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Osteoarthritis: Complementary Therapies ReviewedABSTRACT: Many patients with osteoarthritis (OA) try such complementary therapies as special diets, nutritional and herbal supplements, yoga, t'ai chi, magnets, and acupuncture-but only 40% of these patients tell their physicians. Glucosamine and chondroitin sulfate can produce at least symptomatic relief; in addition, glucosamine (1500 mg/d) may increase or stabilize cartilage in osteoarthritic knees. Alert patients to the potential toxicities of many herbal remedies, as well as the risks of harmful drug interactions and possible contaminants and impurities. Yoga postures may have a beneficial effect on knee OA; t'ai chi may reduce joint pain and swelling and increase mobility. Small studies have shown that applied pulsed electromagnetic fields can reduce pain and improve function in patients with chronic knee OA. Acupuncture has also been shown, in small studies, to alleviate the pain of OA. Autologous chondrocyte transplantation was recently approved for treatment of knee OA. The efficacy and safety of various types of gene therapy are currently being evaluated.
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Chronic Hepatitis C:The most common chronic blood-borne infection in the United States is caused by hepatitis C virus (HCV), an RNA virus transmitted through blood-to-blood contact. In this article, we identify risk factors for HCV infection and discuss which patients should be tested and treated.
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Rectus Sheath Rupture With Hematoma FormationThe authors present a case of rupture of the rectus abdominis muscle with subsequent rectus sheath hematoma-an uncommon and often misdiagnosed cause of acute abdominal pain.
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Woman With Exertional Dyspnea, Weakness, and DizzinessA 66-year-old woman presents tothe emergency department(ED) with exertional dyspnea, generalizedweakness, and orthostaticdizziness; the symptoms startedabout 1 week earlier and have progressedinsidiously. The patient alsoreports diaphoresis and nausea withoutvomiting. She has no chest pain,palpitations, cough, or hemoptysis;she has not had a recent respiratorytract infection. While she is waitingto be admitted, she has an episode ofsyncope.
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A Retrospective Diagnosis of Ventricular TachycardiaVentricular versus supraventricular tachycardia? This case offers diagnostic and treatment strategies when the diagnosis is uncertain.
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Allergic Contact Dermatitis From Tea Tree OilThe sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.
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Acute Appendicitis: Two CasesThe diagnosis of acute appendicitis is usually straightforward. When the presenting symptoms are atypical, abdominal ultrasonography can be of diagnostic assistance if it shows the thickened walls of the appendix and a distended, noncompressible lumen.
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Dyslipidemia: How Aggressively to Intervene in the Older Patient?ABSTRACT: Lipid abnormalities are extremely prevalent among the elderly, a group at very high risk for cardiovascular disorders. Accordingly, the treatment guidelines of the National Cholesterol Education Program Adult Treatment Panel do not suggest that lipid management be any less aggressive in older patients than in younger ones. Management decisions focus on the calculated low-density lipoprotein cholesterol level as part of a full fasting lipid panel. Dietary counseling remains an important element in the management of lipid disorders, but almost all elderly patients require medications to reach their lipid goals. The statins are the mainstay of treatment for most patients, but some will require additional agents, such as a fibrate, niacin, ezetimibe, fish oil, or a bile acid sequestrant.
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Case In Point: Acute eosinophilic pneumonia in a 19-year-old manThe authors describe a case of acute eosinophilic pneumonia (AEP) that occurred in a previously healthy young man. The presentation was similar to that of acute respiratory distress syndrome (ARDS), and the diagnosis was established by bronchoalveolar lavage (BAL). The authors note that it is important to recognize the subset of patients with AEP who present with an ARDS-like picture, especially since corticosteroids are very effective in this setting.
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Medicaid Pharmacy Cost-Containment Policy Actions and Access to Prescription Drugs and MedicalWe assessed the association between pharmacy cost-containment policy actions by states’ Medicaid programs and access to prescription drug and medical care, controlling for nonpharmacy cost-containment policy actions and socio-environmental differences among states.
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Tips on Averting Cimetidine Drug InteractionsAfter cimetidine was releasedin the late 1970s,case reports of clinicallysignificant drug interactionsquickly emerged.1-3Controlled trials soon validated theseinitial clinical observations. Since1983, when a comprehensive reviewof cimetidine drug interactions waspublished,4 more interactions havebeen reported, as use of this agenthas increased because of cost constraintsand the rapid growth of managedcare. Examples of well-documentedinteractions are listed in theTable.
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IT Investments Save VA BillionsThe US Department of Veterans Affairs (VA) invested in health information technology (IT) and produced a net savings of $3.09 billion, according to results of a new study conducted by the Center for Information Technology Leadership (CITL).1
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Severe Hypersensitivity Reaction to Antituberculosis MedicationsA66-year-old white man with tuberculosis of the shoulderjoint had a severe hypersensitivity reaction to antituberculosismedications. Symptoms included development of pulmonaryinfiltrates, hepatic dysfunction, renal insufficiency, andneutropenia. The patient improved after the medicationswere withdrawn. [Infect Med. 2008;25:287-291]
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Acute Renal OsteodystrophyThis x-ray film of a man in his 50s illustrates an extreme case of renal osteodystrophy. On examination, the patient's legs were very tender and one could actually see the femur bend in the examiner's hands as if it had a greenstick fracture.
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Are the Most Heavily Marketed Drugs the Least Beneficial?In a perfect world, doctors would not prescribe – and patients would not take – drugs that do more harm than good.
