Alcohol is unique in the pantheon of abusable substances. In addition to the association between chronic, heavy drinking and cirrhosis of the liver, peripheral neuropathies, dementia, and other medical and behavioral problems (eg, those that lead to traffic fatalities), there is also an association between moderate use and lowered rates of coronary artery disease and stroke--as the following articles describe.
The next time a young patient presents with epistaxis, try this approach. Thoroughly soak several cotton balls with phenylephrine, and pack them in the bleeding nostril.
he use of suction can help you avoid the unpleasant odor and splatter that often occur during abscess drainage.
Offer patients a glass of water when you ask them to swallow during a thyroid examination.
This 41-year-old woman rushed to the emergency department with a swollen, blistered tongue and difficultly in swallowing and speaking. Twenty minutes earlier she had eaten fish (for the first time in her life).
Three days after having eaten fish, a 66-year-old woman with a known allergy to fish and a history of schizophrenia was brought to the emergency department because of macroglossia--a presentation of anaphylaxis.
Abstract: Prompt correction of hypoxemia is a basic goal in the treatment of critically ill patients. Improvements in global oxygen delivery may be achieved by several means, such as providing an adequate fraction of inspired oxygen and using packed red blood cell transfusions for volume resuscitation. Low levels of positive end-expiratory pressure often help improve arterial oxygen tension. Measurement of mixed venous oxygen saturation (Sv?248-175?O2) can be useful in patient assessment. Sv?248-175?O2 may be decreased in patients with hypoxemia, hypovolemia, or anemia and may be elevated in patients with sepsis. Serum lactate levels may not quantitate the degree of tissue hypoxia, but serial measurements can help monitor the patient's response to therapy. For patients with septic or hypovolemic shock, early fluid resuscitation with isotonic crystalloid solution is essential. Catecholamine vasopressors can be useful when fluid administration fails to restore adequate blood pressure. (J Respir Dis. 2005;26(5):209-219)
CRS is the most common chronic disease in the United States, affecting 17.4% of adults, with an estimated direct cost of $5.6 billion yearly.1,2 There frequently is no definitive or quick cure. The clinical diagnosis of CRS is based on the presence and persistence of certain symptoms. The finding of mucosal thickening on coronal CT scan of the paranasal sinuses strengthens the clinical diagnosis.
Most of the symptoms of allergic rhinitis, including nasal obstruction, rhinorrhea, sneezing, and nasal itching, respond to intranasal corticosteroids administered once or twice daily. However, many patients also need to take an antihistamine for adequate control of symptoms. While an antihistamine/decongestant combination can provide symptomatic relief, it fails to address the inflammatory component of allergic rhinitis. Thus, combining an intranasal corticosteroid or oral leukotriene modifier with an antihistamine might be a more effective strategy. Factors that can facilitate treatment adherence include minimizing the number of daily doses, allowing patients to select their own dosing schedules, and providing written instructions. Specific immunotherapy can be beneficial in select patients whose allergic rhinitis symptoms are not sufficiently controlled by pharmacotherapy. (J Respir Dis. 2005;26(5):188-194)
Menstrual disorders are one of the most common complaints of women seen in primary care. Abnormal uterine bleeding (AUB) is a broad term that encompasses bleeding at abnormal or unexpected times or excessive flow at times of expected menses.
A 17-year-old girl had a "mole" on the chin since childhood. The ovoid lesion had grown slightly over the previous few years, but it had maintained the same general configuration. A prominent duality of pigmentation, with the center being darker than the periphery, was noted.
My healthy 74-year-old patient exercises 30 minutes 3 times a week and 60 minutes twice a week at a rate of 3.5 to 3.8 miles per hour. He perspires considerably after 20 minutes without any other adverse effects and has done this for more than 30 years.
An 8-year-old boy was evaluated because of widespread lesions on his face, arms, and legs. The lesions had been present for 3 years and were occasionally pruritic, especially when scratched. The child was otherwise healthy.
A 71-year-old woman presents to the emergency department accompanied by her daughter. The patient woke up in the morning "feeling fine" and then complained of a headache. She became progressively less oriented over the next 45 minutes.
A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration. Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.
A 55-year-old right-handed house painter has had a constant dull ache in his right shoulder for 3 weeks. The pain worsens when he steers his car or elevates his arm, and the inability to raise his arm above his head interferes with his work.
In Dr Henry Schneiderman's interesting case of swelling and redness of the lids in an elderly woman, the photograph clearly illustrates a sharp demarcation of the area of swelling above the cheekbone.
Several popular diets, such as the South Beach Diet and Sugar Busters, are based on the glycemic index; however, many patients are confused about its significance.
Is there a role for statins in the treatment of chronic progressive renal disease?Inflammation is a component of the pathophysiology of progressive renal disease and may also be associated with other major modifiable risk factors, such as atherosclerosis, hypertension, and diabetes mellitus.
Lesions on the tongue and lips prompted a 61-year-old woman to seek medical attention. She also complained of craving ice and cold liquids. Her history included depression, which was treated with ser-traline, and lifelong recurrent epistaxis. She denied pulmonary or neurologic symptoms.
