Neurotoxicity<div id="article-content-body"> <p>Cephalosporins are usually considered relatively safe antibiotics; however, serious neurological adverse effects can occur following administration.<sup>1-5 </sup>Manifestations of cephalosporin-induced neurotoxicity may include confusion, disorientation, twitching, somnolence, myoclonus, and seizures, particularly in patients with reduced renal function.<sup>6,7</sup> Here we discuss the mechanism, risk factors, and management of cephalosporin-induced neurotoxicity.</p> </div>
Calcified Splenic Cyst<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1523699&t=1266349264138" style="width: 238px; height: 205px; float: left;">A 38-year-old man found lying on the floor in his home was hospitalized because of <span class="DrugLink">alcohol<span></span></span> intoxication. A chest radiograph showed a large calcified lesion in the left upper abdomen<strong></strong>. A CT scan with intravenous contrast revealed a large, well-defined, cystic mass with mural calcification in the spleen<strong></strong>. The CT findings were not consistent with a vascular malformation or echinococcal cyst—specifically, the mass was sharply demarcated, unilocular without septations, and round with a thin wall and attenuation similar to water. Urine <em>Histoplasma</em> antigen test results were negative.</p>
Collagenomas<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1523319&t=1266346526654" width="150" height="147" style="float: left; margin-left: 8px; margin-right: 8px;"></p><p><span class="article-text"><span>During a skin cancer screening, a 45-year-old male soldier was noted to have bilateral subcutaneous nodules on the dorsa of his feet. The patient reported that the nodules had remained unchanged since they first appeared in his early 20s and were asymptomatic. He had no other lesions.</span></span></p>
Unilateral Superficial Venous Thrombosis
Refractory Groin Rash<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1518836&t=1265377142381" width="150" height="120" style="margin-left: 8px; margin-right: 8px; float: left;">A 51-year-old man is seen because of a painful groin rash. Has not cleared despite 3 months’ topical corticosteroids and antifungals. Does not have diabetes but does abuse <span class="DrugLink">alcohol<span></span></span> and has alcoholic cardiomyopathy; obese.</p>
GI Anomalies<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1523853&t=1266350604717" width="150" height="150" style="float: left; margin-left: 8px; margin-right: 8px;" /></p><p>During hospitalization for aortic valve replacement, a 45-year-old man with rheumatoid arthritis and an extensive history of cardiac disorders was found to have a urinary tract infection (UTI) and pneumaturia. He had had recurring UTIs and pneumaturia for the past 2 months. Review of systems was otherwise negative.</p>
GI Anomalies<p><img alt="" height="150" src="http://www.consultantlive.com/image/image_gallery?img_id=1523836&t=1266350331167" style="float:left" width="158" /></p> <p>For 2 days, an 81-year-old man had episodes of sharp, intermittent, nonradiating periumbilical pain that lasted about 1 to 5 minutes. He also reported decreased appetite and nausea. He had a percutaneous endoscopic gastrostomy (PEG) tube, which had been changed 6 months earlier. The patient recently had 4 loose stools but no hematochezia or melena. He had dyspnea, which he attributed to chronic obstructive pulmonary disease. He denied vomiting, fevers, chills, and chest pain.</p>
GI Anomalies: Dieulafoy Lesion<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1523828&t=1266350259301" width="169" height="150" style="display: block; float: left; margin-left: 8px; margin-right: 8px;" /></p><p>Two days after a 70-year-old man was treated for suspected GI bleeding, he presented to the hospital with dyspnea, weakness, and light-headedness. He denied loss of consciousness, fall, bright red blood from rectum, diarrhea, nausea, vomiting, and pain.</p>
HIVThe treatment of human immunodeficiency virus type 1 (HIV-1) infection is usually directed by subspecialists.
Complete Heart BlockA 92-year-old woman presented with signs and symptoms of heart failure, including marked bilateral lower extremity edema, jugular vein distention, and difficulty in breathing at rest.
Pygmies<p><img src="/sites/default/files/africa-1_large.jpg" width="150" height="150" style="float: left; margin-left: 8px; margin-right: 8px;" />We lie awake in our one-room hut before dawn listening to the cacophony of sounds emanating from the forest as the birds awake. The Bwindi Impenetrable Forest of Southwest Uganda contains over 350 species of birds, and it seems that they are all chattering to each other at once. The Bwindi Forest is also home to more than half of the world’s 650 mountain gorillas.</p>
Insulin DosingInsulin Dosing: How High Can You Go?
- <p><a href="/sites/default/files/vaccine_shingles.jpg"><img alt="" height="150" src="/sites/default/files/large_vaccine_shingles.jpg" style="float:left" width="150" /></a>A documented anti–varicella-zoster virus (VZV) titer is generally accepted as evidence of protection against VZV infection, and a known case of shingles, such as that described in the Photoclinic case of an older man with ophthalmic zoster (Tran KT, Qualm AS, Shannon MA. CONSULTANT, December 2009, page 767), might reasonably be expected to boost anti-VZV titers in the affected patient. Why then would administration of the zoster vaccine be included in this patient’s treatment plan?</p>
Physician-Volunteers<p>As a screener and admissions committee member at our medical school (University of California School of Medicine at Davis), I am privileged to review the personal statements of many, many applicants who want to be doctors in spite of the recent hard times in our country that have led more than a few American physicians to believe that our profession is less valued and less desirable as a life work than it has been in the past.</p>