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Dyslipidemia: Effective Statin Treatment for Cardiovascular Disease PreventionDyslipidemia plays a dominant role in atherosclerotic plaque formation and as a modifiable risk factor for cardiovascular events.
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Using elastic compression stockings to prevent post-thrombotic syndromeThe reported incidence of postthrombotic syndrome (PTS) after a first episode of deep venous thrombosis (DVT) is quite variable, depending on the measurement scale used and the severity. Most studies suggest that the rate is 20% to 50%, with symptoms ranging from minor skin discoloration to chronic swelling and ulceration.1 However, the incidence of symptomatic PTS was less than 5% in a population of patients who underwent orthopedic hip and knee arthroplasty, regardless of whether they experienced symptomatic postoperative DVT.2
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Posaconazole: A New Triazole AntifungalPosaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
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“Mad Cow Disease”:What You-and Your Patients-Need to Know NowWhat is bovine spongiform encephalopathy(BSE), or “mad cow disease,” and how is itthought to infect cattle?
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Oropharyngeal candidiasis: Diagnostic clues, treatment tipsThe most common manifestation of oropharyngealcandidiasis (OPC) is pseudomembranous candidiasis, commonlyknown as "thrush," which appears as a whitish yellow,curdlike discharge on the mucosal surfaces. Other forms ofOPC include denture stomatitis, angular cheilitis, and glossitis.Patients with denture stomatitis are usually asymptomatic, butthe tissue beneath the denture is typically red and hyperplastic.Patients with angular cheilitis may complain of a burning sensationat the margins of the lips. Candidiasis involving thetongue can be exuberant and is usually associated with complaintsof a white tongue, taste alterations, and a burning sensationof the tongue. The diagnosis of OPC can be establishedby identifying typical fungal elements on potassium hydroxidepreparation or Gram stain of scraped material. Treatment optionsinclude clotrimazole, fluconazole, itraconazole, and nystatin.(J Respir Dis. 2008;29(3):128-135)
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ST-Segment Elevation Myocardial Infarction:What Role for Anticoagulants and Antiplatelet Agents?The goal of treatment in acute coronary syndromes is the restoration and maintenance of myocardial perfusion. To this end, numerous pharmacological agents are available, as well as percutaneous coronary intervention (PCI).
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Lipoprotein(a): A New Treatment Target?Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).
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Back Extension Exercises for Patients With OsteoporosisExercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.
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Bronze Skin in HemochromatosisA 60-year-old white man was evaluated for dyspnea on exertion. Hepatomegaly and abnormal skin pigmentation were noted, particularly in the upper extremities.
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Disseminated Intravascular Coagulation as an Unusual Presentation of Acute Retroviral SyndromeMultiple atypical presentations of acute retroviral syndromehave been reported in the literature, but rarely has acute retroviralsyndrome been associated with disseminated intravascularcoagulation (DIC). We detail a case of a 19-year-old manadmitted to the hospital with initially unexplained severe DICthat on workup was found to be secondary to acute retroviralsyndrome. [Infect Med. 2008;25:24-28]
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Biologics Are Changing the Face of Psoriasis TreatmentAs dermatologists' use of biologic drugs for psoriasis grows, MCOs must take an increasingly active role in managing the near-term utilization of these high-cost agents while also taking into account that some of the "payback" for these drugs comes in the form of long-term costs avoided. Meanwhile, physicians, insurers, and employers continue to wrestle with issues such as step-down dosing; step therapy; patient-administration versus physician-administration; and whether biologic drugs should be covered under a plan's pharmacy benefit, medical benefit, or some combination. (Drug Benefit Trends. 2008;20:143-147).
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Patient Goals Should Figure Prominently in Tx DiscussionsWanted: Physicians who will interact with patients the way a good financial counselor would.
