A previously healthy 56-year-old woman presented to her primary care physician with progressive dyspnea and pleuritic chest pain. She was afebrile and had a heart rate of 83 beats per minute, blood pressure of 104/70 mm Hg, and respiration rate of 20 breaths per minute. Her oxygen saturation was 87% on room air and 92% while receiving 3 L of oxygen via nasal cannulae.
Abstract: Because of recent advances, more patients may potentially benefit from a variety of interventional bronchoscopic techniques. Nd:YAG laser phototherapy is the most widely used modality and is the treatment of choice for patients with endobronchial malignancies who have large-central airway obstruction. Cryotherapy may be superior to Nd:YAG phototherapy for more distal airways lesions because of the lower risk of airway perforation, but it may be suboptimal for bulky airways disease that requires quick relief of obstruction. Brachytherapy relieves symptoms, such as cough, dyspnea, and hemoptysis, in many patients who have locally invasive airway malignancies. Endobronchial ultrasonography appears to be a safe and sensitive method for staging lung cancer. In select patients with emphysema, a 1-way endobronchial valve can be used to reduce lung volumes. Bronchial thermoplasty is being studied as a potential treatment for asthma. (J Respir Dis. 2006;27(10):415-428)
A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.
A 29-year-old man presents with a recent episode of light-headedness of sudden onset. Although he denies associated loss of consciousness, witnesses report that he was briefly unresponsive to verbal stimuli. He also denies chest pain, dyspnea, palpitations, and diaphoresis; he is currently asymptomatic.
An 89-year-old woman, who has long lived on the special care (dementia) unit of a nursing home because of advanced Alzheimer disease, is seen to assess possible injuries after a fall. Many prior falls have been ascribed to her lack of safety awareness in negotiating the environment, rather than to neuromuscular, sensory, or cerebellar deficits.
ANN ARBOR, Mich. -- Natrecor (nesiritide) is associated with a significant increase in early mortality in patients with acute decompensated heart failure, even when the drug is used at recommended doses, according to investigators here.
NASHVILLE, Tenn. -- Many patients haven't a clue about the meaning of the dietary information in food labels, researchers here reported.
SUITA CITY, Japan -- Heart failure patients who added 30 mg of Pepcid (famotidine) to standard therapy significantly improved NYHA functional class and reduced plasma B-type natriuretic peptide levels compared with those given 150 mg of teprenone.
NEW YORK -- The Environmental Protection Agency's new emission standards for soot have drawn scorn from medical societies and public health advocacy groups that predict dire cardiovascular and pulmonary fallout.
COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.
COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.
My patient has diabetes, end-stage renal disease, and congestive heart failure (CHF)--and does not want to use insulin. What oral medication(s) would be considered optimal in this setting?
A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL. A trial of fluids does not lower the creatinine level. Renal ultrasonography shows no obstruction but reveals increased kidney size (left, 11.4 3 4.4 3 5.0 cm; right, 10.1 3 4.6 3 4.5 cm) with increased diffuse echogenicity.
In patients with diabetes who have end-stage renal disease and CHF, the choice of oral medications is limited because metformin is contraindicated. Glipizide has a 5% renal clearance and is relatively safe. Studies suggest that glimepiride is the safest of the sulfonylureas.
A 62-year-old previously healthy man is admitted for right upper quadrant pain; a workup reveals acute cholecystitis as the cause. During evaluation for surgery, his creatinine level is found to be 6.0 mg/dL; 1 year earlier it was 1.0 mg/dL.
NEWCASTLE, Australia -- A pair of meta-analyses has offered yet more evidence that Vioxx (rofecoxib) was the bad actor of the Cox-2 class of pain-killers. And there are new safety concerns about diclofenac, an older nonsteroidal anti-inflammatory drug.
NEWCASTLE, Australia -- A pair of meta-analyses has offered yet more evidence that Vioxx (rofecoxib) was the bad actor of the Cox-2 class of pain-killers. And there are new safety concerns about diclofenac, an older nonsteroidal anti-inflammatory drug.
MONTREAL -- A coronary artery calcium score, obtained via CT, can accurately predict the development of atherosclerotic and ischemic disease in asymptomatic patients with type 2 diabetes, according to a report at the American Society of Nuclear cardiology meeting here.
MEMPHIS, Tenn. -- For children with high-risk medulloblastoma, an aggressive approach can boost five-year survival to about 70% from the current 55%, researchers here reported.
ROCKVILLE, Md. -- The FDA has approved a fully implantable mechanical heart, but has limited the use to a subset of heart failure patients unlikely to live for more than a month without the device.
FRESNO, Calif. -- Pumping up the statin dose may decrease the risk for cardiovascular events in patients with coronary disease and metabolic syndrome.
BARCELONA, Spain -- Acenon (perindopril) plus a diuretic was not a winning combination for reducing heart failure deaths, but it may ease symptoms and improve exercise capacity, according to a trial reported here.
The patient was a 40-year-old African American woman, with no significant past medical history, who presented to our medical center with a 4-week history of shortness of breath and lower extremity edema. The onset was progressive and initially occurred only with moderate exertion until about 2 weeks before presentation; at that time, her symptoms had worsened to the point where she experienced shortness of breath at rest. Orthopnea also developed at this time. The patient also reported intermittent palpitations, wheezing, and a dry cough of unknown duration.
ABSTRACT: Subclinical hypothyroidism is associated with elevated low-density lipoprotein (LDL) cholesterol levels and several factors related to atherosclerosis, including increased C-reactive protein levels and impaired endothelium-dependent vasodilatation. However, considerable controversy exists about screening for and treating this thyroid disorder. Thyroxine therapy lowers elevated LDL cholesterol levels in patients whose serum thyroid-stimulating hormone (TSH) concentrations are higher than 10 mIU/L ; thus, most experts recommend treatment for such patients. However, there is no consensus regarding the management of patients with TSH levels of less than 10 mIU/L. Although the evidence supporting treatment of these patients is not compelling, it is reasonable to offer a therapeutic trial of thyroxine to those who have symptoms.
Five days after starting aspirin and warfarin with an enoxaparin bridge for new-onset atrial fibrillation, a 92-year-old man presented with abdominal pain, nausea, and vomiting. The patient appeared ill and was tachycardic. He had dry mucous membranes; pale sclerae; diminished bowel sounds; and a large, tender left lower abdominal mass. Hematocrit was 22% (baseline, 39%); hemoglobin, 6.8 g/dL; blood urea nitrogen, 65 mg/dL; and creatinine, 3.2 mg/dL (baseline, 1.3 mg/dL). His "pre-renal" ratio was 20. These findings were consistent with bleeding and acute renal failure. He also had a supratherapeutic international normalized ratio (INR) of 4.1.
