An 11-month-old infant was referred by his pediatrician for possible surgical correction of a bilateral entropion. The mother stated that her son's lashes appear to turn in on occasion; however, he never rubbed his eyes, the eyes were not red, and no discharge or drainage was noted.
The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?" (CONSULTANT, July 2006, page 845), prompted a number of readers to write in. A selection of the comments received, along with a response from Dr Nash, appears below. Additional comments appear on www.ConsultantLive.com.
Five days after starting aspirin and warfarin with an enoxaparin bridge for new-onset atrial fibrillation, a 92-year-old man presented with abdominal pain, nausea, and vomiting. The patient appeared ill and was tachycardic. He had dry mucous membranes; pale sclerae; diminished bowel sounds; and a large, tender left lower abdominal mass. Hematocrit was 22% (baseline, 39%); hemoglobin, 6.8 g/dL; blood urea nitrogen, 65 mg/dL; and creatinine, 3.2 mg/dL (baseline, 1.3 mg/dL). His "pre-renal" ratio was 20. These findings were consistent with bleeding and acute renal failure. He also had a supratherapeutic international normalized ratio (INR) of 4.1.
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 (Figure 1). Over the past 3 to 4 weeks, he has had malaise, nonproductive cough, and a decline in mental status but no fever, headache, nausea, light-headedness, hemoptysis, or melena.
When young children have an irritant in their eyes, it can be very difficult to get them to open their eyes so that they can be irrigated. 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.- D. Brady Pregerson, MD Los AngelesMore Practical Pointers
The term "prehypertension" was introduced in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines to describe blood pressures (BPs) of 120/80 mm Hg to 139/89 mm Hg.1
Alopecia was noted on the right anterior scalp of a 53-year-old man who had been hospitalized for jaundice of 2 weeks' duration. The hairs in the affected area were broken off at various lengths (A). The patient, who was left-handed, repeatedly pulled individual hairs on his head; it was suspected that he occasionally swallowed them.He had a history of heavy alcohol consumption and end-stage liver disease.
To initiate a discussion with a patient about excess weight without causing embarrassment or offense, try reporting the patient's body mass index (BMI), saying something like the following: "Mr X, did you know that your BMI is 36?" Patients typically answer with something such as "No--what's a BMI?" This creates an easy opening for discussion of the comorbidities associated with excess weight and counseling about lifestyle changes.
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?
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.
