September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Warfarin Interactions: Update on the Most Common and Clinically Significant
March 1st 2006Numerous factors, includingother drugs, diseases,and diet, affectthe response to warfarin.Some of these factorsdecrease the response and maylead to therapeutic failure; othersenhance the response and may resultin life-threatening bleeding.
Understanding the basics of rigid bronchoscopy
March 1st 2006Abstract: 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)
Chest Film Clinic: What caused this man's miliary lung nodules?
March 1st 2006A 37-year-old man presented withnew-onset fever and abdominal painof several days’ duration. No respiratorysymptoms were reported.The patient had a history of multiplestab wounds to the abdomenand back, resulting in chronic backpain and a neurogenic bladder.During a previous hospital admission,he was treated for Enterobacterpyelonephritis with intravenousgentamicin for 12 days.
When to suspect allergic bronchopulmonary aspergillosis
March 1st 2006Abstract: Inhalation of Aspergillus is responsible for a variety of lung infections and diseases; Aspergillus fumigatus is the most common causative agent. Allergic bronchopulmonary aspergillosis (ABPA), caused by sensitivity to A fumigatus, is diagnosed primarily in persons with asthma or cystic fibrosis. Differentiating ABPA from other Aspergillus-related lung infections and diseases is often challenging. A patient's symptoms, underlying risk factors, and any prior pulmonary disease contribute to the diagnosis. Findings include pulmonary infiltrates, total serum IgE levels greater than 1000 IU/mL, IgE and IgA anti-A fumigatus antibodies, peripheral blood and pulmonary eosinophilia, and central bronchiectasis. Untreated ABPA often results in chronic bronchiectasis, pulmonary fibrosis, and dependence on corticosteroids; an accurate diagnosis of ABPA is critical to avoiding irreparable disease. (J Respir Dis. 2006;27(3):123-134)
Clinical Consultation: Distinguishing sinus headache from migraine
March 1st 2006This is a difficult question, because most "sinus headaches" are migraines.1-3 In fact, there is no such thing as a sinus headache. The International Headache Society (IHS) defines a headache attributable to rhinosinusitis according to the criteria listed in Table 1.4 This requires a diagnosis of acute rhinosinusitis and a headache that occurs at the same time.
Photo Finish: Acute Dx: What Cause of Sudden Illness?
March 1st 2006A 56-year-old man presents with diffuse erythema. He has not changed his routine or eaten anything unusual. The rash initially appeared the previous night as asymptomatic erythema on the face and body. On awakening in the morning, the patient noticed that the erythema had spread over most of his body and had become pruritic. Over-the-counter diphenhydramine did not relieve the symptoms.
Residual Effect of Refractive Surgery
March 1st 2006During a basketball game, a 23-year-old soldier had been hit in the right eye with the ball. The eye was slightly red with copious lacrimation; vision was normal. Using a Wood lamp and fluorescein dye, MAJ Kenneth S. Brooks, APA-C, of Camp As Sayliyah, Doha, Qatar, examined the patient's eye for corneal abrasions and saw these results. Note the almost complete halo of dye, with gaps at the 6 o'clock and 11 o'clock positions on the iris. This curious phenomenon was baffling until the soldier was asked about recent eye surgeries; he answered that he had undergone photorefractive keratectomy (PRK) several months earlier.
Hypothyroidism and Fibromyalgia
March 1st 2006Monday morning your nurse hands you charts for 4 new patients. Each patient is a woman with widespread body pain, stiffness, and fatigue. All have already been evaluated by another physician and were advised that they should reduce stress and practice distraction techniques. They are in your office today seeking a second opinion.
Apparently Healthy Man With History of Injection Drug Use: The Initial Approach
February 2nd 2006A 45-year-old man comes to see you for a routine physical.He has no complaints and no significant medical history.However, while questioning him you discover that he usedintravenous heroin until about 10 years ago-and sometimesshared needles. He also drank 6 or more beers a day for about 20 years, a practicehe stopped at the same time that he quit using illicit drugs. He has multiple tattoos,which were done at commercial parlors. He is married but has no children. His wife hasno history of hepatitis. Physical examination is unremarkable.
Cutaneous Conundrums, Dermatologic Disguises
February 2nd 2006A nonhealing ulcer recently developedin a painful facial rash that hadworsened over several months. The44-year-old patient is a heavy drinkerwith a history of elevated liver functionlevels. She has had numerousunprotected sexual contacts over theyears.
Hereditary Hemochromatosis: Early Detection of a Common Yet Elusive Disease
February 1st 2006Although widely regarded as a raredisorder, hereditary hemochromatosisis the most common genetic disease inCaucasians. In certain populations ofnorthern European descent, 1 of every200 persons is homozygous for thecausative mutation.1
Community-acquired pneumonia: An update on therapy
February 1st 2006Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)
Avian Flu: Why All the Squawk?
February 1st 2006Physicians around the country are being bombarded with questions about avian flu. This brief review of the current status of the avian flu outbreak and its treatment and prevention provides the information you will need to answer the most pressing patient questions.
Case In Point: Middle-Aged Man With Worsening Cough and Dyspnea
A 52-year-old man with hypertension and hyperlipidemia presents to the emergency department with a 5-month history of cough and dyspnea.
The Dizzy Patient: How You Can Help
February 1st 2006Most primary care practitioners approach the patient who complains of dizziness with some trepidation. This is chiefly because the differential diagnosis involves multiple organ systems and a wide variety of disorders. In this article, I offer a rational, straightforward, and cost-effective approach that uses only minimal, selective diagnostic testing.
Cystic Hygroma in a Young Girl
February 1st 2006A 21-month-old previously healthy child is brought to the pediatrician's office because of increasingly labored breathing that began the night before. The father reports that the child has had fever, congestion, nonproductive cough, and irritability for 2 days and that she is slightly hoarse.
Whats The Take Home?: Worsening Fatigue and Dyspnea in a New Mother
February 1st 2006A 22-year-old woman presents with progressive fatigue and dyspnea on exertion that develops after she walks about 30 feet. She also reports orthopnea, lower extremity swelling, weight gain, dry cough, and paroxysmal nocturnal dyspnea.