Emphysematous pancreatitis is typically managed with broad-spectrum antibiotics and early surgical debridement. Here, a case that supports more recent evidence for conservative therapy.
Extensive condylomata acuminata are beyond the capacity of all topical therapies. The area was initially treated by carbon dioxide laser ablation, and residual small foci of infection were subsequently treated with topical 5% imiquimod cream.
ASH is the largest organization of hypertension researchers and health care providers in the United States committed to preventing and treating hypertension and its consequences. The editors of ConsultantLive bring you updates from the 2013 ASH conference in San Francisco, CA. Read More
Prominent, pigmented polyangular scales on the extensor surfaces of the arms, legs, and trunk suggested recessive X-linked ichthyosis. More in this article.Read More
More than 1300 physicians of all specialties responded to the 2012 survey. Many of the respondents are primary care physicians. See how your colleagues responded and learn what concerns them most.Read more
To distinguish between hypertensive emergencies and urgencies and nonurgent acute blood pressure elevation, evaluate the patient for evidence of target organ damage. Perform a neurologic examination that includes an assessment of mental status; any changes suggest hypertensive encephalopathy.... More »
Bilateral swelling and pain in the distal interphalangeal (DIP) joints for several
months brought this 65-year-old woman to her physician. She complained also
of stiffness in the region of the DIP joints when she arose in the morning and
after short periods (less than 15 minutes) of inactivity. A... More »
Extreme synovial inflammation resulted in the articular degradation seen in the hands of this 40-year-old woman who has Still disease, or juvenile rheumatoid arthritis (JRA). More »
A 34-year-old white woman presents
with a 4-month history of diarrhea,
with bulky, foul-smelling stools; flatulence;
diffuse abdominal discomfort;
and episodic nausea and vomiting. She
has lost 13.5 kg (30 lb) during this period.
The patient has had no fever, and
her medical, family, and travel... More »
A 65-year-old woman, who was confined to a wheelchair
because of severe rheumatoid arthritis, was concerned
about nodules that had erupted on her fingers and hands
during the previous 3 weeks (A). Her medical history
included colon cancer, chronic renal insufficiency, anemia,
and hypertension. The... More »
Ten weeks before presentation, this
55-year-old woman noticed decreased
sensation in her feet and a bluish discoloration
of her toes. These symptoms
progressed rapidly, and pain and
coldness in both feet increased in intensity.
Her feet subsequently became
gangrenous. Her seropositive arthritis
had... More »
Numerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse... More »
Treatment of fibromyalgia syndrome (FMS) is a challenge. However, most patients benefit from appropriate management. Essential to treatment are a physician's positive and empathetic attitude, continuous psychological support, patient education, patience, and a willingness to guide patients to do... More »
A methodical approach to diagnosis usually reveals the cause of fever. In patients with simple fever, a careful history taking and physical examination combined with basic laboratory and imaging studies (complete blood cell count with differential, urinalysis, and possibly a chest film and blood... More »
To the Editor: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any part of the body, including the central nervous system. Psychiatric manifestations during SLE are not unusual; their characteristic features are early occurrence and clinical polymorphism.1,2 This clinical case shows a picture of SLE in which the first manifestat
Osteoporosis is a common problem in thalassemics. As the most affected bone is spinal vertebrae, theoretically, it should have the greatest risk of fracture. However, vertebral fracture (VF) in thalassemics was rarely reported. Screening for asympt
Raloxifene and alendronate are anti-resorptive therapies approved for the prevention and treatment of postmenopausal osteoporosis. Raloxifene is also indicated to reduce the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk of invasive breast cancer. A definitive study comparing the fracture effectiveness and rate of breast cancer for raloxifene and alendronate has not been published. The purpose of this retrospective cohort study was to eval
