A generalized pruritic, vesicular eruption on an erythematous base developed in a 34-year-old man.
<DIV id=article-content-body> <P>The "Quick Take" on water fluoridation states that "fluoride prevents caries primarily after tooth eruption" (CONSULTANT, March 2001, page 472). Certainly, toothpastes, rinses, and gels that contain 1000 to 1500 ppm of fluoride achieve a temporary benefit as posteruptive topical treatments. However, the primary benefit of fluoridated water is the incorporation of fluoride into the enamel-a process that begins before eruption and that lasts for the life of a tooth.<BR>In infants and children, the 1 ppm of fluoride in fluoridated</P></DIV>
<div id="article-content-body"><p> </p><p><em>A 3-year Australian study found that when patients who underwent bypass surgery were given coenzyme Q10 for a week or more before the operation, their heart muscle tolerated stress better, recovered more quickly, and had better pumping ability after surgery than did the heart muscle in patients given placebo.<sup>1</sup><br> Should patients who are scheduled to undergo bypass surgery routinely be given coenzyme Q10 before the operation?<br> —Richard S. Banfield, MD<br> New Canaan, Conn</em></p></div>
A man with a 15-year history of episodic migraine presents to the emergency department at 5 AM with a right-sided throbbing headache of 4 hours' duration.
Must primary care clinicians be fluent in acid-base physiology? Yes, for 2 major reasons: First, many common disease states can be recognized through identification of acid-base disturbances
The mother of an 8-year-old boy sought medical care for her son, who had complained of a sore throat for 3 days. No fever, drooling, rash, rhinorrhea, cough, congestion, ear pain, neck stiffness, or dyspnea was reported. The boy had not been in contact with any ill persons, although his complaints coincided with a local outbreak of streptococcal pharyngitis.
After several days of suffering fever, headache, and malaise, a 17-year-old boy noticed a rash developing over much of his body.
<p><img alt="" src="/sites/default/files/transfer/brown_patch.jpg" style="border:1px solid black; display:block; height:107px; margin-left:8px; margin-right:8px; width:150px; float:left" />A 12-year-old boy has had this brown patch on his left buttock since birth. His mother is concerned that the patch has grown over the years, and she wants to be sure that it will not be a health concern for her son. The mother has not noticed lesions elsewhere on the child. There is no family history of skin disease.</p>
The evaluation of head injuries in young athletes can be challenging.
I recently had the privilege of visiting a couple in Europe; I arrived the day before their first child was born. The parents are both in their mid-30s. They both have advanced degrees. They each speak 4 languages. They had read a bunch of “baby books” before their daughter arrived. Labor and delivery went well.
These thoraco-omphalopagus twins were born at 33 weeks gestation via cesarean delivery.
<P>A 17-month-old boy was brought for evaluation of bilateral foot pain of 3 weeks’ duration. He had been born with curly toes—medial curving of the third, fourth, and fifth toes bilaterally. The mother reported that the overlapping of the third toe by the second toe had developed when the infant was about 6 months old and had progressively worsened.</P> <P>The infant’s father and sister had similar toe deformities. Radiographs of the feet revealed no bone abnormalities. The patient was referred to a pediatric orthopedist to reassure the mother.</P>
<p><strong>Trading one dangerous scenario</strong><strong> for another?</strong></p><p>Pertussis has long been known to cause severe disease and death in infants, especially in those<br />who are unvaccinated or who are too young to be immunized. With the number of pertussis cases in the United States increasing,1 those of us who care for susceptible infants are looking for solutions to this dangerous problem.</p>
Several forms of measurement proved to be effective in evaluating physical function in patients with psoriatic arthritis, a recent clinical study revealed.
A17-year-old boy who had been struck in the left eye by a glass bottle 3 days earlier presented to the emergency department with orbital bruising, eye pain, and swelling.
For 3 days, a 6-year-old boy had “redness and pain” of skin on his left upper abdomen.
<p><img src="/sites/default/files/images/May_figA%26B_CTscan.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="250" height="149">A 73-year-old woman was found on the ground by her husband. She was unable to move her left arm or leg, and she was confused and disoriented.</p><p>In the emergency department, the patient was drowsy and unable to follow commands. She withdrew from painful stimulation to her right side but not to her left. She did not open her eyes to verbal or painful stimuli. </p>
<p><img src="/sites/default/files/Untitled-10.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="200" height="108">A 46-year-old man with HIV infection was hospitalized for evaluation of a nonhealing, tender wound on the right lower extremity. The lesion had been present for 2 months following a minor injury to the leg, but it flared the week before admission. A month before hospitalization, the patient was given trimethoprim/sulfamethoxazole and minocycline for treatment of the wound, with no improvement.</p>
<p><img src="/sites/default/files/Untitled-9_0.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="142" height="271">A 7-year-old girl presented with pain and discomfort in the left leg that was exacerbated by physical activity. She had been born with a port-wine stain on the left knee. As her mobility increased, she occasionally complained of discomfort in the left leg.</p><p>Klippel-Trenaunay syndrome (KTS) was diagnosed at age 3 years after an evaluation for swelling, discoloration, and pain of the left leg. Magnetic resonance angiography and venography had revealed abnormally dilated, tortuous veins in the subcutaneous tissues from the distal thigh to the posterolateral calf with involvement of the proximal anterior tibial muscle. The parents had elected for conservative management with observation.</p><p>At the patient’s current visit, she was noted to have 2 erythematous to bluish vascular plaques on the superior and inferior aspects of the patellar surface with subcutaneous nodular swellings and varicosities predominantly on the lateral aspect of the lower leg.</p>