November 22nd 2024
Your daily dose of the clinical news you may have missed.
Predicting the Risk of Type 2 Diabetes: When Does the Clock Start Ticking?
March 3rd 2010American medicine is undergoing the greatest financial scrutiny in its history. The hue and cry for reform stems primarily from the soaring costs of health care. However, placing the blame for these costs solely on increased utilization of technology, cutting-edge pharmaceuticals, cost-shifting hospitals, and physicians misses a bigger mark.
Don't Super Size It: Lifestyle, Eating Habits, and Renal Lithiasis
January 11th 2010Urologists and pediatricians are puzzling over an apparent substantial increase in renal lithiasis among children.1 In 2007, a singlecenter study found a nearly 5-fold increase in the number of children presenting with kidney stones.
Fatigue, Weight Loss, and Dysphagia in an Older Man
December 11th 2009For 1 month, a 60-year-old white man has had increasing fatigue, generalized weakness, and exertional dyspnea. He becomes short of breath after he walks only 100 to 150 yards on level ground or climbs only 1 flight of stairs. In addition, he has unintentionally lost 12 lb in the past month and has experienced intermittent dysphagia with solid foods. He attributes this last symptom to long-standing gastroesophageal reflux disease (GERD), for which he regularly takes over-the-counter omeprazole.
For Easier Pap Smears: Condom vs Glove
December 8th 2009I read with interest Dr Adam Breinig’s Practical Pointer, “For Easier Pap Smears, Use a Condom” (CONSULTANT, August 2009, page 488). I agree that this is an excellent way to retract the lateral vaginal walls during the speculum examination in an obese patient.
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).