American family physician
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American family physician · Dec 1992
Review Case ReportsMercury toxicity. Agency for Toxic Substance and Disease Registry.
Because mercury has several forms and because it produces subtle effects at chronic low-level exposures, mercury toxicity can be a difficult diagnosis to establish. Elemental mercury vapor accounts for most occupational and many accidental exposures. The main source of organic methyl mercury exposure in the general population is fish consumption. ⋯ The central nervous system and kidneys are key targets of mercury toxicity. Chelation therapy has been used successfully in treating patients who have ingested mercury salts or inhaled elemental mercury. There is no antidote for patients poisoned with organic mercury.
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American family physician · Dec 1992
ReviewClinical and imaging evaluation of the solitary pulmonary nodule.
Management of a solitary pulmonary nodule remains a common clinical problem. The main goal of management is to choose a diagnostic and therapeutic scheme that is appropriately matched to the patient's clinical risk of malignancy. Clinical risk can be estimated from consideration of data on the overall prevalence of malignancy in solitary pulmonary nodules in various populations, the size of the pulmonary nodule, the patient's age and the patient's history of smoking. ⋯ Suspicious nodules require further evaluation. The approach for patients at low clinical risk for malignancy may be clinical and radiographic observation, while that for patients at moderate to high risk for malignancy may be needle biopsy or thoracotomy. Whenever possible, the patient should be encouraged to participate in the decision-making process concerning the management of this clinical problem.
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American family physician · Dec 1992
ReviewCombining insulin and oral agents in diabetes: indications and controversies.
Patients with noninsulin-dependent diabetes demonstrate peripheral insulin resistance that is aggravated by increased hepatic glucose production and results in elevated serum insulin and serum glucose levels. These levels can be affected by intensive diabetic management, including diet, exercise, lifestyle modifications and insulin or sulfonylurea therapy. Sulfonylureas stimulate endogenous insulin production, increase peripheral sensitivity to insulin and suppress hepatic glucose production. In spite of its added expense, increased potential for side effects and questionable efficacy, combination therapy with insulin and a sulfonylurea is often considered in noninsulin-dependent diabetics with difficult-to-control disease.