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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.

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.

CHICAGO -- Milk does a bowel good -- or at least as good as a pricey commercial contrast agent that produces only marginally better results for abdominal CT scans.

BOSTON -- The biologic agents used to treat rheumatoid arthritis are no better or worse for the heart than methotrexate, according to a case-control study.

ITHACA, N.Y. -- Poor nutrition may lead to increased disability among older community-dwelling women, researchers here said.

CHICAGO -- A way to use ultrasound to measure the elasticity of tissue surrounding suspicious breast lesions demonstrated 100% diagnostic sensitivity and 99% specificity in a small study.

CHICAGO -- Six weeks of intensive rote memorization exercises led to improved verbal and episodic memory skills for older patients, an improvement that corresponded with metabolic changes in brain, researchers here reported.