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Case studyA woman aged 59 years presented with a 12-month history of painful nodules on her fingers, which had recently worsened and become ulcerated. The patient had no dysphagia, dyspnoea, asthenia, muscle weakness or joint inflammation. Comorbidities included obesity, alcoholic liver disease...

How does the test work?Regional cerebral blood flow (rCBF) is closely linked to regional cerebral metabolism under conditions of normal brain autoregulation. Cerebral perfusion studies with single photon emission computed tomography (SPECT) image the distribution of one or other of the technetium...

Topical nitrates in painful diabetic neuropathyDear EditorI wish to thank Drs Votrubec and Thong1 for their comprehensive review of pharmacological management of neuropathic pain (AFP March 2013). I wish to raise the question of the use of topical nitrates in painful diabetic neuropathy.Three...

ACEI associated angioedemaDear EditorWe were pleased to see the recent article by Andrew et al1 drawing attention to the important issue of angioedema occurring as a complication of therapy with angiotensin converting enzyme inhibitors (ACEIs) (AFP January/February 2012). We understand that the...

Case 1Depression and anxietyYou are keen to have a structured approach to consultations with patients who have depression and anxiety.Question 1You are aware cognitive behavioural therapy (CBT) is a strategy used in depression, but are wondering about the evidence for efficacy. Your research on...

Figure 1. Scattered excoriated papules over the trunk and axillary foldsFigure 2. Scabby plaques in the interdigital web spaces of the handsFigure 3. Erythematous nodules and scratching lesions located on the scrotum and penile shaftQuestion 1Based on the history and physical examination, what is...

Angioedema is an infrequent but potentially serious adverse effect of angiotensin converting enzyme inhibitors (ACEIs).

Chronic urticaria is a common condition encountered in general practice and a frequent source of referral to the clinical immunologist, allergist and dermatologist.

Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated.

Erectile dysfunction (ED) is a common clinical problem managed in the general practice setting. While the majority of men will find phosphodiesterase-5 (PDE-5) inhibitors effective, there is a subgroup of men who require second and third line therapies.