Pleural and pericardial effusions with fever and altered mental status: an atypical presentation of bartonellosis.

A male in his 60s presented to the emergency department (ED) with a 3-week history of fever and progressive confusion. Initial laboratory and radiographic workup was largely unremarkable except for moderate bilateral pleural effusions. The patient was admitted on broad-spectrum antibiotics and further workup for fever of unknown aetiology.

Outpatient Vasectomy: Safe, Reliable, and Cost-effective.

Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization.

Neonatal Circumcision.

Neonatal circumcision is one of the most common elective surgical procedures in the United States and globally. This procedure, to remove part of the penile prepuce or foreskin, is done for a variety of personal, social, and medical reasons. There are several proposed benefits, risks, and ethical considerations to discuss with parents before the procedure.

Skin Ulcers: Surgical Management.

Surgical debridement refers to the use of sharp instruments to remove devitalized tissue from wounds. Skin grafting is an adjunctive therapy that uses human (autograft or allograft), nonhuman (xenograft), or artificial (synthetic graft) skin to cover nonhealing ulcers. Bilayer artificial skin plus compression is more effective for venous leg ulcers (VLUs) than standard dressings plus compression.

Skin Ulcers: Pharmacotherapy.

Topical wound therapies have unclear benefits for patients with pressure ulcers, venous leg ulcers (VLUs), and arterial ulcers. There is slightly more evidence supporting the use of systemic therapies. Used with compression therapy or alone, oral pentoxifylline has been shown to be more effective than placebo or no therapy in improving and healing VLUs.

Skin Ulcers: Wound Management.

For patients with chronic ulcers, the primary management goal, when possible, is complete wound healing. When this is not possible, palliative wound care provides a patient-centered alternative. Malnutrition is a risk factor for pressure ulcer development, but it is unclear whether interventions improve wound healing or other outcomes.

Skin Ulcers: Prevention and Diagnosis of Pressure, Venous Leg, and Arterial Ulcers.

Pressure, venous leg, and arterial ulcers are common and costly skin conditions that affect patients in all clinical settings. Clinical features can help differentiate these ulcers. Pressure ulcers are associated with restricted mobility, poor perfusion, and compromised skin status.

Common Skin Conditions in Children: Congenital Melanocytic Nevi and Infantile Hemangiomas.

Congenital melanocytic nevi (CMN) are hamartomas present at birth that are composed of nevomelanocytes and thought to originate from faulty migration of precursor melanocytes in the neural crest. Classification is based on projected adult size of the lesion. CMN size correlates positively with risk of melanoma and neurocutaneous melanocytosis.

Common Skin Conditions in Children: Skin Infections.

Skin infections account for a significant subset of dermatologic conditions of childhood. Common cutaneous viral infections in children include warts, molluscum contagiosum, hand-foot-and-mouth disease, and herpes simplex. Although viral infections are self-limited and often only mildly symptomatic, they can cause anxiety, embarrassment, and health care use.

Common Skin Conditions in Children: Noninfectious Rashes.

Cutaneous adverse drug reactions are among the most common noninfectious rashes of childhood. Cutaneous adverse drug reactions are classified as morbilliform, urticarial, bullous, pustular, or psoriasiform. Atopic dermatitis is one of the most common inflammatory cutaneous eruptions, and is characterized by pruritus and flexural distribution.

9 tips to help prevent derm biopsy mistakes.

The authors--with expertise in dermatology and pathology--provide pointers that can help you improve your approach to skin biopsy.