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New Treatments for Early and Late COPD: Part 1, PreventionABSTRACT: The key factor in reducing morbidityand mortality in patients with chronicobstructive pulmonary disease (COPD)continues to be smoking cessation. Newerformulations of nicotine replacementtherapy-a nasal spray and an inhaler-provide rapid delivery of nicotine and maybe appropriate for highly dependent smokers.Bupropion has been shown to improvesmoking cessation rates, either when usedalone or with a nicotine patch. Both theinfluenza and pneumococcal vaccines arerecommended to reduce the morbidity andmortality associated with respiratory infectionsin patients with COPD.
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COPD: How to Manage Early and Late DiseaseThe goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.
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Paralytic IleusThis obstruction is caused by a failure of intestinal peristalsis; there is no evidence of mechanical obstruction. Paralytic ileus is common after abdominal surgery, especially if anticholinergic drugs are given preoperatively and/or narcotics are used postoperatively. It usually lasts 2 to 3 days. Paralytic ileus may also be caused by peritonitis; ischemia or surgical manipulation of the bowel; retroperitoneal hemorrhage; spinal fracture; systemic sepsis; shock; hypokalemia; uremia; pharmacologic agents (eg, vincristine, loperamide, and calcium channel blockers); diabetic ketoacidosis; and myxedema.
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Share the Burden of Uncertainty With PatientsWe have to let patientsknow that theimpact of mammography isnot that large-especiallyin women aged 40 to 49years. We simply do notknow whether early detectionof breast cancer leadsto improved outcomes inthis age group.
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Medical Training for the 1%Internal medicine doctors train predominantly in our high-tech academic medical centers, yet most will provide outpatient care. Here, Dr Andrew Morris-Singer frames one of modern health care’s greatest disconnects.
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A rare complication of empyema: Thoracic aorta perforationThis case represents an unusualcomplication of cellulitiscaused by methicillin-resistantStaphylococcus aureus.
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A Neurologist on a Medical MissionHealth expectations and standards of safety in this part of the world are clearly different from what most of us are used to. But it is my impression that “laying on of hands” offers encouragement and hope.
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Renal Infarction: An Unusual Complication of Cocaine AbuseA 63-year-old African American man presented with severe epigastric pain of 1 day's duration. The pain was sharp and continuous and radiated toward the left flank. There were no aggravating or relieving factors or previous similar episodes.
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What You Forgot About the Neurologic Exam, Part 2:ABSTRACT: Asymmetry-whether of strength, reflexes, or sensory function-is an important localizing finding in the neurologic evaluation. Asymmetric deficits of strength may indicate an acute CNS lesion. Symmetric hyperreflexia or hyporeflexia alone is not diagnostic; compare reflexes between sides of the body and between upper and lower extremities. The extensor plantar response (Babinski reflex) suggests an upper motor neuron lesion. During the sensory examination, look for asymmetry and determine whether both light touch and pinprick sensation are intact. Simultaneous stimulation with 2 sharp objects on opposite sides of the body-done to detect extinction of response on 1 side-can uncover subtle sensory deficits.
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Pellagra I a 45-Year-Old Man#onc_figure_border{ width: 175px; float:right; display:block;clear:right; border-left: 1px solid #a5a5a5; padding: 2px 0px 10px 10px; margin: 0px 0px 0px 10px;}
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Chronic Diarrhea:Chronic diarrhea presents difficulties for clinicians as well as for patients. Because the differential diagnosis is enormous, management can be challenging. In this article, we present a strategy for quickly narrowing the differential based on a simple analysis of stool characteristics. We then describe an appropriate workup for each of the basic types of diarrhea.
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Orbital Pseudotumor Disguised as Orbital Cellulitis and SinusitisA 58-year-old man with a past medical history of chronic sinus disease and hypothyroidism presented with left periorbital pain and erythema that worsened despite outpatient treatment with topical antibiotics. An outpatient CT scan showed pansinusitis and orbital stranding. The diagnosis was orbital cellulitis and sinusitis.
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Concurrent Management of Achalasia and Morbid ObesityThe development of a standardized treatment that simultaneously addresses achalasia and obesity is becoming more imperative as obesity becomes epidemic in the US. Here’s a case in point.
