In addition to the extensive body of literaturethat supports medical therapiesfor osteoporosis and for preventionof postmenopausal fractures, numerousstudies have explored thebenefits of exercise in both premenopausaland postmenopausal women.1The results of these studies indicatethat weight-bearing exercise and resistancetraining may play a role in preventingbone loss and increasing bonemass.
DALLAS - Their risks to impressionable young minds aside, too many TVs appear to be teetering on the brink of crashing down on little bodies, warn emergency specialists. The findings give new meaning to the term "fall season."
Some sexually transmitteddiseases (STDs), such assyphilis and gonorrhea, arecenturies-old scourges; othershave attained clinicalsignificance only in recent years.Despite the availability of effectivetherapy for many of these diseases,they remain an important publichealth problem.
CHICAGO ? It's a complicated trail twixt man and rats, but neonatal environmental estrogen exposure in the rodents appears to predispose them to prostate cancer as adults.
LOS ANGELES ? Celebrex (celecoxib), the Cox-2 inhibitor, and Tarceva (erlotinib), the EGFR-receptor inhibitor, have been teamed with some preliminary success to inhibit late-stage non-small-cell lung cancer.
Patients with psychiatric disordersoften present a diagnostic challenge-even for psychiatrists. Their demeanormay not readily reveal the nature orseverity of the problem. Nevertheless,there are clues that can help you sortthrough the differential and arrive atthe correct diagnosis.
A 77-year-old woman who had hadanorexia and weakness for 3 monthswas seen after a syncopal episode. Sheappeared pale but alert. Heart rate was110 beats per minute; respiration rate,22 breaths per minute; and blood pressure,170/70 mm Hg. Her hematologicindices were: hemoglobin level, 4.3 g/dL;mean corpuscular volume (MCV), 60fL; mean corpuscular hemoglobin concentration(MCHC), 29 g/dL; red bloodcell count, 1.6 million/μL; white bloodcell count, 7500/μL; and platelet count,452,000/μL.
Anemia is usually detected as an incidentalfinding on a screening completeblood cell (CBC) count. Occasionally,a patient presents with symptoms andsigns that strongly suggest anemia,and a CBC count is ordered. In eithersetting, the next step is to determinethe cause of the anemia.
With proper guidance, a parent canassist in the difficult task of examininga young child’s throat.
Allergy testing can be done any time that allergy is suspected, and it should be done if it is not clear whether the patient's symptoms are related to allergic or nonallergic causes. Seasonal allergies can often be controlled with medication--either a single medication or a combination. If this is possible, then allergy testing is not really necessary. The test results might be interesting to the patient and health care provider but would not change what they would do.
The results of this study by Madden and associates suggest that sildenafil may be useful in managing pulmonary arterial hypertension (PAH) in select patients with parenchymal lung disease.
Abstract: Failure to recognize heparin-induced thrombocytopenia (HIT) can lead to devastating thrombotic events, including pulmonary embolism and stroke. In most cases, the problem develops within 5 to 14 days after a first-time exposure to heparin. HIT can occur with either unfractionated heparin or low molecular weight heparin (LMWH), but the incidence is much lower with LMWH. When HIT is suspected clinically, a functional assay and immunoassay should be performed. However, treatment should not be delayed while waiting for laboratory confirmation. All forms of heparin should be eliminated, and treatment with an alternative anticoagulant should be initiated to prevent new thromboembolic events. Argatroban and lepirudin are the direct thrombin inhibitors that have been approved for the treatment of HIT. Because of the risk of warfarin-induced venous limb gangrene or skin necrosis, warfarin should be avoided in patients with acute HIT until their platelet counts have recovered and they are improving clinically. (J Respir Dis. 2006;27(6):248-259)
The endothelin receptor antagonist bosentan has been demonstrated to be effective in the management of pulmonary arterial hypertension (PAH). Now, Benza and associates report that bosentan is beneficial in patients who have PAH associated with congenital heart disease. Specifically, they found that treatment with bosentan significantly reduced right atrial pressure and mean pulmonary artery pressure. Moreover, they found no evidence of systemic desaturation or worsening volume overload associated with bosentan therapy.
Abstract: Advances in CT technology afford the ability to create 3-dimensional (3-D) reconstructions of the airways in only a few minutes. The 2 basic types of 3-D reconstruction imaging methods are CT bronchography, which depicts the external surface of the airways and its relationship to adjacent structures, and virtual bronchoscopy, which allows the viewer to navigate the internal lumen of the airways by a means similar to conventional bronchoscopy. Although axial images are routinely used to evaluate the upper airways, multiplanar reformations in the coronal and sagittal planes also help evaluate upper airway pathology. Coronal multiplanar reformation images are useful in defining the anatomy of the larynx; sagittal images provide excellent delineation of the epiglottis, vallecula, and piriform sinuses. Axial images are the reference standard for assessing tracheal wall thickening and, therefore, may be particularly helpful in the differential diagnosis of tracheal stenosis. (J Respir Dis. 2006;27(6):266-273)
Diabetic nephropathy, the leading cause of end-stage renal disease (ESRD) in the United States, affects 20% to 30% of patients with diabetes. Early diagnosis and aggressive treatment may delay the progression of kidney disease.
ABSTRACT: The key features of polycystic ovary syndrome (PCOS) are menstrual bleeding disturbances caused by chronic oligoovulation or anovulation and clinical or biochemical hyperandrogenism. The finding of polycystic ovaries on ultrasonography alone has limited predictive value. Obesity often coexists with PCOS and can exacerbate metabolic disturbances, particularly insulin resistance, but it is not a diagnostic finding. Laboratory results can rule out other conditions in the differential, such as an androgen- producing neoplasm, hypothyroidism, and late-onset congenital adrenal hyperplasia.
A 17-year-old boy landed with most of his weight on his plantar-flexed right foot during a skateboarding accident. He felt pain on the top of his right foot and could not bear weight on it.
One More Cause of Poliosis
The treatment of polycystic ovary syndrome (PCOS) is based on the patient's presenting symptoms and any significant abnormal findings. Symptoms can be managed with combined oral contraceptives (OCs), insulin-sensitizing agents, antiandrogens, and medications used to induce ovulation.
A 60-year-old woman complains that she has had "no energy" for the past 6 months. She wants to know how she can get a better night's sleep and inquires about new insomnia medications she has seen advertised on television.
