Gallbladder Agenesis<div style="padding: 7px; width: 170px; float: left;"><img src="http://www.consultantlive.com/image/image_gallery?img_id=1484698&t=1257452484772" alt="" align="right" width="170" hspace="2" vspace="2" border="0"></div><p>A 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis<strong></strong>. The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits, or urinary symptoms. <span class="article-text"><span></span></span></p>
Demodicidosis<div id="article-content-body"><p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1484660&t=1258577785810" width="150" height="92" style="margin: 2px 8px; float: left;">For several months, a 43-year-old woman had erythematous plaques on the cheeks that were more prominent on the right side. The patient had no pruritus but reported occasional facial burning. She had tried over-the-counter lotions but no medicated or corticosteroid topical preparations. She was otherwise healthy and was currently taking no medications.</p></div>
Sleep Apnea, sleep<p><span style="color: #33cccc;"><span style="font-size: x-large;"><strong></strong></span></span>I understand that patients with refractory hypertension have a high risk of obstructive sleep apnea (OSA) syndrome. Can this be screened for in an office setting?</p>
- Since HCV infection is chronic and can lead to cirrhosis, decisions regarding its management, referral, and follow-up are of the utmost importance.
Dehydration<p><span class="article-text"><span>A strict definition of “dehydration” is a relative absence of water as manifested by hypernatremia. However, patients who are dehydrated are usually also volume-contracted; I prefer the latter term for a patient who has experienced vomiting, diarrhea, or decreased intake. Volume contraction denotes the need for replacement with saline equivalents, whereas dehydration indicates the need for water—and only possibly saline as well.</span></span></p>
Heart failureThe role of coenzyme Q10 in the development of heart failure and as a potential treatment is still being studied.
Type 1 Diabetes, Complications of Diabetes Mellitus<p><img src="http://www.consultantlive.com/image/image_gallery?img_id=1483172&t=1257181031524" width="150" height="179" style="float: left; margin-left: 8px; margin-right: 8px;"></p><p><span class="article-text"><span>Chronic diseases and multiple comorbid conditions can be a frustrating part of any primary care day. Health care professionals work hard and are long overdue to see the “fruits” of their many labors. One area in which progress and personal satisfaction have been particularly slow in coming is the day-to-day management of diabetes. Often, the tragic litany of amputations, blindness from retinopathy, sudden death from coronary disease, and dialysis for failed kidneys was the only consistent refrain. But that has changed, and now is the time to say, “A job well done!”<sup>1</sup></span></span></p>