During the last few weeks of gestationor shortly after birth, the layersof the processus vaginalis normallyfuse together and obliterate the entranceto the inguinal canal in thevicinity of the internal inguinal ring.An indirect hernia results from a failureof fusion of the processus vaginalis;the bowel subsequently descendsthrough the inguinal canal.
Abstract: For some patients with allergic rhinitis, symptoms can be reduced substantially by the use of allergen avoidance measures. However, many patients require pharmacotherapy, including antihistamines, decongestants, and intranasal corticosteroids, to adequately control their symptoms. The oral antihistamines are effective in reducing rhinorrhea, itching, and sneezing but are not effective against nasal congestion. Intranasal azelastine has been shown to be beneficial in patients with moderate to severe symptoms that are not sufficiently controlled by an oral antihistamine. Additional therapies include intranasal ipratropium, which specifically targets rhinorrhea, and cromolyn, which can reduce many of the symptoms of allergic rhinitis and can be used prophylactically. (J Respir Dis. 2005;26(4):150-162)
In their photographs of a 73-year-old woman with an itchy, painful rash on one side of her face and 3 lesions on the forehead, Drs Leslie Trope and Glen Marin identified the 3 lesions as molluscum contagiosum
In his response to a reader's query about the connection between celiac disease and type 1 diabetes, Dr David Wyatt recommends that all children with type 1 diabetes be screened for celiac disease.
How important is control of obesity in the treatment of hypertension?
An 82-year-old woman presented with a 4-day history of "filmy vision" in the right eye. Her history included mitral valve prolapse with regurgitation, for which she took warfarin and digoxin, and mild hyperlipidemia, which was controlled with diet. The results of recent carotid artery studies were negative.
A 70-year-old man sought medical attention for a white lesion with surrounding erythema on the thumb of his right hand. The lesion had been present for many years and had recently become inflamed and painful. He had no other symptoms. No other areas were affected. His medical history was unremarkable, and he was not taking any medications.
Now that the role of inflammation in the pathogenesis of cardiovascular disease has been recognized, biomarkers of inflammation have become the subject of intense research interest. Once considered a novel cardiovascular risk factor, the inflammatory biomarker C-reactive protein (CRP) is currently believed to improve global risk prediction in patients not previously deemed at high risk.
When a patient presents with unilateral abdominal pain, always consider shingles--especially if the patient is elderly.
To save time, decrease writing, reduce pharmacy calls, and ensure that specimens are properly labeled.
I use an analogy to help patients understand patellofemoral syndrome (chondromalacia). I ask them to imagine a sliding closet door that always goes off its tracks.
For 2 years, a 79-year-old man had postprandial fullness and epigastric discomfort. He also experienced regurgitation and substernal pain after eating that was relieved by belching. He had a history of hypertension and gout. The patient’s vital signs were normal. Laboratory test results were within normal limits.
Silent Thyroiditis, Standard Treatment, Hypothyroidism
These painful eczematous lesionsat the angle of the mouth and thebase of the nostrils had been presentin a 52-year-old woman for 3days (A). Some of the vesicles hadulcerated and left a crust over theregion. The patient said she had hadsimilar attacks in the past. The diagnosisof recurrent herpes simplexvirus 1 (HSV-1) infection was made.The patient was treated with acyclovirfor 1 week, and all the lesionsdisappeared.
For 2 years, a 79-year-old man had postprandial fullness and epigastric discomfort. He also experienced regurgitation and substernal pain after eating that was relieved by belching. He had a history of hypertension and gout. The patient’s vital signs were normal.
A 34-year-old man experienced feverand arthralgia several days afterappearance of the rash shown here(A). He did not recall being bittenby a tick, as is often the case withpersons who contract Lyme disease.
ABSTRACT: To determine the stability of the injury, examine phalangeal and metacarpal fractures for intra-articular involvement. Suspect carpal bone fracture in any patient with wrist pain and tenderness; proper splinting is essential to prevent avascular necrosis of the bone, arthritis, and chronic disability. After successful reduction of a distal or proximal interphalangeal joint dislocation, order follow-up x-ray films. Apply stress testing of the joint space to all injured joints to ensure ligamentous integrity. Carpal and carpometacarpal dislocations require immediate consultation with a hand specialist. Therapy for bite wounds includes copious irrigation, debridement (in the operating room if necessary), and antibiotic prophylaxis. A patient with an infected bite wound requires hospitalization and intravenous antibiotics.
In their article, “Diabetes: How Early-and Aggressively-to Intervene?”(CONSULTANT, November 2005, page 1416), Drs Thomas Clark and John R.Holman discussed the results of the lifestyle intervention and metformin armsof the Diabetes Prevention Program (DPP) study. However, the authors neglectedto include data from the troglitazone arm of the DPP study.
Exercise is a safe and effective therapy for patients with osteoarthritis or rheumatoid arthritis. It can reduce pain, increase flexibility and strength, and prevent deconditioning. To help motivate patients to initiate and adhere to an exercise program, educate them about these benefits, encourage them to set specific goals, recommend that they commit to a routine for at least 6 to 8 weeks (the minimum time needed to appreciate significant results), and warn them not to be discouraged by initial soreness. An exercise program for a patient with arthritis should include stretching (to improve joint flexibility), strengthening (to prevent deconditioning of the muscles that keep the joints stable), and aerobic exercise (to enhance overall fitness). Isotonic strengthening exercise is particularly important because it can reverse muscle wasting. Recommend that patients exercise for 30 minutes a day, 5 days a week. Water exercise is especially beneficial.
A massive amount of blood in the inferior medial quadrantof the conjunctiva and ecchymosis of the lowereyelid of the right eye prompted a 60-year-old woman toseek medical attention. She had first noted blood in theeye 5 days earlier. There was no history of trauma.