Because of the potential complications associated with mechanical ventilation, noninvasive ventilation is considered an attractive alternative in some settings. How useful is it in patients with acute cardiogenic pulmonary edema? Researchers who addressed this question found that the early application of noninvasive ventilation in the emergency department (ED) can decrease the relative risk of mortality by 39% and the need for endotracheal intubation by 57%.
A major disadvantage of unfractionated heparin is its intravenous administration and the need for coagulation monitoring and hospitalization. However, subcutaneous administration may be an alternative, according to Kearon and coworkers. They found that fixed-dose subcutaneous unfractionated heparin appears to be as effective and safe as low molecular weight heparin (LMWH) for the outpatient treatment of acute venous thromboembolism (VTE).
ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.
ABSTRACT: Painful recurrent ulceration of gingival tissue suggests a secondary intraoral presentation of herpes simplex virus (HSV) infection. Unlike the lesions of HSV, lesions associated with coxsackievirus do not erupt in the anterior mouth but rather on the soft palate and pharynx. Furthermore, unlike HSV infection, coxsackie infections may recur, because there is considerable viral variation. Patients with atrophic or erythematous candidiasis report burning pain and a metallic taste. The typical patient with benign mucous membrane pemphigoid is a woman older than 50 years; the condition usually involves the attached gingiva around the teeth. The lesions of erythema multiforme may erupt on any intraoral mucosa; biopsy may be required to rule out other conditions with similar presentations.
Is it appropriate to routinely order urinalysis for patients in a nursing home (both with and without dementia) when they exhibit behavioral changes but show no signs or symptoms of urinary tract infection (UTI)?
Seborrheic keratoses are the most common neoplasms in elderly persons and affect up to 60% of this population. Risk factors for these lesions are thought to include genetic predisposition, age, and sun exposure.
A 49-year-old man presents with recurring facial pain of 6 months' duration. The pain initially occurred several times per week; it now occurs as often as several times per day. The paroxysmal pain is intense and incapacitating but abates within several minutes. It occurs in the right maxillary region and lower jaw and is sharp and lancinating. Hard chewing and teeth cleaning are the usual precipitating events. Between episodes, the patient is asymptomatic, without numbness or deficit in the affected region.
If you notice labile thyroid-stimulating hormone (TSH) values in a patient receiving levothyroxine therapy for primary hypothyroidism, ask how he or she takes the medication. Levothyroxine should always be taken on an empty stomach (usually first thing in the morning) with water only; no other fluids, food, or medications should be consumed for 30 minutes afterwards.
In patients with chronic liver disease or coagulation disorders, nasogastric tubes may result in significant nasopharyngeal trauma and uncontrolled bleeding. In such patients, use an orogastric tube instead.
The cause of mid-abdominal pain and tenderness can sometimes be just a strained rectus abdominus muscle. To test for this, apply firm pressure to the rectus abdominus with your hand and have the patient lean forward. As the patient leans, your hand is pushed toward the muscle and away from the viscera. If the tenderness worsens, muscle strain is a more likely cause of the pain and you may forgo expensive diagnostic tests.
A 72-year-old man was evaluated for worsening dysphagia and weight loss. The dysphagia had been intermittent for 20 years, but in the past year it had begun to occur daily. He regurgitated food after every meal, often many hours after ingestion.
During a routine checkup, a middle-aged woman asks you whether she should stop wearing moisturizers and makeup that contain sunscreen. She has read that increased sunlight exposure enhances vitamin D production, which may prevent certain types of cancer. What would you tell her?
CHICAGO -- Partial breast irradiation using a percutaneous brachytherapy balloon may be a safe and effective alternative to whole breast radiation, according a small single-center series.
IRVINE, Calif. -- The chemical compound at the heart of the so-called abortion pill also appears to block breast cancer, at least in experimental mice.
ROCKVILLE, Md. -- An FDA advisory panel said Wednesday that the Cox-2 inhibitor Celebrex (celecoxib) should be approved for treatment of pain associated with juvenile rheumatoid arthritis.
DALLAS - Women who develop chorioamnionitis during a first pregnancy have twice the risk for the amniotic infection in the next, suggesting a genetic component, researchers reported.
SHREVEPORT, La. -- When shown the instructions on five common prescriptions, only a third of mostly low-income patients of mixed literacy understood how to carry them out.
CHICAGO -- Hypnosis during a breast biopsy significantly reduces post-procedure pain and anxiety compared with standard care, investigators reported here.
CHICAGO -- When sperm motility is only minimally impaired by varicoceles, spermatic vein embolization may improve fertility, German researchers reported here.
BOSTON -- More than a third of clinical trials watchdogs have financial relationships with industry, calling into question the overall objectivity of institutional review boards, reported researchers here.