Polycystic ovary syndrome: Fertility, prenatal care, pregnancy, and postpartum care.

Polycystic ovary syndrome (PCOS) is a complex, heterogeneous reproductive endocrinopathy affecting 8% to 13% of women in their reproductive years. PCOS has a vast array of clinical manifestations, including metabolic complications, biochemical and phenotypical hyperandrogenism, menstrual cycle dysfunction, and anovulation resulting in infertility. Understanding the relationship of the disorder's pathophysiologic and clinical manifestations is key to successfully managing patients with PCOS.

Maximizing patient safety when prescribing opioids for pain management.

Cytochrome P450 enzyme metabolism is altered by environmental and genetic factors, which can affect the efficacy and safety of opioids. This article describes CYP polymorphisms and how pharmacogenetic testing could be used to help clinicians make safer decisions about opioid use in patients.

Migrainous infarction: A serious complication of a common condition.

Migrainous infarction is a rare neurologic condition that stems from an ordinary migraine with aura, and can cause ischemic stroke in young women. The pathophysiology of migrainous infarction is not entirely understood. An aura that is similar to previous auras but lasts longer than 60 minutes, along with evidence of acute ischemia on MRI, are diagnostic of migrainous infarction.

An overview of esophageal atresia and tracheoesophageal fistula.

Esophageal atresia and tracheoesophageal fistula are often-concomitant pathologies that primarily afflict neonates. The complications of these anomalies may lead to increased morbidity and mortality, and clinicians should be familiar with the diagnosis and management of these pathologies. Clinicians can improve patient outcomes by having a thorough understanding of the signs and symptoms, classification systems, diagnostic workup, and surgical intervention options for these patients.

Lymphadenopathy secondary to tattoo ink in a patient with a history of Hodgkin lymphoma.

The finding of lymphadenopathy on physical examination and radiographically can suggest a wide range of differential diagnoses for patients, including a benign inflammatory process, infection, or malignancy. This article describes a patient with a history of Hodgkin lymphoma who developed postremission left axillary lymphadenopathy caused by deposits of tattoo ink in the node.

Complications of a congenital iris cyst in a newborn.

Congenital iris cysts are a rare condition in infants that can lead to multiple complications. This report describes an infant born with an iris cyst who developed complications including secondary glaucoma, cataracts, and visual impairment, requiring management with multiple surgical interventions and medications.

Tuberous sclerosis complex: A multisystem disorder.

Tuberous sclerosis complex (TSC) is a genetic disorder that affects multiple organ systems but often goes unrecognized, and a delay in diagnosis can lead to multiple complications. Healthcare professionals should be educated on the many signs and symptoms associated with the disorder, know how to treat them symptomatically, and recommend routine screening to assess for complications. Correctly identifying, diagnosing, and treating TSC can give patients a better quality of life and prevent further complications associated with the disorder.

Fecal microbiota transplantation in the treatment of Crohn disease.

Fecal microbiota transplantation (FMT) is an alternative treatment option with minimal risk for patients with Crohn disease. This article explains FMT and how it effectively targets the gut microbiota changes associated with the pathogenesis of Crohn disease.

ACE inhibitor-induced angioedema causing small bowel obstruction.

Mucosal angioedema of the face, lips, tongue, and throat is a well-recognized adverse reaction to angiotensin-converting enzyme (ACE) inhibitors that is experienced by a minority of patients. Rarely, this angioedema can involve the small bowel, and patients commonly present with abdominal pain and small bowel obstruction. Due to the increasing number of patients being treated for hypertension, clinicians should consider the diagnosis of small bowel angioedema secondary to ACE inhibitor use in all patients with this presentation who are using this class of medications.

Hijab pin inhalation.

Foreign body aspiration can be an acute life-threatening emergency and, if left untreated, can result in severe complications. Among Muslim women, the hijab pin can be accidentally aspirated. The article describes standard management with rigid bronchoscopy and a new technique involving magnets.

A review of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) describes a group of heritable disorders of connective tissue comprising mutations in the genes involved in the structure and/or biosynthesis of collagen. Thirteen EDS subtypes are recognized, with a wide degree of symptom overlap among subtypes and with other connective tissue disorders. The clinical hallmarks of EDS are tissue fragility, joint hypermobility, and skin hyperextensibility.

Leber congenital amaurosis in a young female.

Leber congenital amaurosis is a rare congenital disorder caused by a mutation in any of several different genes that causes rod-cone dystrophy and may eventually lead to blindness. Characteristic findings on fundoscopic examination include retinal pigment migration and macular atrophy. Confirmation can be obtained using electroretinograms and the specific gene can be identified with genetic testing.

Recognizing abdominal wall endometriosis.

Abdominal wall endometriosis is ectopic endometrial tissue in the abdominal wall. Consider this condition in any woman presenting with chronic abdominal pain and a surgical history significant for exposure of the abdominal cavity to the endometrial canal. The diagnosis can be suspected with accurate history taking and a thorough physical examination.

Targeted inhibition of the BRAF pathway in a patient with stage IV melanoma.

This article describes the use of vemurafenib, a BRAF inhibitor, to achieve disease regression in a woman with extensive metastatic melanoma and the BRAF V600 gene mutation. Given the improved survival rates seen in these patients, clinicians need to be aware of long-term patient management and adverse reactions to the drug.

Plantar fasciitis: A review of treatments.

Plantar fasciitis is the most common cause of heel pain in the United States. Many treatments are available and differ in efficacy and cost. This article discusses the theorized causes for plantar fasciitis and various treatments.

Treatment options in immune thrombocytopenia.

Immune thrombocytopenia (ITP) is an autoimmune condition that can cause life-threatening bleeding. ITP may develop idiopathically, after an infection or administration of a medication, or as a comorbid condition. Treatment depends on whether life-threatening, active bleeding is occurring.

Complicated Meckel diverticulum in a 15-year-old boy.

Meckel diverticulum is the most common gastrointestinal (GI) anomaly, occurring in 2% of the population. This condition often presents symptomatically similar to acute appendicitis in children. The most common presentation is GI hemorrhage, followed closely by obstruction due to intussusception.

A woman with sensory deficits, paresthesias, and ataxia.

Multiple sclerosis (MS) is a demyelinating and inflammatory disease that is thought to be autoimmune in nature. MS typically affects young women ages 20 to 40 years, but late-onset MS (after age 50 years) is more prevalent than previously thought. Between 4% and 9% of patients with MS have symptoms onset after age 50 years.

A guideline to efficiently treating traumatic brachial artery injury.

In patients with traumatic arterial lacerations, the benefits of short-term tourniquet use may outweigh the risks and be life- and limb-saving. Duplex ultrasound is the most efficient diagnostic test.

Aplastic anemia following viral hepatitis.

Post-hepatitis aplastic anemia is a rare but severe variant of aplastic anemia. Early diagnosis and treatment via stem cell transplant can improve patient survival.