These joint deformities occurred in a 61-year-old man with chronic tophaceous gout. The patient had had joint pain and swelling since he was 40 years old; the symptoms began in 2 fingers and were initially mild. He did not seek medical attention. Within 5 to 10 years, joint abnormalities had developed in the fingers and then in the left elbow and right ankle. The toes were not affected. He had no family history of joint pain or swelling. Serum uric acid level was 9.7 mg/dL.
For several months, a 45-year-old woman had ocular irritation, tearing, blurred vision, and swelling of the eyelids in both eyes. During that time, she had been treated for allergic conjunctivitis and blepharitis by several physicians, including an ophthalmologist. Her medical history included lupus and seasonal allergies, for which she was taking hydroxychloroquine and loratadine.
Benign prostatic hyperplasia (BPH)-histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate-affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.
Patients frequently present with symptoms they describe as “carpal tunnel syndrome.” When a patient complains of this syndrome, I often use a modified paper clip to test 2-point discrimination in all digits.
Penicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4
It is with great pleasure that we welcome Dr Kaplan to our Editorial Board. His commitment to teaching primary care medicine makes him well qualified to serve as one of our key advisors.
An 89-year-old woman is seen because of a white area on the tongue. She has been hospitalized on a behavioral health unit for 2 weeks; 1 day ago, enoxaparin was begun for a new left leg deep venous thrombosis. Recent antibiotic therapy for a urinary tract infection; candidal vulvitis followed and was treated with topical clotrimazole. Has penicillin allergy.
Hypertension affects approximately 73.6 million persons in the United States or one-third of the adult population. This is an increase from 72 million persons in 2007, 65 million persons in 2002, and 50 million US adults in 1994 (or one-third, 29%, and 25% of the adult population, respectively).
Despite clear evidence of its benefits, widespread adoption of electronic prescribing (ePrescribing) has been slow. The vast majority of prescriptions are still written by hand, a process plagued with errors and inefficiencies. The Southeast Michigan ePrescribing Initiative (SEMI), a collaborative effort of employers, health plans, physician groups, and others, was launched in 2005 to speed the adoption of ePrescribing. SEMI has accomplished much in 4 years, enrolling more than 3000 physicians who have transmitted nearly 9.5 million electronic prescriptions while improving patient safety and winning over physicians. (Drug Benefit Trends. 2009;21:23-26)
Influenza develops in about 20% of the global population each year. In the United States, annual influenza epidemics typically occur between late December and early March. While influenza may affect persons of any age, infection rates are highest among children.
Former Senate Majority Leader Thomas A. Daschle (D, SD) will become the nation’s health care policy czar with enormous influence on health care policy and reform. In addition to being named secretary of the vast 65,000-employee Department of Health & Human Services (HHS)-home of the FDA, the Centers for Medicare & Medicaid Services (CMS), and the NIH-
Most US adults still rely on word-of-mouth and physician recommendations when selecting health care providers despite an increase in health care price and quality transparency initiatives, according to findings of a study by the Center for Studying Health System Change (HSC) released on December 4. HSC interviewed 13,500 adults for its nationally representative 2007 Health Tracking Household Survey. The study was funded by the California HealthCare Foundation.
Generic drug utilization has reached its highest levels to date-60.4% for retail prescriptions and 49.3% for mail-service prescriptions (Cover Figure), while pharmacy reimbursement continues its downward trend.
One year after the Academy of Managed Care Pharmacy (AMCP) was founded in 1988, the first issue of Drug Benefit Trends was published. The past 20 years have seen the evolution of managed care from infancy to, well, young adulthood-established but still changing. By showcasing innovative research and ideas on drug benefit design and delivery, DBT has long supported the mission of AMCP: “AMCP’s mission is to empower its members to serve society by using sound medication management principles and strategies to improve health care for all.”
What are the most effective ways to reduce the incidence of acute exacerbations of chronic obstructive pulmonary disease (COPD)?
p>Drug-induced lung disease (DILD) can be caused by a variety of agents, including chemotherapeutic drugs, antiarrhythmic agents, antibiotics, and NSAIDs. The clinical syndromes associated with DILD include alveolar hypoventilation, acute bronchospasm, organizing pneumonia, and hypersensitivity reactions. Amiodarone lung toxicity often manifests as a chronic fibrosing alveolitis, characterized by an insidious onset of cough, dyspnea, and weight loss. Important components of the workup include chest radiography, pulmonary function testing, and bronchoscopy with bronchoalveolar lavage (BAL). BAL is particularly helpful in identifying eosinophilic pneumonia and diffuse alveolar hemorrhage and in ruling out infectious causes. Management includes drug withdrawal and, in some cases, corticosteroid therapy. Before starting corticosteroids, it is important to rule out infectious causes of lung disease, particularly in patients receiving chemotherapy. (J Respir Dis. 2009;30(1))
The population of elderly nursing home residents who have dementia has been steadily increasing. It is not unusual to be called early in these patients’ course, day or night, and be asked to prescribe something for agitation-triggered by strange new surroundings and people. Nearly 1 in 5 new nursing home residents receives an antipsychotic drug within 100 days of arrival.1 Does this “typical” practice have a downside?
Although gout has been recognized since ancient times, its management remains challenging. In a previous article (CONSULTANT, December 2008, page 1010), I focused on diagnosis; here I discuss how the treatment approaches for an acute flare and for chronic gout differ, and I compare the safety and efficacy of available therapies.
These firm papules, a classic sign of sarcoidosis, are seen around the eyes of a 27-year-old woman (A) and the external ear of a 33-year-old woman (B).
For several months, a 59-year-old woman has had numerous asymptomatic lesions on her arms and legs. During this period, she has not been exposed to the sun and has taken no new medications.
