July 16th 2025
ENDO 2025. People with inconsistent access to GLP-1 medications still achieved clinically significant weight loss when therapy was combined with lifestyle changes and coaching.
Autosomal Dominant Polycystic Kidney Disease in a 30-Year-Old Man
August 2nd 2004A 30-year-old man presentedwith severe left flankpain radiating to his abdomenand gross hematuriaof 5 to 10 days’ duration.He also reported a 4- to 6-monthhistory of nausea with intermittentvomiting, anorexia, and progressiveweight loss. He took no medicationsand had no allergies.
Food-Borne Illnesses: A Primary Care Primer
August 1st 2004Backyard cookouts . . . picnics at the beach . . . these warm-weather pleasures can heighten your patients' risk of exposure to food-borne pathogens. An egg salad sandwich, left in the hot sun too long, can become a breeding ground for Salmonella, and undercooked burgers can harbor Escherichia coli O157:H7.
Case In Point: Hyperthyroidism: 5 Cases to Hone Your Diagnostic Skills
July 1st 2004A 32-year-old woman presents with weight loss of 6.4 kg (14 lb) during the past 8 months and diarrhea of recentonset. Menstruation had ceased 10 weeks earlier. She appears anxious, with pressured speech. Physical examination detectsbaseline sinus tachycardia, sweaty palms, and a diffusely enlarged thyroid gland. Laboratory tests reveal a thyroid-stimulatinghormone (TSH) level of 0.00 µU/mL (normal, 0.45 to 4.5 µU/mL), a free thyroxine (FT4) level of 4.8 ng/dL (normal,0.61 to 1.76 ng/dL), and a positive thyroid-stimulating immunoglobulin (TSI) level with high titer.
Images of Hyperthyroidism: Pretibial Myxedema
July 1st 2004Swelling of the lower legs broughtthis 57-year-old woman to a familypractice clinic. She had a history ofhyperthyroidism with weight loss,tachycardia, and anxiety. This conditionwas confirmed with blood testsand radioactive iodine uptake testing.
Graves Disease with Exopthalmos and Pretibial Myexdema
July 1st 2004This 17-year-old presented with a 1-month history of weight loss, increased appetite, mild insomnia, hand tremor, palpitations, sweating, heat intolerance, and quick loss of temper. The number of daily bowel movements had increased from 1 to 2. There was no family history of thyroid disorders.
Diving Medicine: Questions Physicians Often Ask, Part 1
June 1st 2004Recreational diving continues to increase in popularity; as many as 15 million Americans are certified scuba divers. Although a few serious and possibly life-threatening conditions require recompression treatment, most diving injuries are uncomplicated and can be managed by the primary care physician. In this article, we address the questions most often asked about fitness and safety issues. In a future article, we will review the principal medical problems associated with sport diving.
Helping Cancer Survivors Make Informed Choices About Diet and Exercise: Recommendations From the ACS
June 1st 2004Many of the 9.5 million cancer survivors in the United States seek advice about food, physical activity, dietary supplements, and complementary nutritional therapies. Recently, the American Cancer Society (ACS) issued a guide that provides clinicians with information that can help these patients make informed choices.1 Highlights of the report follow.
Matters of the Heart: Aortitis
May 2nd 2004An obese 61-year-old man who hadchronic obstructive pulmonary diseaseand sleep apnea heard a “pop”in his stomach while lifting a heavyweight; severe abdominal pain followed.He was short of breath thenext morning, and his physician empiricallyprescribed cephalexin.
Woman With Celiac Sprue and Primary Immunodeficiency
March 2nd 2004A 34-year-old white woman presentswith a 4-month history of diarrhea,with bulky, foul-smelling stools; flatulence;diffuse abdominal discomfort;and episodic nausea and vomiting. Shehas lost 13.5 kg (30 lb) during this period.The patient has had no fever, andher medical, family, and travel historyare unremarkable.
