Consultantlive Staff

This reference provides rapid access to a wealth of diagnostic and therapeuticinformation. The text is divided into 5 sections

About 30% of American adults are obese, and an additional34% are considered overweight. As the prevalence of obesityincreases, so does the incidence of related medical disordersand mortality. Here a team of experts highlights the clinicalimplications of recent research on obesity.

More than one third of American adults experience persistentinsomnia, the second most common complaint-afterpain-in the primary care setting. However, insomnia hasoften been ignored, trivialized, or summarily (often erroneously)attributed to underlying or preexisting psychologicalproblems. This handbook is the first clinically oriented textdedicated to the evaluation and treatment of insomnia.

Reducing intraocularpressure (IOP)slows the progressionof glaucoma-or does it? Until recently,no evidence from arandomized controlled trialsupported the practice oftreating elevated IOP withdrug therapy or surgery.

ROCHESTER, N.Y. -- Childhood obesity remained a focus of pediatrics during the year, along with concerns about safety, particularly the safety of psychiatric medications.

NEW YORK -- The ban on trans fats in this city was the highest profile event during the year in diet and nutrition, as Americans continued to struggle against ever-expanding waistlines and foods deemed unhealthy.

WASHINGTON -- Senator Tim Johnson, a Democrat from South Dakota, was taken to George Washington University today with a possible stroke, his office said. If Johnson, who will be 60 this month, should be incapacitated and unable to serve, it would throw into question the Democrats? takeover of the Senate by a 51 to 49 majority, scheduled for next month. The governor of South Dakota, who would appoint a new senator, is a Republican. Johnson became disoriented while speaking to reporters around noon. After Johnson walked back to his office, he did not feel well, and he was examined by the Capitol physician, who recommended hospitalization.

WASHINGTON -- Senator Tim Johnson, a Democrat from South Dakota, was taken to George Washington University today with a possible stroke, his office said. If Johnson, who will be 60 this month, should be incapacitated and unable to serve, it would throw into question the Democrats? takeover of the Senate by a 51 to 49 majority, scheduled for next month. The governor of South Dakota, who would appoint a new senator, is a Republican. Johnson became disoriented while speaking to reporters around noon. After Johnson walked back to his office, he did not feel well, and he was examined by the Capitol physician, who recommended hospitalization.

ABSTRACT: Painful recurrent ulceration of gingival tissue suggests a secondary intraoral presentation of herpes simplex virus (HSV) infection. Unlike the lesions of HSV, lesions associated with coxsackievirus do not erupt in the anterior mouth but rather on the soft palate and pharynx. Furthermore, unlike HSV infection, coxsackie infections may recur, because there is considerable viral variation. Patients with atrophic or erythematous candidiasis report burning pain and a metallic taste. The typical patient with benign mucous membrane pemphigoid is a woman older than 50 years; the condition usually involves the attached gingiva around the teeth. The lesions of erythema multiforme may erupt on any intraoral mucosa; biopsy may be required to rule out other conditions with similar presentations.

The NIH’s National Institute of Mental Health is fundinga $60 million effort to find treatments to counteract HIV’seffects on the human brain.

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

SAN DIEGO, Calif. -- Strattera (atomoxetine) given to children with attention deficit hyperactivity disorder does not appear to stunt growth over the long term, according to a lengthy study.

SAN DIEGO -- Antidepressant medication should be continued for at least six months past the acute stage of major depressive disorder in children and teens, as is done for adults, researchers reported here.

SAN DIEGO -- Preliminary results of a small ongoing study of vitamin B12 injections for children with autism showed no signs of significant benefit, researchers reported here, but they remained hopeful.

SAN DIEGO -- The black box warnings ordered by the FDA on the risk of suicidality with pediatric antidepressant use cut overall prescriptions for children and adolescents by some 10%, researchers said here.

SAN DIEGO -- Although antidepressants may have an effect on fetuses in utero, so may the lack of the drug during pregnancy.

Atlanta -- The CDC recommended last week that HIV testing should become a routine part of office exams for all patients ages 13 to 64, irrespective of risk, without any pretest requirements. MedPage Today would like your opinion on this dramatic change in public health thinking.

Description

56-year-old man presents with substernal chest pain, diaphoresis, and weakness of 1 hour's duration. He had taken a sublingual nitroglycerin tablet that had been prescribed for his wife.

