Outbreaks of Legionnaires diseasehave been traced to the inhalationof aerosolized water containing Legionellapneumophila, often originatingfrom cooling towers. A recentstudy of an outbreak in Franceindicates that the distance of airbornetransmission of L pneumophilamay be greater than previouslythought.
Abstract: Smoking cessation is still the most important intervention in patients with chronic obstructive pulmonary disease (COPD), regardless of sex. There is some evidence that nicotine replacement therapy may be less effective in women than in men. However, women may derive greater benefits from a sustained quit attempt. For example, one study found that compared with men, women who were sustained quitters had a greater initial rise and a slower age-related decline in forced expiratory volume in 1 second. Men and women do not appear to differ in their response to bupropion or to the various types of bronchodilators. A number of factors contribute to the increased risk of osteoporosis in women with COPD. Both smoking and the degree of airflow obstruction have been identified as important risk factors for osteoporosis. Women may be particularly susceptible to the effects of smoking on bone metabolism. Immobility and decreased physical activity have also been shown to accelerate bone loss. (J Respir Dis. 2006;27(3):115-122)
A 37-year-old man presented withnew-onset fever and abdominal painof several days’ duration. No respiratorysymptoms were reported.The patient had a history of multiplestab wounds to the abdomenand back, resulting in chronic backpain and a neurogenic bladder.During a previous hospital admission,he was treated for Enterobacterpyelonephritis with intravenousgentamicin for 12 days.
Chronic headache that worsened when she bent forward and episodes of usually unilateral vision loss sent a 34-year-old woman for medical consultation. The vision loss occasionally occurred in both eyes simultaneously.
Are follow-up radiographs or laboratory studies needed when lentigo maligna has been completely excised and a biopsy has been performed?
Excess weight increases the risk of having a heart attack, stroke, high blood pressure, arthritis, diabetes, depression, fatigue, and certain types of cancer. Losing weight and keeping it off are very difficult for most persons who are overweight. Here are some suggestions to help you lose pounds and keep your weight down.
In this article, we review the factors that contribute to obesity. We then describe effective approaches to weight control, including exercise, dietary modification, drug treatment, and bariatric surgery.
Phenytoin is one of the most commonly prescribed antiepileptic drugs in both acute and chronic settings; its use has been extensively described. Nevertheless, interactions between phenytoin and numerous other drugs continue to complicate seizure therapy; these have been documented in case reports, studies, textbooks, and epilepsy reviews.
A 39-year-old woman who had a fever and episodes of nonbloody vomiting for 5 days presented to the emergency department after the sudden onset of severe, left-sided flank pain (10/10 severity) that was sharp, constant, and radiated to the front. She had no associated urinary symptoms, vaginal discharge, or bowel disturbances. Her last menses, 10 days earlier, was regular. Aside from a urinary tract infection 2 years earlier, her medical history was insignificant.
A 56-year-old man presents with diffuse erythema. He has not changed his routine or eaten anything unusual. The rash initially appeared the previous night as asymptomatic erythema on the face and body. On awakening in the morning, the patient noticed that the erythema had spread over most of his body and had become pruritic. Over-the-counter diphenhydramine did not relieve the symptoms.
To easily drain an ulnar bursa or a patellar effusion of any size--and simplify preparation of the aspirate for transfer--use an evacuated blood draw kit with an 18-gauge needle attachment, a see-through-labeled tube coated with whatever anticoagulant your laboratory specifies, and several large additive-free tubes. Begin with the coated tube
When examining a patient who complains of earache, start by looking in the "good" ear.
Dermclinic: A Photo Quiz to Hone Dermatologic Skills
An 85-year-old man was hospitalized because of lower GI bleeding. He was hemodynamically stable. Because gastroscopy and colonoscopy failed to reveal the source of the bleeding, push enteroscopy was performed. This study showed an ulcerated tumor in the proximal jejunum.
Monday morning your nurse hands you charts for 4 new patients. Each patient is a woman with widespread body pain, stiffness, and fatigue. All have already been evaluated by another physician and were advised that they should reduce stress and practice distraction techniques. They are in your office today seeking a second opinion.
A 45-year-old man comes to see you for a routine physical.He has no complaints and no significant medical history.However, while questioning him you discover that he usedintravenous heroin until about 10 years ago-and sometimesshared needles. He also drank 6 or more beers a day for about 20 years, a practicehe stopped at the same time that he quit using illicit drugs. He has multiple tattoos,which were done at commercial parlors. He is married but has no children. His wife hasno history of hepatitis. Physical examination is unremarkable.
A nonhealing ulcer recently developedin a painful facial rash that hadworsened over several months. The44-year-old patient is a heavy drinkerwith a history of elevated liver functionlevels. She has had numerousunprotected sexual contacts over theyears.
The parents of this 5-month-old boy were concerned that his eyes wereturned in toward the nose. The infant was otherwise healthy. Physical findingswere normal. In particular, when a light source was projected onto theeyes, the light reflex was centered in both eyes.
The "Quick Take" on water fluoridation states that "fluorideprevents caries primarily after tooth eruption" (CONSULTANT,March 2001, page 472).
How can you readily determinewhether your patient with bronchitismay benefit from an inhaled bronchodilator?
