Clinical problem-solving. A sharp right turn.
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Biomedical subjects
Publications and source records attributed to Michael T Flannery.
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An African American man was admitted with multiple systemic symptoms. The work-up revealed a unilateral cavitary lung mass with hilar adenopathy, sub-centimeter abdominal mesenteric lymph nodes, and a natural killer cell lymphocytosis in the bone marrow. Transbronchial biopsy revealed areas of noncaseating granulomas suspicious for sarcoidosis. Additional studies for infectious and malignant agents were negative.
OBJECTIVE: This study evaluated the efficacy and safety of the alpha(1A)/alpha(1D) subtype-selective blocker tamsulosin for the increasingly common treatment of benign prostatic hyperplasia (BPH) in the primary care setting. METHODS: A total of 493 men (age > or = 45 years), 99.6% of whom had moderate or severe BPH at baseline, were given tamsulosin 0.4 mg/day in a multicenter, open-label study conducted over 45 days by 42 primary care physicians and two urologists. RESULTS: Mean American Urological Association (AUA) Symptom Score decreased by 7.5 from a baseline of 20.0 on day 4, representing a 37.5% improvement over baseline (p < 0.001). AUA Obstructive and Irritative Scores declined significantly by day 4 (-4.7 and -2.7, respectively), as did AUA Bother Score (-5.4, p < 0.001) and mean BPH Impact Score (-2.5, p < 0.001). The Investigator's Global Assessment showed slight or greater improvement in 77.2% of patients (13.7% markedly improved). Effects were maintained from day 4 through day 45. CONCLUSIONS: Overall, patients treated with tamsulosin in a primary care setting experienced rapid, significant improvement in their signs and symptoms of BPH, based upon the change in the AUA Symptom Score. Tamsulosin was well tolerated; no new safety concerns were observed. Tamsulosin was not associated with significant effects on blood pressure or first-dose hypotension.
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We present the case of an elderly patient with abdominal pain, weight loss, and subjective fever in whom a magnetic resonance imaging study revealed a perihepatic abscess without invasion. After drainage, anaerobic cultures yielded Actinomycosis israelii. We discuss Actinomycosis species, with an emphasis on its pathology and multiple presentations.
We present a case of relapsing group B streptococcal bacteremia in a patient with cirrhosis secondary to hepatitis C. As no focal infection was found, other then cervical carriage, the patient required secondary prophylaxis with penicillin following the third episode of primary bacteremia within a twelve month time frame.
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Explore the source record for details and available documents.