Abnormal uterine bleeding can be defined as bleeding that deviates from the patient's normal pattern; it may be heavier, more frequent, or abnormal in timing. Bleeding of any kind in a postmenopausal patient should be considered abnormal unless she is receiving hormonal therapy that is associated with regular cyclic withdrawal bleeding.

Most pain in or around the oral cavity is attributable to tooth or mucosal pathology. However, tooth or mucosal pain may also be caused by a variety of other conditions, including brain pathology; vascular inflammatory and cardiac disease; jaw infection or neoplasm; neuropathic abnormality not associated with central pathology; pathology in the neck and thoracic region; myofascial and temporomandibular joint pathology; and disease of the ear, eye, or nose, or of the paranasal sinuses, lymph nodes, and salivary glands. Accurate diagnosis is facilitated when the features of pain presentation in this region are understood.

ABSTRACT: A number of nondental conditions may cause significant oral pain. Pain associated with temporal arteritis is localized to the maxillary posterior teeth, the maxilla, or the frontal-temple region. This pain is often associated with exquisite tenderness of the scalp and face. The pain of trigeminal neuralgia is typically felt in the anterior maxillary or mandibular anterior teeth; it radiates along the mandible toward or into the ear on the ipsilateral side of the trigger. Pain may remit for months or years but is often severe when it recurs. Burning mouth syndrome preferentially affects postmenopausal women older than 50 years; one half to two thirds of patients experience spontaneous remission within 6 to 7 years, with or without treatment. The pain of postherpetic neuralgia is unilateral and restricted to the affected dermatome; it may be aggravated by mechanical contact or chewing.

While working in her garden in Virginia, a 40-year-old woman felt a sudden, sharp pain between the fingers of her right h and saw blood coming from an open wound. Immediately, she experienced a burning sensation at the site and noticed numbness and swelling in the hand. The patient was rushed to the emergency department.

A 53-year-old man with type 2 diabetes mellitus and hypertension presented to the emergency department with pain in his left upper chest and back, neck, and shoulder. The pain increased with passive and active range of motion testing and decreased at rest. His physical examination was unremarkable except for restricted left shoulder movement and generalized tenderness in the left shoulder area.

An 86-year-old woman had noted intermittent, transient “shading” and “hazing” of the vision in her right eye. Her best corrected vision in that eye was 20/20. She had pseudophakia from past cataract surgery.

ABSTRACT: Serum levels of aspartate aminotransferase and alanine aminotransferase that exceed 1000 IU/L indicate acute viral hepatitis (A, B and, rarely, C), acute drug toxicity (eg, acetaminophen overdose or isoniazid hepatotoxicity), or ischemic liver injury. In chronic hepatitis (ie, hepatitis B or C or autoimmune), values range from mildly elevated to usually less than 400 IU/L. Elevated levels of alkaline phosphatase and gamma;-glutamyltransferase (GGT) are consistent with cholestatic disease: primary biliary cirrhosis, primary sclerosing cholangitis, idiosyncratic drug reactions, or mechanical biliary obstruction (eg, biliary stones or tumor). Elevation in the GGT level can also be induced by alcohol consumption or medications (eg, phenytoin). Isolated unconjugated hyperbilirubinemia suggests Gilbert syndrome or a hematologic disorder; conjugated hyperbilirubinemia reflects impaired hepatic excretion. Serum bilirubin and albumin and INR have prognostic significance in chronic liver disease; bilirubin and INR are more useful in acute liver failure because albumin has a long half-life.

Glaucoma isthe leadingcause ofblindness inthe UnitedStates.1Nearly 3 millionpersons have the disease,and about 100,000 newcases are diagnosed eachyear.1 Between 3 and 6 millionAmericans are thoughtto be at increased risk forglaucoma because of elevatedintraocular pressure(IOP).2

A 75-year-old woman complained of“tired and heavy eyes” and being unableto keep her eyelids open to readat night.

Over the years, a 78-year-old man hadnoticed a progressive drooping of theright upper eyelid, which finally occludedhis right pupil and obstructedhis vision. Although the droopingworsened as the day went on, the ptosiswas evident even when the patientawoke in the morning. He denied anyophthalmic or periocular surgery ortrauma. He was otherwise healthy andhad no other neurologic complaints.