Endocrinology

ABSTRACT: A 4-pronged approach that includes patient education, skin and nail care, appropriate footwear, and proactive surgeries can effectively prevent diabetic foot problems. Teach patients with diabetes to examine their feet daily to detect new onset of redness, swelling, breaks in the integrity of the skin, blisters, calluses, and macerated areas. Have them follow a daily foot care regimen that includes warm water soaks and lubrication, and have them keep toenails properly trimmed. Recommend that patients select shoes that fit properly and have sufficient padding and toe box space; have them use inserts, lifts, orthoses, or braces--as recommended-to correct abnormal gait patterns. Finally, if deformities develop, simple proactive surgical procedures can correct these problems before they result in the development of wounds.

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

HOUSTON -- For establishing the tumor status of women with breast cancer, a gene-expression microarray appears to have accuracy approaching standard tests, researchers found here.

DALLAS -- Galvus (vidagliptin), an investigational oral dipeptidyl peptidase IV-blocker (DPP-4) for type 2 diabetes, was as effective as a rosiglitazone at glycemic control, without associated weight gain, reported researchers here.

A 75-year-old woman had undergone a total thyroidectomy, with histologic evidence of poorly differentiated follicular thyroid cancer. She subsequently received an ablative dose of iodine-131. After a disease-free interval of about 2 years, she presented with evidence of recurrence in the thyroid bed. She had enlarged cervical lymph nodes and complained of dyspnea on exertion.

In his recent editorial Putting Guidelines for Chronic Kidney Disease IntoPractice (CONSULTANT, October 2006, page 1295), Dr Gregory Ruteckidiscussed the results of a study that shows many clinicians fail to follow evidence-based guidelines for the management of chronic kidney disease(CKD), such as when to consult a nephrologist.1 A sampling of the feedbackwe received appears below, along with Dr Rutecki's responses.

During a routine diabetes follow-up visit, a 55-year-old man complains of increasing pain in his right groin and hip. He is also being treated for hypertension, and his body mass index is 28.

DENVER -- Three cases of prepubertal gynecomastia have raised red flags about the estrogenic-like and anti-androgen effects of tea tree oil and lavender, two popular additives in soaps and lotions.

A 63-year-old man presented for his annual eye examination. He has had type 2 diabetes for the past 20 years and takes glipizide.

FREIBURG, Germany -- Long-acting release Sandostatin (octreotide) seems to have no benefit for hepatocellular carcinoma either in clinical outcomes or quality of life, German researchers discovered.

A 54-year-old woman reported a red jagged area of new onset in her right eye, along with many dark red spots and streaks in that eye. She also felt that her vision had become blurrier in that eye.

I very much appreciated Dr Douglas Ross's article, Subclinical Hypothyroidism: When to Treat, When to Watch (CONSULTANT, September 1, 2006, page 1121), and I have several questions for him.

On a warm August day, a 79-year-old man is hospitalized because of progressive lethargy over the past week. Previously, he was alert and able to converse. He has no chest pain, dyspnea, or cough. His history includes hypertension of unknown duration, chronic obstructive pulmonary disease, and a recent hospitalization for pneumonia.

An 80-year-old woman has a 3-month history of increasing dysphagia (withboth solids and liquids), fatigue, and dyspnea on exertion. She has also involuntarilylost 50 lb during the same period. She reports no abdominal pain orchange in bowel function.

A 47-year-old woman complains ofepisodic headaches that began severalmonths earlier and are accompaniedby sweating, flushing, abdominal pain,and vomiting; these attacks have progressivelyworsened. She takes no medicationsand denies fever, chills, andnight sweats. The medical history isunrevealing.

A 52-year-old woman presents with a3-month history of a tender, erosivedermatitis on the nipples and in thevulvar/perineal region. Can youidentify these lesions?

A 78-year-old widower with hypertension, type 2 diabetes, and hyperlipidemiais referred for a comprehensive geriatric assessment.His daughter is concerned about her father’s decline following her mother’s death a year ago.His memory seems to be deteriorating. His desk is cluttered with bills, but he refuses to lethis daughter help him or even look at his checkbook.

A 67-year-old man complains of a lesion on the floor of his mouth that hasenlarged over the past year. When he touches the lesion, it bleeds easily andis friable and intermittently tender. The lesion has been present for manymonths; initially, it was a painless whitish area. The patient has no other lesionsin his mouth, and he has no dysphagia, dysarthria, or other problemsthat indicate oral dysfunction.

For several days, a 35-year-old woman has had a swollen, painfulfinger. She is otherwise healthy and has no significant medical history.

For 3 months, a 41-year-old womanhas had a pruritic acneiform eruptionon the lateral aspects of the neck andthe left side of the face. She is otherwisehealthy and takes no medication.

Q:Do evidence-based data support combination therapy with anangiotensin-converting enzyme (ACE) inhibitor and an angiotensin IIreceptor blocker (ARB)?

Your middle-aged patientwith type 2 diabetes wishesto start a weight-trainingprogram. What recommendationswill you offerhim? Another diabetic patient hasperipheral neuropathy; which exercisesare safest for her?

The FDA has approved a new syntheticconjugated estrogen formulation(Enjuvia), from Duramed Pharmaceuticals,for the management ofmenopausal vasomotor symptoms.This product is the only plant-derivedsynthetic conjugated estrogen compoundthat includes the componentdelta 8,9-dehydroestrone-an activeestrogenic compound.

The FDA has approved the use ofan estradiol transdermal system(Menostar), from Berlex LaboratoriesInc., to prevent osteoporosis in postmenopausalwomen. The hormoneis impregnated in a dime-sized, once a-week patch that delivers 14 μg/d ofestradiol: this dosage is half that ofother currently available transdermalestrogen patches. No supplementaryprogestin therapy is generally needed.This product can be prescribed for women who are without a uterus.The most common side effects areirritation at the patch site, joint pain,and leukorrhea.

Cataracts areone of themost importantcauses ofreversibleblindness in elderly persons.1 A recent report thatpredicts a surge in cataractincidence has heightenedawareness of the importanceof proper timing andtechniques for cataract extraction.The study, authoredby the Eye DiseasesPrevalence ResearchGroup, estimated that thenumber of Americans withcataracts will increase byapproximately 50% in thenext 20 years as the populationages.2 Cataracts werethe leading cause of low vision(less than 20/40 bestcorrected visual acuity inthe better-seeing eye)among whites, blacks, andHispanics.

For several weeks, a 68-year-old man has had painful blisterson his hands that crusted as they healed. The patienthas diabetes mellitus, hypertension, and chronic renalfailure, for which he is undergoing hemodialysis. His longtermmedications include a hypoglycemic agent and adiuretic.

A 62-year-old woman was found on thefloor of her bathroom at home with herwheelchair partially on top of her.She was unresponsive except to painfulstimulus.

A 62-year-old woman presents with severe, sharp pain in her right mid chestthat worsens when she breathes. The pain began the previous night, shortlyafter she had been awakened by a shaking chill, followed by the sensationof fever. She also has a relatively nonproductive cough of recent onset.

When sterile saline is needed for repeatedhome use (eg, for daily cleansingof a foot ulcer), suggest thatthe patient buy an over-the-counter,

The Ottawa ankle rules are said to help in ruling out ankle fractures and cuttingdown on needless ordering of roentgenograms. How effective are they in differentiatingbetween strain or sprain and inflammatory or noninflammatory arthritis inthe ankle?