Anemia

A 26-year-old white man had blurred vision for 4 weeks. A sluggish light reflex was noted in the left eye. Funduscopic examination showed left-sided optic disc swelling with dot hemorrhages and hard exudates.

An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.

For 2 months, a 68-year-old man had had progressive weakness, arthralgia, myalgia, and a rash on the arms and legs. Closer examination of the rash showed petechial lesions and follicular hyperkeratosis with perifollicular hemorrhage and corkscrew hairs. The patient also had poor dentition and swollen, purple, spongy gingivae.

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

The differential diagnosis of generalized weakness is enormous; it includes disorders at all levels of the neur-axis. A variety of electrophysiological, pathological, radiographic, and other laboratory studies may be indicated depending on the specific diagnostic possibilities; costs can be controlled if such investigations are selected judiciously.

A 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.

A 66-year-old woman was hospitalized because of severe anemia secondary to myelodysplastic syndrome. She had had associated fatigue and throbbing pain in both legs for several days.

A 74-year-old woman presented with a refractory pruritic eruption. Four months earlier, she had sought evaluation of a thickened, slightly crusted 6 3 8-cm patch on her right ankle of 2 months' duration. Contact dermatitis with secondary impetigo from scratching was suspected, and a topical corticosteroid and an oral antibiotic were prescribed.

The sharply demarcated, smooth red plaques on this 3-year-old's tongue had been present for several months.

NASHVILLE -- Mortality for new hemodialysis patients can be reduced by 41% during the first year of treatment by an intensive case monitoring program, researchers here found.

PHILADELPHIA -- The FDA has approved topotecan (Hycamtin) capsules for treatment of relapsed small-cell lung cancer, GlaxoSmithKline has announced.

NEW YORK -- Giving bigger ribavirin doses to heavier hepatitis C patients appears to result in better outcomes, especially for African Americans, researchers here said.

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

CALGARY, Alberta -- Nocturnal dialysis at home six times a week markedly reduced left ventricular hypertrophy in patients with end-stage renal disease compared with conventional treatment, according to a preliminary study.

LEBANON, N.H. -- Epoetin alfa (Epogen or Procrit) failed to reduce red-cell transfusions in ICU patients but appeared to decrease mortality in trauma patients, researchers reported. Still, the drug increased thrombotic events.

A 47-year-old woman who recently completed adjuvant chemotherapy for colon cancer has painless cervical lymphadenopathy of 1 to 2 cm. She has no fever, sore throat, cough, or unexplained weight loss, and she denies exposure to ill persons or animals.

MINNEAPOLIS -- Progressively more stringent safety standards for blood donation have unexpectedly cut the national donor pool to 37.8% of the U.S. population, researchers here found.

ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

A 39-year-old woman complained of excruciating pain that radiated from a chronic lesion on the left upper lip to the entire left side of the face. She had AIDS but was not receiving antiretroviral therapy.

SUTTON, England -- Progression-free survival in chronic lymphocytic leukemia was extended significantly over monotherapy by combining fludarabine and cyclophosphamide, found an international study. But overall survival did not improve.

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

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ROCHESTER, Minn. -- For smoldering multiple myeloma, the risk of progression to active disease may be predicted by a pair of factors at diagnosis, according to researchers here.

PROVIDENCE, R.I. -- Even mild preoperative anemia or polycythemia were associated with an increased risk of death and serious cardiac events in older veterans having major noncardiac surgery, researchers here reported.

ROYAL OAK, Mich. -- Kidney disease and cardiovascular disease are intertwined risk factors, each contributing to the other, according to two studies.

CHICAGO -- Confirming results of earlier studies, pemetrexed combined with either cisplatin or carboplatin demonstrated activity in previously untreated malignant pleural mesothelioma, said researchers here.

CHICAGO -- A shorter lead-in time between recommended vitamin B12 supplementation and pemetrexed (Alimta) therapy may reduce treatment delays without impairing its efficacy.

CHICAGO -- Adding the monoclonal antibody cetuximab (Erbitux) to standard platinum-based chemotherapy for first-line treatment of head and neck cancers prolongs overall survival, researchers said here.

A 50-year-old man with end-stage renal disease secondary to long-standing hypertension had an elevated hematocrit and progressively increasing hemoglobin levels. For the past 7 years, he had been receiving hemodialysis 3 times a week. He denied headache, flushing, easy bruising, bleeding, nausea, vomiting, chest pain, dyspnea, and other symptoms. He was not receiving exogenous erythropoietin.

A 62-year-old woman is seen because of profuse vaginal bleeding that has led to anemia (hemoglobin, 4.5 g/dL). She has also noticed a lump in her navel.