Benzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of "scope" procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.
A 38-year-old man presented to the emergency department after experiencing the sudden onset of right upper extremity numbness, heaviness, and loss of coordination, which resolved after 20 minutes. He had 2 similar episodes 19 years and 11 years earlier. Diagnostic evaluation (including MRI of the brain, carotid Doppler ultrasonography, and echocardiography) at the time of the second episode was unrevealing.
ABSTRACT: Many patients with diabetes are anxious or fearful about the disease. These negative emotions stem in part from the fact that the patient is responsible for many facets of diabetes management, such as exercise, dietary modification, and blood glucose measurement. For example, failure to adhere to a regimen may engender guilt. Up to 30% of patients with diabetes are depressed, and hemoglobin A1c levels are higher in such patients. Even patients with good metabolic control may not be doing well psychologically. It is thus essential to ask about patients' concerns and fears, identify their psychosocial needs, and provide emotional support.
Methicillin-resistant Staphylococcus aureus (MRSA) became a "bug" to be reckoned with nearly 50 years ago. At that time, however, it targeted only patients who were exposed to infection in the hospital.In recent years, the epidemiology of MRSA has significantly changed. The pathogen is now a major culprit in community-acquired infections.
ABSTRACT: In addition to appropriate pharmacotherapy and assistance with smoking cessation, a secondary prevention plan should include counseling about a heart-healthy diet, a structured exercise program and/or increased physical activity, and assessment of psychosocial risk factors, such as depression. Advise patients to reduce their intake of salt, sugars, refined carbohydrates, and saturated and trans fats; incorporate more fruits, vegetables, and fish into their diet; and balance caloric intake and physical activity to achieve and maintain a body mass index between 18.5 and 24.9 kg/m2. Cardiorespiratory fitness is the key to cardioprotection; the threshold for improving it in persons with coronary heart disease is about 70% of the mea-sured maximal heart rate. Encourage patients to engage in multiple short bouts of physical activity daily, such as taking the stairs instead of the elevator or walking the dog. Among previously sedentary persons, this approach has effects on cardiorespiratory fitness, body composition, and coronary risk factors similar to those of a structured exercise program.
A 57-year-old man requests an extensive medical evaluation as part of a transition in the ownership of his business. He is generally healthy, although he reports that his capacity for physical exertion has diminished over the past several years. He denies chest pain with effort, dyspnea at night or on exertion, cough, and sputum production.
ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.
ABSTRACT: Prevention of skin cancer requires photoprotection (eg, the use of a sunscreen with both UVB and UVA protection) and regular monitoring of the skin for suspicious lesions. Encourage patients to examine all areas of their skin, including the interdigital and genital regions, for unusual macules, papules, and nodules. Teach patients the "ABCDE" warning signs of melanoma (asymmetry, border irregularity, color variegation, diameter greater than 0.5 cm, evolving lesion). Office skin examinations are recommended for patients with risk factors for skin cancer and for those with obvious sun damage. Correct lighting, preferably daylight, and cross-illumination are crucial. Palpation may be helpful in detecting lesions such as actinic keratoses, which have a gritty, sandpaper-like surface.
This lesion had erupted on the back of an elderly man with diabetes mellitus. The inflammatory process involved contiguous follicles with pus evident at several openings.
Everyone knows the trick of pressing with the diaphragm of a stethoscope to locate the tenderness in a child with abdominal pain, without him or her being aware of your "palpation." To further alleviate the child's anxiety and distract him, invite him to listen through the stethoscope while you move it around his abdomen.
Two days after "heading" a soccer ball, a 17-year-old boy presented to the emergency department with progressive pain and a foreign-body sensation in his left eye. Visual acuity was 20/20 in the right eye and 20/25 in the left eye. The pupils were equally round and reactive; full extraocular movements of both eyes were noted. The left eye had conjunctival injection and a 1-mm foreign body on the medial cornea with a surrounding halo of discoloration--typical of a metallic corneal foreign body. A Seidel test (which demonstrates streaming of fluorescein dye from the aqueous humor when illuminated with UV light) revealed no evidence of corneal perforation; there were noareas of fluorescein dye uptake.
Generalized muscle weakness, ataxic gait, and numbness and tingling in her hands and feet prompted a 45-year-old woman with a history of heavy alcohol abuse to seek medical attention. Atrophic glossitis and decreased sensation to light, touch, and vibration of the distal extremities were noted.
The lesion is a hypertrophied papilla--an enlarged teat-like structure that may develop in an anal crypt. Treatment options include surgical excision, electrodesiccation, or cryotherapy.
While playing on a brick walkway in her backyard, a 4-year-old girl stepped on a puss caterpillar and was stung. The ecchymosis exactly outlined the caterpillar's spines and remained visible for at least 3 months. The initial sting caused intense pain that lasted for more than an hour.
A 53-year-old perimenopausal woman presented to the emergency department with throbbing lower abdominal pain and distention. The pain started 5 days earlier and worsened with sitting and walking; she also experienced increasing dyspnea. She had noticed increasing abdominal girth about 5 months earlier. Since then, she had gained 5 to 10 lb, despite dieting. The patient reported a 22-pack-year history of smoking but no alcohol use. She was taking over-the-counter painkillers and allergy medications. Her family history was notable for a brother who died of laryngeal cancer.
Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.
Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.
CLEVELAND -- Infliximab (Remicade) showed no efficacy against two related rheumatic diseases, according to researchers here and in Italy.
BELMONT, Mass. -- Exercise-associated hyponatremia, a potentially fatal condition of endurance athletes, may be brought on by suppression of renal water excretion exacerbated by too much fluid intake, reported Boston Marathon doctors.
BOSTON -- Mice with induced brain atrophy that were exposed to new toys and new pals in an "enriched environment" were able to build new pathways to faded memories, said researchers here.