The American journal of the medical sciences
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Radiological evidence of presence of air or gas within the stomach wall is termed "gastric pneumatosis" and is considered an ominous sign. However, the etiological associations range from benign self-limiting causes to life-threatening emergencies. The authors report the case of gastric pneumatosis in a 34-year-old man who presented to the emergency department with severe abdominal pain after multiple episodes of vomiting. The authors also review the clinical associations of this uncommon condition and discuss risk stratification and management strategies.
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Overweight, obesity, pre-diabetes and diabetes have become epidemic in most of Western society. An estimated 25.8 million United States adults have diabetes and some 79 million have prediabetes and are thus at high risk for future development of diabetes. Appropriate treatment of the ABCs of diabetes [A1C, blood pressure and cholesterol (dyslipidemia)] can reduce the risk for the development and progression of diabetic complications. ⋯ Multiple studies have demonstrated that intensive glycemic control will reduce the risk for diabetes microvascular and neuropathic disease, but none showed decreased macrovascular disease events during the initial phase of the trials, although benefit was seen in long-term follow-up of the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association goals for glycemia informed by these studies indicate the importance of individualizing targets for patients based on factors including the duration of diabetes, presence of acute and chronic complications and life expectancy. Writing groups convened by these organizations have also developed treatment algorithms to help clinicians appropriately use both lifestyle and pharmacotherapy interventions to safely achieve glycemic targets.
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The value of measuring procalcitonin (PCT) in patients with community-acquired pneumonia (CAP) is unclear. The aim of this study was to determine the value of PCT as a marker for microbial etiology and a predictor of outcome in CAP patients. ⋯ High PCT levels indicate that pneumococcal pneumonia and PCT levels depend on the severity of pneumonia. PCT measurements may provide important diagnostic and prognostic information for patients with CAP.
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Gender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness (IMT) has not been studied in a biracial (black-white) community-based asymptomatic young adults. ⋯ Although men versus women had thicker IMT, the observed increasing trend of femoral IMT with increasing number of risk factors in asymptomatic young women suggests that women may be relatively more susceptible to the burden of multiple risk factors.
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Acute kidney injury (AKI) is a rare complication of carcinoid syndrome. A 61-year-old man developed carcinoid syndrome 51 months after pneumonectomy for bronchial carcinoid, and 8 episodes of AKI 101 to 118 months after pneumonectomy. Serum chromogranin A and urine 5-hydroxyindoleacetic acid levels were elevated for more than 1 year before AKI occurred. ⋯ Hyponatremia persisted but was more severe during AKI. Elevated plasma levels of vasoactive substances other than 5-hydroxytryptamine, perhaps dopamine or other catecholamines, could explain recurrent AKI. The natriuretic effect of elevated plasma dopamine levels could explain chronic hyponatremia.