A 32-year-old man complains ofknee pain that resulted when he felland twisted his right knee skiing theday before. He suffered other minorcontusions from the fall, but none ofthese required medical attention. Heis otherwise in good health and hasno relevant medical history.
Bowman MA, Baxt WG (eds)OFFICE EMERGENCIESPhiladelphia, WB Saunders Company, 2003, 416 pages,softcover $34.95
Quinolones are commonlyused to treat a widevariety of infectious diseases,such as community-acquired pneumoniaand urinary tract infections. Somequinolones are also given as prophylaxisfor spontaneous bacterial peritonitis.These popular antimicrobial agents areassociated with several clinically significantdrug interactions, which can beclassified into 2 major categories1-3:
Q:Under what circumstances is 24-hour ambulatoryblood pressure monitoring (ABPM) appropriate?
For several days, a 35-year-old woman has had a swollen, painfulfinger. She is otherwise healthy and has no significant medical history.
For 3 months, a 41-year-old womanhas had a pruritic acneiform eruptionon the lateral aspects of the neck andthe left side of the face. She is otherwisehealthy and takes no medication.
Q:Do evidence-based data support combination therapy with anangiotensin-converting enzyme (ACE) inhibitor and an angiotensin IIreceptor blocker (ARB)?
Your middle-aged patientwith type 2 diabetes wishesto start a weight-trainingprogram. What recommendationswill you offerhim? Another diabetic patient hasperipheral neuropathy; which exercisesare safest for her?
A 32-year-old man complains oflong-standing low back discomfortthat has worsened to frank pain overthe past month. He denies fever, trauma,and excessive physical activity. Hismedical history is noncontributory.
An 83-year-old woman is hospitalized for treatment of deep venous thrombosisin her left leg. She underwent left hip replacement surgery 2 months earlier.At that time, mild anemia (hemoglobin level, 10 g/dL) was noted, and iron therapywas initiated. An iron panel obtained shortly after the hip surgery revealeda serum iron level of 80 μg/dL, a transferrin level of 360 mg/dL, and a ferritinlevel of 50 ng/mL.
Issues of when and whom to screen for various diseases and conditions have longbeen sources of controversy. The amount of information about screening tests canbe overwhelming, and the costs of the latest preventive technology can be daunting.To provide an evidence base for decision making in one source for busy clinicians,Dr Snow has compiled key previously published reviews of the data behind the latestUS Preventive Services Task Force (USPSTF) screening recommendations fortype 2 diabetes, postmenopausal osteoporosis, breast cancer, colorectal cancer, andprostate cancer. Also included are reviews of the evidence concerning chemoprophylaxisof cardiovascular disease (with aspirin and with hormone replacementtherapy) as well as reviews of the latest data on screening for hypertension and depression,which were specially commissioned for this volume. The reviews containguidelines on which patients to screen and address the issue of screening frequency-in terms of both optimum patient care and maximum cost-effectiveness. Inaddition, a list of key points that summarize important “take-home” messages precedeeach review. The book also contains a valuable introduction (“How to ThinkAbout Screening” by David M. Eddy, MD, PhD) and a concise guide to 25 preventiveservices.
A 51-year-old woman has had a progressiverash on the trunk, proximalarms, and legs for 2 weeks, followingthe latest round of chemotherapy forbreast cancer. Around the time thatthe rash erupted, she was also takinglevofloxacin for a productive cough.Cutaneous lupus erythematosus wasdiagnosed years ago, but she hasbeen disease-free for the past 5 years.Chemotherapy is being withheldpending diagnosis of the rash.
For the past 3 days, a 45-year-old man has had discomfort andloss of hearing in one ear. There is no fever or history of trauma. The manwas recently treated for an ear infection at a local clinic. Physical examinationreveals erythema of the postauricular area and purulent exudate from the earcanal.
When patients cite muscle pain anddiscomfort as an excuse for not exercisingregularly, suggest they try anapproach that athletes use.
The FDA has approved the use ofan estradiol transdermal system(Menostar), from Berlex LaboratoriesInc., to prevent osteoporosis in postmenopausalwomen. The hormoneis impregnated in a dime-sized, once a-week patch that delivers 14 μg/d ofestradiol: this dosage is half that ofother currently available transdermalestrogen patches. No supplementaryprogestin therapy is generally needed.This product can be prescribed for women who are without a uterus.The most common side effects areirritation at the patch site, joint pain,and leukorrhea.
Among American children,acute otitis media(AOM) is the most commonbacterial infectiontreated with antibiotics.Rising rates of antibacterial resistancecoupled with the increasingcost of antibiotics have focused attentionon the need to prescribethese agents judiciously. Recently,the American Academy of Pediatricsissued recommendations on the diagnosisand management of uncomplicatedAOM in children aged 2months to 12 years.1 These guidelinesapply only to otherwise healthychildren who have no underlyingconditions that may alter the naturalcourse of AOM, such as cleft palate,Down syndrome, immunodeficiencies,or the presence of cochlear implants.Also excluded are childrenwho have recurrent AOM or AOMwith underlying chronic otitis mediawith effusion (OME). Highlights ofthe guidelines are presented here.
Trospium chloride (Sanctura) recentlybecame available for the treatmentof overactive bladder and urge urinaryincontinence. This drug, fromIndevus Pharmaceuticals, is a muscarinicreceptor antagonist that relaxesthe smooth muscle tissue of thebladder, thereby decreasing contractionsand counteracting overactive orunstable detrusor muscle function.
The authors of the book’s 51 chapters are clinicians and scientists from some ofthe world’s leading centers of AD research. Topics covered include the basic biology of AD, prevention strategies, early changes and preclinical conditions, typical patient presentations, state-of-the-art therapy and emerging therapeutic strategies, treatment of common comorbidities, late-life issues, and guidance onhow to help caregivers cope with feelings of isolation and despair.
Patients with COPD are at greater risk for osteopeniaand osteoporosis than persons who do not haveCOPD. Studies have reported osteopenia in 35% to 72%and osteoporosis in 36% to 60% of patients with COPD.1,2
Lately I have heard that "tissue ACE" properties are important in endothelial remodelingand in the prevention of myocardial infarction and stroke.