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The Dangers of ATVsAn all-terrain vehicle-ATV-is described by the American National Standards Institute as one that "travels on low pressure tires, with a seat that is straddled by the operator, and with handlebars to be used for steering."1 By this definition, an ATV is designed for interactive riding by a single operator. Drivers are able to shift their weight freely in all directions depending on the situation and terrain. According to ATV safety standards and recommendations, children younger than 6 years are never to be on an ATV of any size-alone or with someone else.
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High-Risk Hypertensive Patients:ABSTRACT: In high-risk patients with vascular disease, blockade of the renin- angiotensin system (RAS) can help prevent cardiac remodeling that ultimately results in left ventricular hypertrophy (LVH) and heart failure. Optimal treatment of these patients, who often have diabetes or renal disease, usually involves a combination of agents-1 of which should be a thiazide diuretic-to reduce blood pressure, control the comorbid condition, and prevent end-stage organ damage. The manner in which the RAS is interrupted may be important. For example, although a thiazide diuretic and an angiotensin-converting enzyme (ACE) inhibitor are recommended for hypertensive patients with LVH, an angiotensin II receptor blocker (ARB) in combination with a diuretic was recently found to reduce cardiovascular morbidity and mortality in these patients to a greater degree than a ß-blocker/diuretic. Both ACE inhibitors and ARBs delay the progression of diabetic nephropathy and reduce albuminuria. ARBs were recently shown to reduce progression from microalbuminuria to macroalbuminuria. In patients with systolic heart failure who cannot tolerate ACE inhibitors, an ARB can be used with a ß-blocker.
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Oral Herpesvirus Infection With Impetigo BullosaFor 3 days, a 5-month-old infant had a red, papular, nonpruritic rash around her mouth and vesicles on her hands. The child was being breast-fed by her mother, who had a similar rash around her nipple. The child was afebrile, and the physical examination revealed no abnormal findings. There was no history of allergy or change in diet.
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Colorectal Cancer Survivors: The Primary Care Physician's Role in Follow-upDeaths from colorectal carcinoma (CRC) have diminished in recent years; the absolute annual decrease is 1.5% per year.
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Endophthalmitis Caused by Rhizobium radiobacterPostsurgical endophthalmitis caused by Rhizobium radiobacterdeveloped in a 62-year-old man. The patient was treatedwith empiric intraocular therapy. On identifying the causativeorganism, systemic ciprofloxacin was added to the treatmentregimen. Therapy resulted in complete resolution of visualchanges caused by the infection. [Infect Med. 2008;25:274-276]
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Thyrotoxic Periodic ParalysisAttacks of muscle weakness associated with this condition can range in severity from mild deficit to complete paralysis. Episodes may alternate with periods of normal muscle function.
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Depression: Symptoms in the ElderlyHighlights:Unique features of depression in the elderly.Keys to picking up the diagnosis.Pharmacologic treatment.When to recommend referral.
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Tension and Cervicogenic Headaches:ABSTRACT: A thorough history and physical examination can establish the diagnosis of tension headache; further evaluation is generally unnecessary. In contrast, the workup of cervicogenic headache includes standard radiographs, 3-dimensional CT, MRI, and possibly electromyography; nerve blocks may also be used to confirm the diagnosis. Episodic tension headache can be treated effectively by trigger avoidance, behavioral modalities, and structured use of analgesics. Reserve opioids for patients with intractable headaches. Chronic tension headache is treated primarily by prophylactic measures, such as antidepressants and anticonvulsants, and behavioral and physical therapy. Treatment options for cervicogenic headache include analgesics; invasive procedures, such as trigger point injections, greater or lesser occipital nerve blocks, facet joint blocks, segmental nerve root blocks, and diskography; spinal manipulation; and behavioral approaches.
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ECG Changes in Polymorphic Ventricular TachycardiaTorsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.
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Choose a Set of Guidelines From a Major Medical Organization and Follow the RecommendationsBreast cancer remainsa significant healthconcern for women. Amongwomen at average risk,breast cancer will develop in1 of 8, and 1 in 30 will die ofthe disease.1 Although therehas been recent excitementabout the potential of geneticscreening to predict individualbreast cancer risk, itis important to keep in mindthat nearly 75% of women inwhom breast cancer hasbeen diagnosed have hadno risk factors other thansex and age.2
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Primary Care Condition CriticalIn January 2006, the American College of Physicians (ACP) warned that primary care, rightly referred to as the backbone of the nation's health care system, was on the verge of collapse. The ACP noted then that few young physicians were going into primary care and that many of those already in practice were leaving.
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Coccidioidomycosis risk in patients with diabetes or rhematological disease•Coccidioides species, the cause of coccidioidomycosis, are endemic to the desert soils of the southwestern United States as well as northern Mexico and limited areas of Central and South America. The organisms can become airborne with disruption of the soil, either through natural causes or activities of humans or animals. Nearly all Coccidioides infections are acquired through the inhalation of airborne arthroconidia (spores).
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Sézary SyndromeA 55-year-old woman with no significant medical history reported that diffuse erythematous, patchy, purpuric skin lesions over most of her body had been present for the past year. Applications of an over-the-counter corticosteroid cream helped control the pruritus but did not clear the skin lesions.
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Recurrent Epigastric Pain in an 82-Year-Old WomanAn 82-year-old woman who had recentlyarrived from Japan presented to theemergency department with a 3-dayhistory of abdominal pain that beganimmediately after she swallowed severalpills with a small amount of water.The severe, intermittent pain radiatedto the patient’s back and worsened withmeals. The patient denied chills, nausea,vomiting, coughing, diarrhea, andconstipation. She had well-controlledtype 2 diabetes mellitus and hypercholesterolemia,and had undergone anappendectomy 50 years earlier.
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Nonsustained Ventricular TachycardiaAn 8-year-old boy was brought to his pediatrician for well-child care. On physical examination, an irregularly irregular heart rate was detected.
