Excess weight increases the risk of having a heart attack, stroke, high blood pressure, arthritis, diabetes, depression, fatigue, and certain types of cancer. Losing weight and keeping it off are very difficult for most persons who are overweight. Here are some suggestions to help you lose pounds and keep your weight down.
A 49-year-old man presents for a routine examination. He has a 15-year history of essential hypertension and a 7-year history of hypercholesterolemia and type 2 diabetes mellitus.
A 49-year-old man presents for a routineexamination. He has a 15-yearhistory of essential hypertension anda 7-year history of hypercholesterolemiaand type 2 diabetes mellitus.The patient has lost 7.5 lb in the past3 months. The physical examinationis remarkable for a blood pressure(BP) of 168/94 mm Hg and a palpablemidline epigastric mass that isnontender, firm, and immobile.
A 64-year-old man has experienced melena 4 or 5 times in the previous24 hours. He has had no emesis but complains of moderate epigastric pain.He has had similar-although milder-pain in recent weeks.
A 52-year-old man with hypertension and hyperlipidemia presents to the emergency department with a 5-month history of cough and dyspnea.
22-year-old man is hospitalized because of severe hypertension. In addition, he reports exertional retrosternal pressurelike pain, with a severity of 5/10, that lasts for 2 to 3 minutes.
A 71-year-old man presented with a 6-week history of decreased vision in his right eye. The patient, who had hypertension and migraine headaches, had successfully recovered from a stroke that occurred 1 year earlier. His medications included aspirin, 81 mg/d, clopidogrel, atenolol, and furosemide. He also took gabapentin, 300 mg hs, for his migraine headaches. He had a remote history of cigarette smoking.
A 62-year-old businessman of Japanese descent is brought to the emergencydepartment less than half an hour after he experienced a generalized tonic-clonicseizure during a dinner meeting. His consciousness is markedly diminished(he is incoherent and barely arousable).
An 85-year-old man with a history of hypertension, coronary artery disease, and diabetes mellitus presented with syncope. He had fallen down a flight of stairs and now complained of left shoulder pain
The prevalence of type 2 diabetes is expected to continue to increase rapidly, and it is not surprising that the issue of the potential effects of different classes of antihypertensive drugs on glucose metabolism and glycemic control has sparked debate.
56-year-old man with a history of diabetes mellitus and hypertension presents with chest pain, emesis, pallor, and diaphoresis.
A 54-year-old man with chronic renal insufficiency presented with shortness of breath, nonproductive cough, and chest pain. The patient had hypertension, type 2 diabetes mellitus, and a 30-pack-year history of cigarette smoking. He denied alcohol or illicit drug use and prolonged exposure to asbestos, chemicals, or fumes.
A 57-year-old woman complains of burning and dryness in her left eye and altered sensation in her mouth when eating; these symptoms began the day before. A coworker who had noticed facial asymmetry recommended that she seek medical attention.
Up to 10% of Americans older than 20 years have type 2 diabetes, and more than 20% have the metabolic syndrome. The prevalence of both diseases has risen by 33% over the past decade as a result of an increasingly sedentary lifestyle, the obesity epidemic, the growth of ethnic groups at risk for the disease, and the aging of the population.
For 2 days, a 68-year-old woman had watery, yellowish diarrhea with mucus and left lower quadrant pain. Her medical history included hypertension, diabetes mellitus, and congestive heart failure (CHF); she had left the hospital 5 days earlier following treatment of an exacerbation of CHF with intravenous furosemide and sodium and fluid restriction. The patient was taking furosemide, lisinopril, and glipizide; she denied any recent antibiotic therapy.
For 2 days, a 68-year-old woman had watery, yellowish diarrhea with mucus and left lower quadrant pain. Her medical history included hypertension, diabetes mellitus, and congestive heart failure (CHF); she had left the hospital 5 days earlier following treatment of an exacerbation of CHF with intravenous furosemide and sodium and fluid restriction. The patient was taking furosemide, lisinopril, and glipizide; she denied any recent antibiotic therapy.
A 49-year-old man presented to the emergency department with hematemesis and 2 episodes of melena. Examination findings included resting tachycardia and melenic stool. Blood pressure was 95/50 mm Hg. Multiple raised, soft, bluish 0.3 to 1 cm lesions were noted on the trunk and extremities.
As many as half of patients who are evaluated for abdominal pain do not receive a precise diagnosis. And for about half of those who are given a diagnosis, the diagnosis is wrong. In this article, I will use actual cases (not "textbook" examples) to illustrate an approach to abdominal pain that begins with a careful differential diagnosis. I also offer some general guidelines for evaluating patients.
An 81-year-old man is seen for follow-up of leukocytosis detected during a recent hospitalization for community-acquired pneumonia. The leukocytosis had not resolved by the time he was discharged.
A systematic approach to the patient with resistant hypertension is both cost-effective and rewarding because the evaluation will probably reveal the cause. Initial considerations include lack of adherence, inappropriate treatment, drug-drug interactions, volume overload, and white-coat hypertension.
A 66-year-old woman with a history of coronary artery disease, hypertension, diabetes mellitus, and end-stage renal disease presents to the emergency department 1 week after a coronary artery stent was placed to treat ischemic heart disease.
Each year, about 27 million Americans undergo anesthesia followed by surgery. Roughly 50,000 of these patients have a stress-induced myocardial infarction during the perioperative period.
The metabolic syndrome represents a clustering of conditions and/or risk factors that lead to an increased incidence of type 2 diabetes mellitus and cardiovascular disease. These conditions include abdominal obesity, dyslipidemia, hypertension, insulin resistance, and a proinflammatory state.
In their "What's The 'Take Home'?" case of a pregnant woman with hypertension, Drs Lawrence Kaplan and Ronald Rubin inquire into the most likely cause of the patient's elevated blood pressure. However, this information is not sufficient to make a definitive diagnosis.
An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.
