A healthy 56-year-old woman, who is seeing you for her annual checkup, asks if she still needs to continue the calcium supplements she has been taking. She has heard reports on the evening news that calcium and vitamin D were of negligible value in women her age--and could even cause kidney stones. How would you respond? What is the latest thinking about calcium and vitamin D supplements for postmenopausal women?

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman who is employed as a secretary. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

Recently, a well-designed crossover study assessed the risk of thrombosis during long flights.1,2 Included were persons with such risk factors as factor V Leiden mutation and oral contraceptive use. All 71 patients (15 men, 56 women) were studied (not randomized) in each limb of the protocol--in random order--during each of the following: an 8-hour flight, 8 hours spent watching movies, and 8 hours of typical daily living. Fifteen of the participants took oral contraceptives, 11 had the factor V Leiden mutation, and 15 had both risks.

The optimal approach to subclinical hypothyroidism continues to be debated. Experts disagree over screening for thyroid dysfunction, the threshold TSH level for treatment, and the upper limit of normal of the TSH reference range.

While playing soccer, a 24-year-old man fell on his outstretched hand, felt a "pop," and immediately noticed a deformity of his wrist. He was in severe pain when he presented to the emergency department.

During a baseball game, a 29-year-old man felt pain in the right groin and required assistance to walk after sliding into second base.

An up-to-the-minute review of the array of oral and topical agents as well as those used intraurethrally or for intracavernosal injection.

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.

The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?", prompted a number of readers to write in.

A 62-year-old man presents with a violaceous, nonpruritic eruption that arose 2 weeks earlier on the hands and feet, including the palms and soles, and spread to the arms and legs.

A 26-year-old woman presented with acute pain at the base of her thumb after her ski pole hit her hand as she jumped over a small mogul.

A 12-year-old boy presented with pain in the right shoulder. Six months earlier, he had fallen on his outstretched right hand during baseball practice and had persistent shoulder pain ever since.

The risk of complications (such as lactic acidosis) that can be associated with metformin increases in patients with renal insufficiency. At what creatinine clearance should this agent be discontinued?

Calcium and Vitamin D Supplements: Breaking News on Fracture Prevention

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

What steps can my 68-year-old patient take to help prevent thrombosis on a 14-hour plane flight?

For easy removal of a too-tight ring, spray with glass cleaner. The ring will slip off

When young children have an irritant in their eyes, to reduce the stinging and make opening the eyes easier, try putting a drop of an ocular anesthetic in each medial canthus while the child is supine; be sure to wait for it to seep in.

Application of liquid nitrogen often must be repeated several times when used to treat thick seborrheic keratoses--and still may be ineffective. For an immediate and excellent cosmetic result, try liquid nitrogen for 5 seconds, followed by gentle curettage.

n epidemiologic studies, cigarette smoking is strongly associated with the development of rheumatoid arthritis (RA), in particular seropositive RA. In 1987, Vessey and colleagues1 first reported an unexpectedly elevated risk of RA among women smokers in the Oxford Family Planning Association contraceptive study.