Biomedical subjects
Publications and source records attributed to F T Fitzgerald.
In view of the conflicting data, the patent cultural biases under which we labor, and the possible harmful effects of therapy, it seems best that physicians examine the problems of obesity with the same keen scepticism and science they apply to other unsettled issues. To treat disease in the obese is obviously good. To treat simple obesity as a disease may be another matter entirely.
Hypoglycemia is but one of a number of causes of hypothermia, but is important to keep in mind as a possible precipitating or concurrent event even in those cases in which there are other obvious explanations for decreased body temperature (exposure, alcoholism, starvation, sepsis or hypothyroidism). Hypoglycemia may occur in as many as 40 percent of very cold patients, and be clinically unrecognized because symptoms are masked by the hypothermia itself. Although serum glucose levels are depressed, a cold-induced renal tubular glycosuria may occur. Glucose in the urine, therefore, cannot be used as assurance of hyperglycemia in a hypothermic patient. And, although cold protects against serious end organ damage from hypoglycemia by decreasing tissue metabolic need for glucose, a serum specimen should be drawn for glucose determination in all hypothermic patients and a 50 percent glucose solution immediately given intravenously. If this is not done, serum glucose levels may plummet as the patient is rewarmed and begins to shiver.
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Explore the source record for details and available documents.
The incidence of syphilis, after declining for several years, increased by 23% in the first quarter of 1987. The authors reviewed the charts of 100 patients with syphilis in order to determine how such patients were managed in a university setting. Although 77 patients met Centers for Disease Control (CDC) indications for lumbar puncture, only 11 patients had the procedure. Most patients for whom treatment was indicated either were not treated or were treated with inadequate or incorrect medications. Only 30 patients received follow-up serologic tests, and of these, only one received follow-up at the intervals recommended by the CDC. This study indicates that physicians may either be unfamiliar or disagree with the current CDC guidelines for evaluation and management of patients with syphilis. Physicians should know these guidelines and document their reasoning if they choose not to follow them. Long-term follow-up of patients with syphilis is important to ensure effective treatment and to increase understanding of this disease.