1/5. Scanning electron microscope imaging of onychomycosis.Although scanning electron microscope technology has been used for more than 60 years in many fields of medical research, no studies have focused on obtaining high-resolution microscopic images of onychomycosis of the toenail caused by trichophyton rubrum in a geriatric population. To provide new insight into the intricate structure and behavior of chronic toenail onychomycosis, we produced three-dimensional images of onychomycosis obtained from two geriatric patients with confirmed growth of T rubrum. The photomicrographs illustrate the pervasive integration and penetration of the fungus hyphal elements, underscoring the clinical difficulty of obtaining rapid treatment of fungal infections in the distal and lateral subungual space of the human toenail. Although the scanning electron microscope may not be a practical diagnostic tool for most physicians, it remains invaluable for the researcher to obtain insight into the spatial orientation, behavior, and appearance of onychomycosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Silent stroke associated with minor podiatric surgery.life-threatening intraoperative complications during minor podiatric surgery are rare. This paper presents a case of a "silent stroke," which occurred during total matrixectomies of hallux nails. The podiatric physician must be aware of the risk factors involved in each case and must be prepared to treat any complications that may arise.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Disuse contractures in a patient with tinea manuum and irritant contact dermatitis.Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. An unusual case of severe griseofulvin-alcohol interaction.Drug-alcohol interactions in patients who present to emergency departments with a severe "disulfiram-like" illness (including vomiting, diarrhea, flushing, tachycardia, and hypotension) must be recognized and treated appropriately. We report a case of such an interaction caused by oral griseofulvin and alcohol. Emergency physicians should be aware of this potential interaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. hypersensitivity syndrome reaction to oral terbinafine.Terbinafine is used extensively to treat onychomycosis and other dermatomycoses. The case of a patient who developed a hypersensitivity syndrome reaction to oral terbinafine is discussed. A 66-year-old male was placed on terbinafine (250 mg/day) for the treatment of onychomycosis. After 4.5 weeks of therapy, the patient developed a cutaneous eruption, pyrexia, lymph-adenopathy and hepatic dysfunction. No infectious or other cause was found for the symptoms and signs, which resolved within 6 weeks of stopping terbinafine. The patient had been on prednisone, doxazosin mesylate and aspirin for several months prior to starting terbinafine. These medications were continued during the episode and subsequently afterwards, with adjustment to the prednisone dosage only. The hypersensitivity syndrome reaction in this case involved multiple systems and was idiosyncratic in nature with no apparent predisposing factors. With the increasing use of oral terbinafine, it is likely that rare adverse events will occur more frequently. It is, therefore, important for physicians to be aware of the possible development of a hypersensitivity syndrome reaction in a patient on terbinafine who experiences an adverse event with multisystem involvement. Prompt recognition and determination of the extent of systemic involvement is important for the proper management of the patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |