October 31st 2024
ACG 2024: New study results indicate GLP-1 RAs have a potentially protective role to play in combating EO-CRC, the incidence of which is notably rising worldwide.
October 10th 2024
How do you explain this ulcerative abdominal rash?
November 5th 2009This abdominal rash developed while a 63-year-old woman was traveling in Israel. She was admitted to the hospital, where she received intravenous antibiotics, and was discharged after 5 days. She now returns to the United States and wonders what she had, because she did not understand what the physician in Israel had told her. She has brought all of her medical records.
Diabetes and Cardiovascular Disease: Does Lowering Hemoglobin A1c Help or Harm?
November 3rd 2009Case 1: Mr A. is a 55-year-old man who comes to your office for a routine physical examination. He is a traveling salesman and has recently gained weight. He does not exercise much and is a frequent visitor to fastfood establishments. His father had “a touch of diabetes” and died of a myocardial infarction (MI) at age 59.
What to Do for Patients With Hepatitis C?
November 3rd 2009No matter what primary care demographic your practice represents, it would be most unusual not to encounter patients infected with hepatitis C virus (HCV). Since HCV infection is chronic and can lead to cirrhosis (occurring in 20% of patients over a period of 10 to 20 years), decisions regarding its management, referral, and follow-up are of the utmost importance.
Anaphylaxis: 36 Commonsense Ways to Reduce the Risk
August 3rd 2009In 2000, the World Allergy Organization (WAO) published a consensus definition of anaphylaxis as a severe, life-threatening generalized or systemic hypersensitivity reaction. The reaction is caused by the release of bioactive mediators from mast cells and basophils.
Skin Disorders in Older Adults: Vascular, Lymphatic, and Purpuric Dermatitides, Part 2
July 10th 2009All elements of the skin are affected by age. In this 2-part article, I discuss how the blood vessels, the lymphatics, and the ground substance- which surrounds these vessels- respond to age, and I show how the aging elements of the vasculature can engender a variety of pathological cutaneous conditions.
Acute Ankle Injuries, Part 1: Office Evaluation and Management
June 9th 2009Each acute ankle injury commonly seen in the office has associated with it a mechanism by which it can be injured, trademark symptoms that the patient experiences during the injury, and a level of disability at the time of the injury and shortly after.
Herniation of a Lung Bulla Through a Thoracostomy Site
May 9th 2009For 3 months, a 63-year-old man had experienced progressively worsening dyspnea. He denied fever, weight loss, and hemoptysis. Eight months earlier, he had had a right thoracotomy to drain a right empyema. Comorbidities included morbid obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. However, he did not have any intrinsic lung disease.
An Old Man With a Floppy Bottom
May 2nd 2009An 88-year-old man who had left hip repair after a fracture a few months earlier is now admitted to behavioral hospital because of implacable refusal to take medications, and because of poor food intake and ongoing refusal of rehabilitation. Ambulated with a walker before fracture but now barely ventures out of wheelchair even with rolling walker and therapist guidance.
Obesity Linked to Prevalence of Migraine in Adults
April 28th 2009Prevalence of migraine is higher in men and women who have total body obesity (TBO) or abdominal obesity (Abd-O), according to the results of a study by Lee B. Peterlin, DO, assistant professor in the Department of Neurology, and colleagues at Drexel University College of Medicine in Philadelphia.
Multiple Myeloma With a Gastric Plasmacytoma
April 2nd 2009Two weeks after being treated for a fracture of the left humerus and several palpable breast lesions, a 63-year-old African American woman was hospitalized for generalized weakness and confusion. She had a history of type 2 diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, and low-grade B-cell lymphoma (which had been in remission for 2 years).
Woman With Recent Respiratory Tract Infection and Anemia
April 1st 2009A 50-year-old woman presents to the emergency department with severe dizziness, weakness, and dyspnea of 1 week’s duration. Ten days earlier, an upper respiratory tract infection (URTI) was diagnosed; over-the-counter cough syrup and acetaminophen were prescribed. However, the patient’s condition has steadily deteriorated since then. In addition, her urine has darkened over the past few days.
Bilateral Leg Ulcers in a Cachectic Man
March 2nd 2009A 51-year-old man is admitted to the hospital with painful ulcers on both lower extremities, severe anemia, and a 45-kg (100-lb) weight loss over the past year. Pain from the ulcers prevents him from walking. The ulcers developed about 5 years earlier, as a result of his wearing high boots for work; they began as small sores and grew over time.
Renal Artery Stenosis: When Is Revascularization Warranted?
February 2nd 2009Q:My patient is a 66-year-old man with long-standing hypertension and atherosclerotic heart disease. During a recent coronary arteriogram, the cardiologist performed renal artery screening, which revealed a left renal artery stenosis. Renal artery angioplasty and stenting were recommended. Is this appropriate?
Woman With Severe Headache and Left-Sided Weakness
December 2nd 2008A 47-year-old Hispanic woman with severe headaches of 1 month’s duration presents to the emergency department (ED). The pain encompasses the entire head, is constant and crushing (10 on a scale of 1 to 10), and has progressively worsened.
Nonalcoholic Fatty Liver Disease: Update on Evaluation and Treatment
November 2nd 2008Nonalcoholic steatohepatitis (NASH) was first reported by Ludwig and associates in a series of patients who had no significant history of alcohol intake but whose liver histology resembled that of alcoholic liver disease.
A Woman With Markedly Asymmetrical Breasts
November 2nd 2008A 77-year-old woman with Alzheimer dementia admitted to a behavioral hospital because of intractable agitation. Denies prior breast problems. Subsequently, her daughters state that she had a diagnostic breast biopsy 5 years earlier; diagnosis confirmed by review of pathology report. Patient has adamantly and consistently refused further investigation or treatment of breasts.
Tonic-Clonic Seizure in a Man With HIV Infection
November 1st 2008A 36-year-old man presents to the emergency department (ED) after a single tonic-clonic seizure. He has a history of numerous male sexual contacts. HIV infection was diagnosed 5 months earlier. At that time his CD4+ cell count was 66/μL and his HIV RNA level was 20,000 copies/mL.