Hypertensive Emergencies and Urgencies:
March 1st 2004To distinguish between hypertensive emergencies and urgencies and nonurgent acute blood pressure elevation, evaluate the patient for evidence of target organ damage. Perform a neurologic examination that includes an assessment of mental status; any changes suggest hypertensive encephalopathy. Funduscopy can detect papilledema, hemorrhages, and exudates; an ECG can reveal evidence of cardiac ischemia. Order urinalysis and measure serum creatinine level to evaluate for kidney disease. The possible causes of a hypertensive emergency include essential hypertension; renal parenchymal or renovascular disease; use of various illegal, prescription, or OTC drugs; CNS disorders; preeclampsia or eclampsia; and endocrine disorders. A hypertensive emergency requires immediate blood pressure reduction (although not necessarily to the reference range) with parenteral antibiotics. An urgency is treated with combination oral antihypertensive therapy.
Fibromyalgia Syndrome: Can It Be Treated?
February 1st 2004Treatment of fibromyalgia syndrome (FMS) is a challenge. However, most patients benefit from appropriate management. Essential to treatment are a physician's positive and empathetic attitude, continuous psychological support, patient education, patience, and a willingness to guide patients to do their part in management. Other important aspects involve addressing aggravating factors (eg, poor sleep, physical deconditioning, emotional distress) and employing various nonpharmacologic modalities (eg, regular physical exercise) and pharmacologic therapies. Drug treatment includes use of tricyclic medications alone or in combination with a selective serotonin reuptake inhibitor, and other centrally acting medications. Tender point injection is useful. It is important to individualize treatment. Management of FMS is both a science and an art.
A Woman With a Big Bump in the Mouth
January 2nd 2004A 67-year-old Hispanic woman is seen for routine physical examination. Has mild hypertension but no other known medical problems. Feels well. No weight loss. No reported difficulty with eating, speaking, or swallowing. Denies any discomfiture in the mouth. States that nothing has changed in her mouth “ever since I lost my baby teeth.” Does not smoke cigarettes nor drink alcohol.
Peripheral Arterial Disease: Tips on Diagnosis and Management
January 1st 2004Signs and symptoms that strongly suggest peripheral arterial occlusive disease include diminished or absent pedal pulses, a unilaterally cool limb, and atrophic skin that is shiny and hairless. An ankle-brachial index of less than 0.5 suggests multisegment disease. Management goals are to decrease functional impairment, treat underlying atherosclerosis, and control risk factors. Smoking cessation is imperative. A graduated walking program is a mainstay of treatment and is associated with greater improvement in pain-free walking than is drug therapy. Surgery and percutaneous intervention are generally reserved for patients with lifestyle-limiting claudication, ischemic pain at rest, tissue loss, or gangrene.
Chronic Pain Control: What's Adequate- and Appropriate?
November 1st 2003ABSTRACT: The results of diagnostic tests do not correlate well with the presence and severity of pain. To avoid missing a serious underlying condition, look for "red flags," such as unexplained weight loss or acute bladder or bowel function changes in a patient with low back pain. Nonopioid medications can be more effective than opioids for certain types of pain (for example, antidepressants or anticonvulsants for neuropathic pain). When NSAIDs are indicated, cyclooxygenase-2 inhibitors are better choices for patients who are at risk for GI problems or who are receiving anticoagulants. However, if nonspecific NSAIDs are not contraindicated, consider using these far less expensive agents. The tricyclic antidepressants are more effective as analgesics than selective serotonin reuptake inhibitors. When opioids are indicated, start with less potent agents (tramadol, codeine, oxycodone, hydrocodone) and then progress to stronger ones (hydromorphone, fentanyl, methadone, morphine) if needed.
Hypertension in African Americans:
September 15th 2003Uncontrolled hypertension is a major health problem among African Americans. Obesity, high sodium and low potassium intake, and inadequate physical activity have been identified as barriers to cardiovascular health in many African Americans. Thus, it is important to educate and counsel patients about lifestyle modifications, such as a low-sodium, DASH (Dietary Approaches to Stop Hypertension)-type diet; regular aerobic exercise; moderation of alcohol consumption; and smoking cessation. All classes of antihypertensive agents lower blood pressure in African Americans, although some may be less effective than others when used as monotherapy. Most patients require combination therapy. Both patient barriers (such as lack of access to health care and perceptions about health and the need for therapy) and physician barriers (such as poor communication styles) contribute to the low rates of hypertension control in African Americans. Patient-centered communication strategies can help overcome these barriers and can improve compliance and outcomes. Such strategies include the use of open-ended questions, active listening, patient education and counseling, and encouragement of patient participation in decision making.