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What’s in a Mass?: Large Native Mitral Valve Mass

After an elective cystectomy, a 77-year-old man developed postoperative atrial fibrillation, resulting in a surprising new finding and a challenging diagnosis. He had no cardiovascular symptoms or cardiac history. The preoperative electrocardiogram was normal. Transthoracic echocardiogram identified a mass on the mitral valve (Figure 1A), new 3+ aortic valve regurgitation, and 2+ mitral valve regurgitation. Left ventricular […]

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Primary Care Management of Skin Abscesses Guided by Ultrasound

Primary care providers often manage skin abscesses in the outpatient setting. Estimating the size and depth of an abscess, and distinguishing abscess from cellulitis by clinical examination can be challenging due to surrounding firm tissue induration. Definitive treatment of abscess requires incision and drainage, and the approach chosen may be altered by abscess size, depth, […]

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Curious Case of Wheezing: Carcinoid Heart Disease

  A 58-year-old African American woman with a history of well-controlled hypertension (on amlodipine and lisinopril) presented with a 2-month history of anorexia, early satiety, dysgeusia, and intermittent loose stools, symptoms that had progressed to the point that she had experienced a 20-pound weight loss. These abdominal symptoms also were accompanied by progressive exertional dyspnea […]

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Silver-Containing Wound Cream Leading to Argyria—Always Ask About Alternative Health Products

Currently, patients are increasingly gaining access to medications and nutritional supplements via the Internet from companies that are not subject to any regulations that protect consumers, such as US Food and Drug Administration standards for safety, efficacy, and current good manufacturing practice (cGMP) manufacturing to ensure quality. In particular, patients who are disappointed by slow […]

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A Rarity in a Common Disease: Thyroid Paraganglioma

Thyroid nodule is extremely common in clinical practice. An evaluation of thyroid nodule is often straightforward. However, pathologic findings can occasionally be surprising. A 42-year-old previously healthy man was referred to the endocrinology clinic with asymptomatic neck enlargement noted during evaluation of acid reflux symptom. He had no previous radiation exposure to the head and […]

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