This paper draws attention to the relationship between the clinical and biological picture of SLE and the immune mechanisms of this disease. The presence, in the same patient, of erythema multiforme-like skin lesions and erythemato-squamous lesions specific for SLE together with a characteristic immune picture (speckled antinuclear antibodies (ANAs), positive anti-Ro antibodies, positive rheumatoid factor) raise the question of a relationship between the immune mechanisms in SLE and the clinical picture. A case of Rowell's syndrome is discussed: systemic lupus erythematosus diagnosed on the occasion of an erythema multiforme-like rash. Starting from this case, we analyse if the clinical and biological picture in SLE is an expression of the immune mechanisms involved in this disease. Our patient presented with speckled antinuclear antibodies, positive rheumatoid factor, anti-Ro antibodies, suggestive of Rowell's syndrome. The patient manifested rheumatoid-like articular pain and high
Determination of bone mineral density in patients with psoriatic arthritis and its correlation with the development of the disease.|Three groups of patients were recruited: group 1--patients with psoriasis arthritis; group 2--patients with rheumatoid arthritis, group 3--control group. Group 1 was divided into: group 1A--patients with disease duration < 5 years and group 1B--patients with disease duration > 5 years. Bone mineral density was determined for total hip by dual X-ray absorptiometry (DXA).|In the group 1A BMD values of total femur were between -1.32 and -1.68 DS; in the group 1B BMD values of total femur were between 1B -1.58 and - 1.77DS; in the group 2 BMD values of total femur were between -2.51 and -3.41 DS and in the control group BMD values of total femur were between 0.29 and 1.3 DS. In patients with psoriatic arthritis, the duration of arthritis was negatively correlated with BMD values of total femur. In conclusion, psoriatic patients with longer duration of disease
Verrucous (Hypertrophic) lupus erythematosus (LE) represents a rare but distinct, variant of chronic discoid lupus erythematosus. We report a case of LE with verrucous lesions for its rarity and peculiar location posing a diagnostic dilemma.
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with abnormal T cell immune responses. We hypothesized that aberrant expression of microRNAs (miRNAs) in T cells may contribute to the pathogenesis of SLE. First, we analysed the expression profiles of 270 human miRNAs in T cells from five SLE patients and five healthy controls and then validated those potentially aberrant-expressed miRNAs using real-time polymerase chain reaction (PCR). Then, the expression of mRNAs regulated by these aberrant-expressed miRNAs was detected using real-time PCR. Finally, miRNA transfection into Jurkat T cells was conducted for confirming further the biological functions of these miRNAs. The initial analysis indicated that seven miRNAs, including miR-145, miR-224, miR-513-5p, miR-150, miR-516a-5p, miR-483-5p and miR-629, were found to be potentially abnormally expressed in SLE T cells. After validation, under-expressed miR-145 and over-expressed miR-224 were noted. We further found that
The amino-bisphosphonates are first-line therapy for the treatment of most patients with osteoporosis, with proven efficacy to reduce fracture risk at the spine, hip, and other nonvertebral skeletal sites. Further, bisphosphonates have been associated with a significant decrease in morbidity and increase in survival. Following the use of bisphosphonates in millions of patients in clinical practice, some unexpected possible adverse effects have been reported, including osteonecrosis of the jaw, atypical femur fractures, atrial fibrillation, and esophageal cancer. Because bisphosphonates are incorporated into the skeleton and continue to exert an antiresorptive effect for a period of time after dosing is discontinued, the concept of a drug holiday has emerged, whereby the risk of adverse effects might be decreased while the patient still benefits from antifracture efficacy. Patients receiving bisphosphonates who are not at high risk for fracture are potential candidates for a drug
Final FRCR Examination Clinical Radiology The Royal College of Radiologists 1 A 1: Cardiothoracic and Vascular 2: Musculoskeletal and Trauma 3: Gastro-intestinal 4: Genito-urinary, Adrenal, Obstetrics &Gynaecology and Breast
Mark Anderson, Churchill Hospital, Oxford The radiology of paediatric infectious diseases Chest infections Dr Alistair Calder, Great Ormond Street Hospital, London Intra-abdominal infections Dr Graham Wilkinson, Edinburgh Childrens
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
Emphysematous pancreatitis is typically managed with broad-spectrum antibiotics and early surgical debridement. Here, a case that supports more recent evidence for conservative therapy. 
This compact slide show provides a range of visual presentations of ecchymosis.
A52-year-old white man presented with a pruritic eruption on the neck of 3 months’ duration. The rash had not responded to a potent... 
