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.
My patient-an 84-year-old woman with hypertension-presented with itchingand blistering of 3 days’ duration on her right foot (Figure).
Q:Should hypertensive patients be discouraged from participating inmoderate to vigorous exercise?A:On the contrary, most patients with sustained hypertension should bestrongly encouraged to exercise regularly at moderate to vigorous levels.Randomized controlled clinical trials have demonstrated that increasedphysical activity can lower blood pressure (BP) and delay or prevent the developmentof hypertension and thus the need for antihypertensive medication.1In addition, physical activity can help reduce cardiovascular risk factors by improvinglipid profiles and reducing weight and blood glucose levels. In elderlypersons, exercise is associated with improvements in osteoporosis, depression,and physical functioning, as well as an enhanced sense of well-being.
Although topical corticosteroid therapy can be highly effective, such treatment can be costly-especially whenbrand-name products are prescribed for extensive or chronic conditions. Here we describe an economical approachthat does not sacrifice either efficacy or safety.
To stop intractable or recurrent hiccups(those that do not respond tophenothiazines, breathing into a paperbag, or other remedies), use a tonguedepressor, spoon, or similar instrumentto apply gentle, steady, upwardpressure to the uvula and posteriorsoft palate.
Cataracts areone of themost importantcauses ofreversibleblindness in elderly persons.1 A recent report thatpredicts a surge in cataractincidence has heightenedawareness of the importanceof proper timing andtechniques for cataract extraction.The study, authoredby the Eye DiseasesPrevalence ResearchGroup, estimated that thenumber of Americans withcataracts will increase byapproximately 50% in thenext 20 years as the populationages.2 Cataracts werethe leading cause of low vision(less than 20/40 bestcorrected visual acuity inthe better-seeing eye)among whites, blacks, andHispanics.
An area of pigment loss in the skinand surrounding hair is noted on thehead of a 10-year-old boy. Examinationof the vertex of the scalp revealsa nevus encircled by depigmentation.
The FDA has approved injectable Acetadote (acetylcysteine)from Cumberland Pharmaceuticals Incto prevent or lessen liver damage resulting from an overdoseof acetaminophen. According to the FDA, unintentionalacetaminophen overdose is responsible for 100deaths and 56,000 emergency department visits per year.
Patients who don’t speak Englishoften bring a translator to their firstvisit but not to subsequent ones.
This child fell from his bicycle 3 days ago and suffered mild head trauma.He lacerated his forehead and sustained some abrasions and bruises in thesurrounding scalp. His mother now seeks medical care because the child’seyelids have become so swollen that he can hardly open his eyes.
To more easily visualize a largerwoman’s cervix, use a regular orextra-large Graves speculum and askthe patient to relax her knees out tothe sides as much as possible.
Apreviously healthy 22-year-oldHawaiian man presents to theemergency department (ED) of a hospitalin California with a 3-day historyof fever and chills. He has also had aprogressively worsening, persistent,dull aching pain in the right upperquadrant of the abdomen for the pastweek. The pain is localized-with noaggravating or relieving factors-andis not related to meals. The patienthas had no nausea, vomiting, loss ofappetite, jaundice, abdominal distension,cough, chest pain, dyspnea,weight loss, or lymphadenopathy.
Is treatment recommended for high-normalblood pressure (BP)-say, 135/88 mm Hg-ina postmenopausal woman?
We chose to present this case to readersbecause the patient’s neurologicexamination was normal and her presentationthus appeared benign.
A 22-year-old man hashad a swollen tongue for the past2 days. The swelling is not associatedwith trauma, recent illness, or medicationuse. The patient denies dysphagia,drooling, and shortness ofbreath but does have some difficultyin speaking because of the swelling.
My patient occasionally has seminal “leakage” from the penis.
A 32-year-old man recently noticed a dark lesion behind his right knee. The patientdenies trauma and fever and has no other medical problems. Since he started workingfor the parks and recreation department of the state of Florida 18 months ago, hehas spent an increased amount of time outdoors.
After a professional football player died of heatstroke, national attention focusedon heat-related illnesses among athletes. However, many amateur and “weekend”athletes do not fully appreciate the stress that a hot environment places on theirbodies when they exercise. As the popularity of outdoor exercise and sports continuesto grow, the number of persons at risk for heat illnesses increases each year.This book-the first to focus exclusively on exertional heat illnesses-describes howto identify, treat, and prevent these disorders. Among the topics covered are thephysiology of heat stress; classification of heat illnesses; exertional heatstroke; heatexhaustion; exercise-associated collapse; heat syncope; exertional heat cramps; hyponatremia;minor heat illness, such as miliaria and sunburn; and predisposingfactors for exertional heat illnesses. Case reports appear throughout the text. Alsoincluded are reproducible checklists, charts, tables, algorithms, and photographs.
A 67-year-old man complainsof abdominal distention and bouts ofdiarrhea with intermittent constipation.These symptoms have beenpresent for weeks but recently havebecome more severe. The patienthas not seen blood in his stool. Hedenies fever, travel to a foreign country,and recent trauma. He has hypertension,which is well controlledwith calcium channel blockers.
When corticosteroids are no longer a viable option for management of Sjögrensyndrome in a particular patient and GI symptoms preclude NSAID use, whatother treatments can be tried?