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Chronic cough: Seeking the cause and the solutionThe major causes of chronic cough include upper airwaycough syndrome (UACS, formerly known as postnasal dripsyndrome), asthma, nonasthmatic eosinophilic bronchitis, andgastroesophageal reflux disease. In fact, one or more of these isthe cause of cough in the vast majority of nonsmokers who arenot receiving angiotensin-converting enzyme inhibitors andwho have no evidence of active disease on chest radiographs. Ahigh index of suspicion is required, because each of these conditionsmay present with cough as the sole symptom. BecauseUACS may be the most common cause, it appears reasonableto try empiric UACS therapy in patients in whom other causesare not evident at initial evaluation. In many cases, the combinationof a first-generation antihistamine and a decongestantmay be most effective. (J Respir Dis. 2008;29(3):113-122)
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Osteoarthritis of the Knee and Hip:For patients with osteoarthritis, nonpharmacologic treatment can be an effective adjunct to drug therapy. Patient education is essential; both community-based and independent self-care programs are available. Weight loss can improve function and alleviate symptoms; however, it is more effective when dietary modification is accompanied by increased physical activity.
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Unilateral Scleral Jaundice in an Elderly Man: An Odd FindingLeft scleral icterus is the only prominent physical finding in the 86-year-old who presented with transient aphasia, ataxia, and general asthenia. Can you dx?
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What Cause of Persistent Diarrhea and Weight Loss?A 28-year-old woman presents with a 4-month history of diarrhea and a 15-lb weight loss. She reports starting “another new diet” a few months ago but was in good health until these symptoms began. There is no family history of GI disease and no sick contacts. She denies recent travel.
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Man With Abdominal Bruit of Unusual OriginA 52-year-old man with a 29-year history of type 1 diabetes mellitus and mild diabetic retinopathy and nephropathy presents for a regular checkup.
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Young Woman With Cardiac Complications of Anorexia NervosaA 23-year-old woman has had 2 episodesof syncope during the past month.Her mother witnessed 1 episode inwhich the patient collapsed and lostconsciousness for a few minutes. Sheexperienced tonic-clonic seizure activitybut no subsequent confusion.
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What caused this woman’s pneumomediastinum?A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.
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GoutA 73-year-old man was admitted to the hospital with pain in his hands, feet, and elbows. The patient, an alcoholic, had a 20-year history of hypertension and diabetes. Deformities of the hands and feet had developed during the past 5 years. Tophi were present over both ear lobes. The serum uric acid level was 15 mg/dL.
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Jaundice:ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.
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An Elderly Woman With IgA Lambda Multiple Myeloma and Kidney DiseaseA 92-year-old woman presented with a 6-month history of progressively worsening fatigue, weight loss, generalized bone pain, and dyspnea on exertion. A skeletal survey found lytic lesions in the pelvis, sacrum, and calvarium (shown here).
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Intracranial Bleeding From Cerebral Amyloid AngiopathyA 59-year-old woman with chronic hepatitis C presented with abdominal pain that had grown progressively worse during the past 3 months.
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Common Shoulder Problems:Our goal here is to help you master the shoulder examination. We review the basics of the examination, and we evaluate emerging concepts in the diagnosis of the more common shoulder conditions.
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Pulmonary Embolism With Pulmonary InfarctionA 72-year-old woman had complained of shortness of breath for the past week. A CT scan showed a large filling defect in the left main pulmonary artery (Figure A, thin arrows) that extended into both the upper and lower branches. Another filling defect (not shown here) was seen along the posterior wall of the right main pulmonary artery, extending into the lower branch. These defects are compatible with pulmonary emboli.
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Foreign-Body Retrieval: Diamonds in the RugaeProgressive weakness, confusion, and decreased oral intake preceded hospital admission for this 73-year-old man with a history of Parkinson dementia and resection for esophageal adenocarcinoma. The real problem, seen here, was revealed on a chest x-ray film.
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Cytomegalovirus InfectionCough, fever, diarrhea, and weight loss had disturbed a 52-year-old woman for 1 month. AIDS had been diagnosed 5 years earlier, but she had declined medical treatment. The patient's vital signs were stable when she was admitted to the hospital. Physical examination results were unremarkable except for thrush and mild, diffuse abdominal tenderness.
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Diffuse alveolar hemorrhage in a patient with SLEThe authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.
