DermclinicChronic sun exposure produces actinic skin changes—referred to as dermatoheliosis—such as actinic comedones.
Dermclinic<p>A 50-year-old woman is concerned about a persistent white papule that erupted on her chest a few months ago. The lesion is asymptomatic.</p>
Dermclinic<p>A 42-year-old man presents with an asymptomatic, annular, keratotic lesion of several months’ duration on his upper arm.</p>
Dermclinic<p>A pruritic, papular eruption arose on a 38-year-old woman’s forehead 1 week earlier. A day before the rash erupted, the patient was given a permanent wave.</p>
- <p>Zamora-Chinchipe Province in Ecuador is home to about 90,000 people and abuts other Andean provinces of similar size. Most residents of this agrarian region are indigenous Shuar, Saraguro, or mixed heritage Indian/Spanish.</p>
- <p>Does your patient who received last year’s influenza vaccine need to be revaccinated this fall? What about a child who was given 1 dose of vaccine last year—will 1 dose suffice this year?</p>
Case in Point<p>A 48-year-old woman with a 50-pack year smoking history presented with worsening dyspnea and progressive weight loss of 25 lb over the previous 4 months. In addition, she had a productive cough with yellowish-brown sputum during the past few weeks, which was not associated with fever, chills, hemoptysis, or night sweats.</p>
- <p><strong>Case 1:</strong> Rheumatoid vasculitis<br /> <strong>Case 2:</strong> Idiopathic dermatomyositis<br /> <strong>Case 3:</strong> Progressive systemic sclerosis<br /> <strong>Case 4:</strong> Rheumatoid nodules</p>
What’s Your Diagnosis?®The clinical diagnosis of tuberous sclerosis complex (TSC) in this patient is based on the presence of facial angiofibromas and hypomelanotic macules
Case in PointRenal artery stenosis is an important cause of surgically correctable hypertension in children.
- <p>A 4-year-old Latino boy with mosaic Turner syndrome (45,XY/45,XO) presented with fever, temperature up to 40.5ºC (105ºF), of 3 days’ duration. He also had swelling on the right side of the neck and difficulty in swallowing. His history was significant for recurrent otitis media.</p>
- <p>What has long been the “state of the art” for cervical cancer screening in primary care? Everyone would appropriately answer the Pap smear, of course. Has it worked? Despite false-positive and false-negative results, it has decreased the incidence of and mortality consequent to cervical carcinoma.<br><br></p>
Commentary<p>A curious thing happened along what has been a muddy and meandering road to health care reform. </p>
Photoclinic<p>A 4-year-old boy of Nicaraguan descent was hospitalized because of worsening perium<span>bilical abdominal pain. The pain began 6 days </span>earlier and was accompanied by decreased appetite, nausea, emesis, and diarrhea. </p>
Photoclinic<p>For 4 days, a 62-year-old woman with type 2 diabetes mellitus had constant, severe, crampy abdominal pain associated with nausea, non-bloody emesis, and anorexia, but not fever. She reported that the pain had an insidious onset and was<span>exacerbated by urination.</span></p>