American family physician
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Pretibial myxedema is a localized dermopathy seen in patients with past or present hyperthyroidism. Massive intradermal deposition of mucin (acid mucopolysaccharide) produces the classic indurated nodules or plaques on the anterior lower legs. ⋯ Mild pretibial myxedema requires no treatment. Topical, intralesional or systemic steroids may be useful in severe cases.
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House calls play a limited but important role in modern family practice. Family physicians make an average of two to six home visits a week for various reasons, including acute illness, terminal care, death pronouncement and hospital follow-up. The rationale for house calls includes enhancing the doctor/patient relationship, providing medical therapy, evaluating and reinforcing the patient's support system, and making an ecologic or family assessment.
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Beyond the age of 30, kidney size begins to decrease, and there are accompanying decreases in total renal blood flow, outer cortical flow, glomerular filtration rate and the ability both to conserve and to excrete sodium. There is also a decline in concentrating ability and possibly in diluting ability. These changes make the elderly patient more susceptible both to hyponatremic and to hypernatremic states.