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Chronic Tophaceous GoutThese joint deformities occurred in a 61-year-old man with chronic tophaceous gout. The patient had had joint pain and swelling since he was 40 years old; the symptoms began in 2 fingers and were initially mild. He did not seek medical attention. Within 5 to 10 years, joint abnormalities had developed in the fingers and then in the left elbow and right ankle. The toes were not affected. He had no family history of joint pain or swelling. Serum uric acid level was 9.7 mg/dL.
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Disseminated Histoplasmosis in a Woman With History of Polymyositis and Possible DermatomyositisFor 3 days, a 28-year-old woman with a history of polymyositis and possible dermatomyositis had fever, chills, and nonproductive cough. She complained of rash, joint pain, and progressive immobility because of severe muscle weakness. For the past 6 years, she had been taking prednisone (60 mg/d), hydroxychloroquine (200 mg bid), and tramadol (100 mg q6h prn for pain).
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Congenital RanulaA 1-day-old neonate was brought for evaluation of a mass on the floor of her mouth. The swelling was fluctuant and had a bluish tint. No bruit was detected. There was mild tongue elevation but no airway obstruction. Other than this swelling, physical examination findings were normal. The infant was born at term and was breast-feeding.
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What Do These Images Reveal?A 64-year-old woman complainsof neck fullness that has increased inthe last few months. She has occasionaldyspnea but denies fever, cough, andhemoptysis. Hypertension is well-controlledwith propranolol.
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Middle-aged Man With Chest PainFor 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.
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Blue Rubber Bleb Nevus SyndromeBRBNS is a rare GI disorder characterized by distinctive cutaneous and GI venous malformations that can lead to occult or massive GI bleeding.
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Gram-Negative Bacteria as Cause of Foot IntertrigoFor a year, a 31-year-old man had asymptomatic, malodorous discoloration of the toe web spaces. He stated that his feet perspire heavily in the boots he is required to wear for work.
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Von Recklinghausen DiseaseA 66-year-old man presented with numerous cutaneous tumors. He had dementia and thus was unable to provide an accurate history.
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Emerging Strategies in HIV PreventionHIV infection continues to exact a devastating toll worldwide.Advances in antiretroviral therapy have helped bring theHIV/AIDS epidemic under control in developed countries.Antiretroviral drugs, however, are not widely available inthose developing countries where HIV poses a catastrophicthreat. Effective strategies for HIV prevention are thereforecrucial to curbing the global epidemic. Vaccination, microbicideuse, and male circumcision are 3 key preventive interventions.Current research is focused on developing effective vaccinesand microbicides and on determining the extent to whichcircumcision helps prevent HIV acquisition and transmission.[Infect Med. 2008;25:63-72]
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Vesicles and Erosions in a Middle-aged Man With DiabetesOver the past 8 years, fragile vesicles,painful ruptured bullae, and erosionshave developed on the sun-exposed skinof a 57-year-old man. Some of the vesicleserupt at sites of minor trauma; othersarise spontaneously. A corticosteroidcream prescribed by another practitionerfor presumed atopic dermatitisfailed to clear the lesions.
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Is There a Medical Explanation?A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
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Orthotopic UreteroceleA 67-year-old woman was admitted to the hospital with fever, chills, unilateral flank pain, dysuria, and urinary frequency and urgency. Her past medical history included several febrile relapses of infection.
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Occupational asthma: Tips on establishing the diagnosisWhen encountering a patient who may have occupational asthma, what is your approach to the initial evaluation? What are the most useful questions to ask?
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Lactic Acidosis in an Infant Receiving HIV ProphylaxisZidovudine is safe and effective in reducing transmission of HIV from mother to infant but rare serious side effects do occur. Is it worth the risk?
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Why patients with asthma should be given a trial of controller therapyAbstract: There is convincing evidence that controller therapies, such as inhaled corticosteroids and leukotriene receptor antagonists, provide many benefits to patients with asthma. These benefits include decreased symptoms, improved lung function, reduced frequency of exacerbations, and improved quality of life. Even patients with mild asthma and normal lung function can benefit from controller therapy. A recent analysis of the burden of asthma suggests that the proportion of patients who have mild intermittent disease is much smaller than previously estimated and that many more patients have persistent asthma. This finding, in combination with the considerable variability of patient responses to therapy and the difficulty in predicting which patients will respond, underscores the importance of considering a trial of controller therapy in patients with asthma.
