1/11. Hypertrophic herpes simplex virus in hiv patients.In conclusion, HSV lesions in hiv patients can present as chronic, hyperproliferative plaques as opposed to the classic acute ulcerative lesions. knowledge of this presentation will motivate the physician to be diligent in the diagnostic workup. This may necessitate repeat biopsies and cultures. Due to the high incidence of resistant isolates, sensitivity testing and knowledge of antiviral mechanisms will facilitate treatment in an hiv patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Fatal hepatic failure secondary to acute herpes simplex virus infection.Acute hepatitis with severe hepatic failure is an uncommon manifestation of herpes simplex virus (HSV) infection. It has been described in both immunocompromised and immunocompetent patients and is usually fatal. Due to the better survival after acyclovir treatment in a few reported cases, physicians need to be aware of the characteristic clinical abnormalities so that early diagnosis and treatment can be implemented. The authors describe an adolescent diagnosed with hodgkin disease who developed fatal hepatic failure secondary to acute HSV. Typical signs and symptoms in patients at risk, when there is no other obvious cause of fulminant hepatitis, should lead to early empirical treatment with acyclovir.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Acquired QT prolongation associated with esophagitis and acute weight loss: how to evaluate a prolonged QT interval.When the physician is confronted with a patient having significant QT prolongation, it is critical to determine whether the patient harbors a genetic defect and a transmissible form of long qt syndrome (LQTS) or whether the QT prolongation has an acquired cause. The distinction has profound ramifications for the type of care provided to the patient and family. We report the case of a previously healthy 14-year-old boy who presented with a 10-day history of painful swallowing, a 10-lb weight loss, and chest pain. A 12-lead electrocardiogram (ECG) showed marked QT prolongation. endoscopy and culture identified a herpes simplex esophageal ulcer. After treatment with acyclovir, the patient recovered completely. Three weeks after the resolution of his symptoms and recovery from his acute weight loss, a follow-up ECG showed complete normalization of the QT interval. This case illustrates yet another potential mechanism for acquired QT prolongation. We also provide a diagnostic algorithm for the careful evaluation of a prolonged QT interval.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Recurrent herpes simplex virus infections and erythema multiforme: a report of three patients.The widespread preoccupation of the media and patients with herpes prompts this report of two patients who developed erythema multiforme, an allergic response to the herpes simplex virus. While this complication is not new, physicians and nurses working in clinics for sexually transmitted diseases should be aware of this allergic response to infection with herpes simplex virus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. hypnosis in the treatment of acute pain in the emergency department setting.Emergency ward physicians are presented daily with patients in pain. Provisions of safe, quick pain control remains one of their major duties. hypnosis can be used as an effective adjunct or substitute for analgesic medications when these drugs prove to be ineffective or contraindicated. Four such illustrative cases of attempted pain control are presented. The psychological foundations of pain and its assessment are discussed. The emergency ward physician can obtain facility in hypnotic techniques with only modest training. hypnosis may then become a valuable tool in helping him provide safe and effective pain management.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/11. Malignant cerebral edema and intracranial hypertension.Cerebral edema and intracranial hypertension occur frequently in neurologic patients. Proper understanding of the pathophysiology of each entity allows prompt recognition and rational therapeutic goals, allowing for better neurologic outcome in many disease states. The recognition of cerebral edema as a distinct entity allows the clinician to treat focal pressure gradients in the brain separately from more diffuse intracranial pressure elevations, appreciating the benefits and pitfalls of directed therapies for each process. The treatment of many of the disorders that cause cerebral edema and intracranial hypertension is heuristic, challenging the managing physician's thorough understanding of cerebral hemodynamics and his or her ability to encounter the human aspects of determining appropriate levels of care for individual patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Delayed fellow eye involvement in acute retinal necrosis syndrome.PURPOSE/METHOD: We studied a case of acute retinal necrosis in which a 30-year delay occurred between involvement of the first and fellow eyes. After systemic treatment with acyclovir and prednisolone, the fellow eye developed a retinal detachment requiring vitrectomy and silicone oil tamponade. RESULTS/CONCLUSION: The fellow eye retained a useful Snellen acuity of 20/120. In a patient who has had acute retinal necrosis, any symptoms or signs in the fellow eye, even several decades later, should alert the examining physician to the possibility of delayed involvement of the fellow eye.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Infectious esophagitis and the primary care physician.The various clinical presentations of infectious esophagitis have been discussed. The physician approach to patients with suspected infectious esophagitis is based on whether the patient has an underlying immune problem. Symptomatic patients with thrush and AIDS should be empirically treated but most other patients should be referred to endoscopy. Considering the AIDS epidemic, any patient without known immune deficiency who is diagnosed with infectious esophagitis should be screened for an immunodeficiency disorder.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
9/11. Uses and safety of acyclovir in pregnancy.acyclovir, an antiviral nucleoside analogue, is a widely used agent highly specific for herpes simplex and varicella-zoster viruses. Unintended exposure to acyclovir early in pregnancy, which is not uncommon, may cause excessive maternal and physician anxiety. This drug has not been studied prospectively in large numbers of pregnant women and lacks the food and Drug Administration's approval for gestational use unless benefits clearly outweigh potential fetal harm. However, data published since acyclovir became available do not indicate increased adverse effects related to its use in pregnancy, especially if prescribed in selected situations, such as disseminated primary herpes simplex infections or maternal varicella pneumonia. This article reports the impact of inadvertent acyclovir exposure on a woman during the first trimester of pregnancy and reviews the literature on acyclovir's pharmacology, safety profile, and potential uses during pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Stymied by seizures. When the clues point to the wrong path.seizures have many causes, and physicians should try not to be shortsighted when an apparent cause seems to leap out. The key is being receptive to the fact that a less obvious source of seizures may exist. In this case, new-onset seizures believed consistent with illicit drug use proved to have an infectious cause.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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