
Quinolones: Keys to Reducing the Risk of Interactions
January 1st 2007Quinolones are commonlyused to treat a widevariety of infectious diseases,such as community-acquired pneumoniaand urinary tract infections. Somequinolones are also given as prophylaxisfor spontaneous bacterial peritonitis.These popular antimicrobial agents areassociated with several clinically significantdrug interactions, which can beclassified into 2 major categories1-3:
Do You Recognize These Sun-Related Lesions?
January 1st 2007A 56-year-old African American man presents with a painful “raw” lip that hasgradually developed during the summer. Physical examination reveals a geographic,superficial erosion; notably, the erosion is surrounded by hypopigmentedand, most distally, hyperpigmented rings. The patient believes that exposureto sunlight has aggravated the condition.