The American journal of the medical sciences
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To report a rare case of Graves' disease without ophthalmopathy presenting with pretibial myxedema (PM) as an initial presentation. ⋯ PM is an autoimmune manifestation of Graves' disease. Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy much later. However, this case represents a rare initial presentation of Graves' disease with PM without ophthalmologic symptoms or findings. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. In patients with diabetes having hyperthyroidism, deterioration in glycemic control should be anticipated and treatment should be adjusted accordingly. Restoration of euthyroidism will lower the blood glucose level.
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Comparative Study
Comparison of clinical features and outcomes of patients with acute myocardial infarction younger than 35 years with those older than 65 years.
The objective of this study was to analyze the clinical characteristics of patients younger than 35 years with acute myocardial infarction (AMI). ⋯ The main risk factors for young adults aged <35 years with AMI include cigarette smoking, hyperlipidemia and family history of coronary artery disease, and smoking cessation and lifestyle improvement are important considerations for the prevention of this disease in this population.
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Case Reports
Retroperitoneal metastatic germ cell tumor presenting as a psoas abscess: a diagnostic pitfall.
Most testicular neoplasms are germ cell tumors, the vast majority of which represent seminomas. Most seminomas present localized to the testis, whereas nonseminomatous germ cell tumors more often present with lymph node metastases. Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process, an adjacent focus of osteomyelitis or septic emboli from distant infectious foci. ⋯ This case represents an extremely unusual clinical presentation of metastatic germ cell tumor presenting as a psoas abscess. This unique case represents an unusual presentation of a recurrent germ cell tumor mimicking a psoas abscess. Awareness of possible metastatic testicular germ cell neoplasm as a psoas abscess could prevent diagnosis delay before retroperitoneal tumor debulking.
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Acute urticaria has many causative factors, which may include infections, medications (nonsteroidal anti-inflammatory drugs, antibiotics, contraceptives and others), insect bites, physical stimuli, allergens or underlying systemic disorders. Blastocystis spp, although ubiquitous in developing countries, is rarely implicated in causing disease in the developed world. The authors present a case of acute urticaria caused by Blastocystis hominis (protozoon parasite) in an elderly farmer in rural United States. This case vignette emphasizes the importance of checking stool for ova and parasites to look for Blastocystis species in patients with urticaria under appropriate clinical settings when other common causative factors of the same have been ruled out.
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Patients with chronic Chlamydia-induced reactive arthritis (ReA) often show a remitting-relapsing disease phenotype. Some information regarding bacterial and host responses to one another during active disease is available but no information for quiescence. This article presents the first molecular genetic insight into the behavior of bacterium and host during remitting ReA. ⋯ Bacterial load in synovial tissue of patients with remitting disease is lower than that of active disease, but mRNAs encoding proinflammatory proteins are equal to or higher than those of active disease. Transcription in the host is attenuated for cytokines and chemokines. These initial results demonstrate that organism is present and metabolically active in synovium during the remitting phase of chronic Chlamydia-induced ReA and that the genetic events characterizing quiescence are complex.