- Pharmacologic treatments and pulmonary rehabilitation improve symptoms, health status, and exercise tolerance in patients with COPD.
- Chronic airflow obstruction is a central feature of chronic obstructive pulmonary disease (COPD).
- Chronic obstructive pulmonary disease (COPD) typically is a complex, multicomponent disease that can affect different systems.
- Chronic obstructive pulmonary disease has replaced cerebrovascular diseases as the third-leading cause of death in the US.
- <div class="section"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Does the evidence still support vitamin and mineral supplementation?</p> </div> </div> </div> </div>
- <p>A 5-month-old girl is brought for evaluation of a neck swelling that had appeared 2 days earlier and had pro- gressively enlarged. She has also had cough and subjective fever. She has had no difficulty in breathing. The mother reports that the infant has had decreased appetite and limited neck movement on the right side for the past few hours. The patient has been otherwise healthy. Immunizations are up-to-date.</p>
- <div class="column"> <p>Case 1:</p> <p>For several weeks, this 72-year-old man has had progressive periorbital edema (A) that was initially thought to be allergic in nature but has become more pronounced and per- sistent. During the same period, jugular venous distention (B) with- out hepatojugular reflux or pedal edema has been noted.</p> <p>What might explain these findings? </p> <div class="column"> <p>Case 2:</p> <p>What would you consider in the differential diagnosis of the vesicular rash near this woman’s eye? </p> </div> </div>
allergic contact dermatitis
What’s Your Diagnosis?®Woman with history of migraine headaches rushed to the emergency department with a new-onset seizure and diagnosed with posterior reversible encephalopathy syndrome.
Nonalcoholic Fatty Liver DiseaseA 58-year-old woman is evaluated after routine blood tests revealed elevated transaminase levels. She is asymptomatic and reports no complaints.
- <p>For 4 days, a 34-year-old preg- nant woman had dyspnea and right-sided chest pain. She denied fever, chills, sweats, cough, lower extremity pain,and edema. Surgical and social histories were unremarkable. She was taking progesterone and clomiphene citrate for the past 6 months for assisted reproduction. </p>
- <div class="column"><p><span><span class="Apple-tab-span"> </span>Half way through a 15-minute iontophoresis treatment for de Quervain tenosynovitis of the right wrist, a 42-year-old woman felt exquisite pain but completed the session. After the therapist returned to the room and removed the electrodes, a light gray circular mark about 5 mm in diameter was noted on the skin. The epidermis was gone, and the underlying dermis was also injured. Within 6 hours, a tender, </span>dark red–brown lesion developed.</p></div>
Influenza<P><SPAN><SPAN class=Apple-tab-span></SPAN>Although annual vaccination remains the most effective method for preventing seasonal influenza virus infection, antiviral medications can also help reduce </SPAN>the incidence of influenza and its complications. The antiviral agents available for use in the United States are oseltamivir, zanamivir, amantadine, and rimantadine. Because more than 99% of currently circulating influenza virus strains are sensitive to oseltamivir and zanamivir, these antiviral agents are recommended. Influenza A (H3N2) and 2009 H1N1 viruses are resistant to adamantanes.</P>
synovial cyst<p><span class="Apple-tab-span"></span>Over the past year, asymptomatic wartlike nodules had slowly developed on the fingers of both hands of a 57-year-old woman. During that time, she also had noticed increasing stiffness and pain in her hands in the evening. She had hypertension, which was treated with an angiotensin-converting enzyme inhibitor.</p>
Photoclinic<p><span>A 38-year-old woman was hospitalized because of bilateral flank pain and gross hematuria. Her medical history included autosomal dominant (adult) polycystic kidney disease (ADPKD). Her father had end-stage renal disease. </span></p>
Photoclinic<P><SPAN class=Apple-tab-span></SPAN>A 4-year-old boy with Down syndrome who underwent chest radiography while hospitalized for fevers, respiratory distress, and hypoxia was found to have an abnormality of the right clavicle. Radiographic results showed hyperinflation of the lungs without a focal infiltrate, indicative of a probable viral pulmonary process, and the incidental finding of a nonunion of the right clavicular bone without callous formation, consistent with congenital pseudarthrosis (A). The parents were not aware of the mal- formation. The patient had no history of arm or shoulder discomfort or recent or past trauma, especially no birth trauma.</P>
acanthosis nigricans<p>For the past 7 years, an obese 22-year-old African American woman had had asymptomatic, velvety hyperpigmentation on both cheeks. Similar hyperpigmentation was present on the neck, in the axillae, and on the elbows. The patient’s only medications were antihypertensives. </p>
Commentary<div class="column"><p><span>Medical </span><span>education is critically important to the evolution of medicine as a whole. The physician’s education is ongoing throughout medical school and career, and buried within the sheer volume of physiologic and medical knowledge is truly an art—that which balances science and humanity, policy and morality, </span>and reminds physicians that healing is just as important as treating. The art of medicine is often assumed to be something you learn along the way, rather than seen as itself an intangible force that stemmed from the minds and practice of those who came before MRIs, retrovirus vaccines, and stem cell research. </p></div>
CommentaryIn this, the last issue of our 51st year of publication, we want to extend our thanks to the following reviewers who appraised at least one manuscript for us in 2011.
Basal cell carcinomaA 5-year-old girl with atopic dermatitis is brought to your office with a 4-day history of what the mother describes as “itchy eczema” on her legs.