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Consultant Vol 44 No 12

Ezetimibe/simvastatin (Vytorin)
recently became available for the
treatment of high LDL cholesterol
levels, as adjunctive therapy to dietary
modification, in patients with
primary hypercholesterolemia or
mixed hyperlipidemia. This drug,
from Merck/Schering-Plough Pharmaceuticals,
inhibits the production
of cholesterol in the liver and blocks
the absorption of cholesterol in the
GI tract, including cholesterol obtained
from food.

For 8 months, a 44-year-old man has
had a 2-mm superficial ulcer on his
tongue. The lesion is surrounded by
a thin white rim and an area of white
discoloration. The patient believes
that the ulcer resulted from the
scratching of the rough edge of a
tooth against his tongue.

A healthy 23-year-old woman, who is a longtime runner, calls your office the day after she
tripped on a tree root while running in the woods and twisted her right ankle. She noted immediate
pain on the lateral side of the ankle but did not hear or feel a pop. She was able to
bear weight and walked out of the woods. However, as she walked, the ankle became more
painful and began to swell. When she reached
home, she applied a heating pad and rested
the ankle. The next morning she noted increased
swelling and moderate discomfort
while walking.

Nitazoxanide (Alinia), from Romark
Laboratories, has been approved
by the FDA for the treatment of
children who have diarrhea caused
by protozoa. This agent targets
Cryptosporidium parvum and
Giardia lamblia.

For 2 weeks, a 60-year-old man had severe nausea and vomiting. Two years earlier, he had had a cholangiocarcinoma, which was treated with palliative cholecystectomy followed by a course of rebeccamycin, an investigational chemotherapeutic agent.

A 23-year-old woman presents with
weight loss, epigastric pain, abdominal
fullness, and mild nausea. She
reports that she has had a slow-growing
mass on her upper middle abdomen.
She denies vomiting and does
not have evidence of jaundice. The
only significant finding in her medical
history is a myringotomy performed
many years earlier. She currently
takes an oral contraceptive.

During his last routine pediatric visit, a 4-month-old boy with a large head circumference (98th percentile for his age) was referred for radiographic evaluation. The infant had been delivered by cesarean birth because of cephalopelvic disproportion; his head size had gradually increased since birth. There was a family history of this condition.

A 67-year-old woman presented with a painful genital ulcer. She denied new sex partners and previous genital lesions.


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