Broadening the differential: A case of penile pyoderma gangrenosum.

Pyoderma gangrenosum can be a challenging diagnosis for even the most experienced clinician. Misdiagnosis can lead to delays in appropriate treatment and unwarranted debridement that can increase the severity of the disease. Penile pyoderma gangrenosum (PG) is a rare presentation of this pathologic process. We describe the diagnostic workup and successful treatment of advanced penile PG in a 42-year-old male with a history of penile fracture who presented with delayed wound healing and multiple unsuccessful urologic surgeries. This case demonstrates the importance of keeping a broad differential, including PG, in order to avoid delays to appropriate care.

Camel Bites: A Case Study with a Summary of Current Epidemiology, Injury Patterns, and Treatment Modalities.

Animal bites are a major source of morbidity and mortality worldwide. In the United States, the majority of animal bites come from domestic pets, including dogs, cats, and rodents. Camel bites, on the other hand, are exceedingly rare in the United States and are poorly described in the western medical literature. Special considerations must be made when camel bite injuries occur, as they may be therapeutically challenging. Although some clinical features of camel bites resemble those of the more common animal bite injuries, the camel's unique dentition and bite force must be taken into account when managing these wounds.

Therapeutic rationale of combining therapy with gemfibrozil and simvastatin.

OBJECTIVES: To examine specific indications for patients receiving therapy with gemfibrozil plus simvastatin at doses of more than 10 mg daily and determine whether these patient-specific indications met Adult Treatment Panel (ATP) III criteria for combination therapy; and secondarily to identify any complications occurring between August 30, 2002, and May 1, 2003. DESIGN: Retrospective cohort study. SETTING: Tertiary care, university-affiliated, Southern Arizona Veterans Affairs Healthcare System from August 30, 2002, to May 1, 2003. PATIENTS: 80 patients with active prescriptions for gemfibrozil at any dose and simvastatin at doses of more than 10 mg daily as of August 30, 2002; and 23 patients who had been prescribed this drug at other institutions. INTERVENTION: Retrospective chart review. MAIN OUTCOME MEASURES: Frequency of meeting ATP III criteria for combination therapy with gemfibrozil and simvastatin was the primary outcome measure (primary). RESULTS: Of the 80 patients, 45 (56%) met ATP III guidelines for combination therapy. Among the 80 patients started on these drugs at this VA facility, gemfibrozil was added to simvastatin in 61 patients, simvastatin was added to gemfibrozil in 18, and the agents were begun simultaneously for 1 patient. Common errors included combination treatment when LDL cholesterol values could not be calculated (because of serum triglycerides levels exceeding 400 mg/dL); use of gemfibrozil at triglyceride levels lower than the 500 mg/dL with attainment of non-HDL goals; and use of gemfibrozil when triglyceride levels were not measured. One death secondary to rhabdomyolysis occurred in a patient whose care did not meet ATP III guidelines. CONCLUSION: Combination therapy with simvastatin and gemfibrozil often did not meet ATP III standards. A higher risk of serious adverse events results from combining these drugs, and systems to improve adherence to guidelines may improve the safety of treating dyslipidemic patients.