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Consultant Vol 44 No 7

A 10-month-old infant was referred for evaluation of possible Sturge-Weber syndrome. According to his parents, the discoloration on the child’s face was present at birth. Physical examination revealed an otherwise healthy infant with extensive port-wine stains on his face. Ophthalmologic and neurologic examination findings were normal.

For 2 months, an asymptomatic rash had been present on the upper arms of a 16-year-old boy of normal weight. The rash, as seen on the patient’s right arm, consisted of abundant fine papules. He had no other lesions.

A 50-year-old man had a long-standing rash on both soles. The patient’s toenails were yellow and dystrophic. These physical findings strongly suggested moccasin-variety tinea pedis and onychomycosis.

A 35-year-old woman (gravida 3, para 2) presented at 25 weeks’ gestation with a 24-hour history of continuous, pressure-like, retrosternal chest pain, radiating only to the back. The pain worsened when she lay down, took deep inspirations, or coughed; it diminished when she leaned forward. The patient had no significant medical history and was not taking any medications; she denied fever and illicit drug use.

For years, a 39-year-old man had an eruption on his hand, which seemed to be
controlled with topical corticosteroids. The patient was a rancher.

A 33-year-old active-duty soldier who had been in Iraq for 6 months presented with a depressed lesion on his left lateral elbow of several months’ duration. It was neither healing nor enlarging. (The yellowish tint to the skin in the photograph was from a topical iodine solution.)

Severe abdominal pain radiating to the back prompted a 72-year-old man to go to the emergency department (ED). The patient had experienced similar pain 2 days earlier and was treated at another hospital for renal colic on the basis of concomitant microscopic hematuria. He had a history of poorly controlled hypertension.

Apidra (insulin glulisine injection)
from Aventis is approved by the FDA
for use in adult patients with type 1 or
type 2 diabetes mellitus for the control
of hyperglycemia. Compared with
human insulin, Apidra has a more
rapid onset and a shorter duration of
action. The drug is designed to manage
mealtime spikes in glucose levels
by administration through subcutaneous
injection or continuous subcutaneous
pump infusion either 15 minutes
before or 20 minutes after starting
a meal.

The continuous use of a corticosteroid cream briefly relieved the pruritus of an
annular, papulosquamous eruption on the left anterior thigh of a 50-year-old
woman. The lesion was present for 6 months and grew larger with application
of the topical corticosteroid.

A painless swelling on the dorsum of the scalp had been present for many years in a 36-year-old man. An increase in the size of the lesion prompted the man to seek medical evaluation.

For 1 year, a 30-year-old man had an intermittent rash that was confined to the
area of his jockey shorts; no other part of the body was affected. The patient
reported that the pruritic eruption arose and disappeared spontaneously and
was more prominent during the heat of summer.

For more than 20 years, a 55-year-old man had a faintly erythematous, papulosquamous
rash with arciform borders on his groin and waistline. The rash
had been treated with a variety of medications. Topical and oral antifungals
and antibiotics and topical corticosteroids had been used but to no avail. No
laboratory tests had been performed.

7-year-old boy presented with an asymptomatic cystic lesion on the lateral aspect of the left ankle of 4 months’ duration. There was no history of trauma. The mass fluctuated in size; it was smaller when the child was recumbent and larger when the child was upright.

Hypertensive crises encompass a spectrum of clinical situations that
have in common elevated blood pressure (BP) and progressive or impending
target organ damage. Each year more than 500,000 Americans (about
1% of all persons with hypertension in the United States) have a hypertensive
crisis. In large urban areas, 25% of visits to the medical section of any given
emergency department (ED) are attributable to a hypertensive crisis.

 
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