1.
Aphthous ulcers are very commonly seen by all family physicians, but
remember that if these occur in a patient who is not otherwise healthy
and has got ‘systemic symptoms’, or ulcers elsewhere like
genital or skin involvement, connective tissue diseases like Behcet’s,
SLE or polyarteritis nodosa should be thought of.
2. Raynaud’s phenomenon is often seen in female
patients in private practice. But, remember that if a patient has
no positive family history and has a systemic symptom like fever,
weight loss, joint pain, skin lesions or involvement of mucous membranes,
then in such a case make a diagnosis of either SLE or scleroderma.
However, the latter can be confirmed clinically only.
3. Unilateral oedema of leg due to DVT is extremely
common and is seen everyday in private practice, but remember that
the dozen conditions listed below rarely present as so-called case
of DVT. These are:-
1. Hansen’s disease
2. Polyarteritis nodosa
3. Wagner’s disease
4. Behcet syndrome
5. Antiphospholipid syndrome
6. Angio-oedema
7. Lymphoedema
8. RSD (Reflex Sympathetic syndrome)
9. Iatrogenic oedema
10. Acute gout
11. Acute cellulitis
12. Oedema due to loss of elasticity of skin (especially in patients
aged more than 60 years).
4. Tuberculosis is extremely common in our country,
but in every patient whose response to AKT is even slightly odd look
for HIV infection or connective tissue disorder or fungal infection.
5. Bronchial asthma : Many patients of asthma respond
very well to modern treatment, but there are some bad asthmatics.
In every bad asthmatic exclude allergic broncho pulmonary aspergillosis,
tropical eosinophilia or allergic vasculitis.
6. Angina Pectoris is a very common disease but I have seen
more than a dozen patients, where an angiography was straight away
carried out which was normal. A diagnosis of HOCM was missed because
a 2D-Echo was not done.
7. Examination of nails often shows pitting for no obvious
cause but in a patient of rheumatoid arthritis, the diagnosis would
go in favour of psoriatic arthritis.
8. Hypertension is a very common disorder, but if associated
with albumin in urine, rule out chronic glomerular nephritis with
small contracted kidneys seen on sonography. If a patient has systemic
symptoms rule our polyarteritis nodosa. Finally, of course if on a
full clinical examination a bruit is heard over renal vessels, a diagnosis
of renal artery stenosis should be made.
9. MSK diseases are musculo skeletal diseases due to connective
tissue disorders, which can be often mistaken for common muscle sprains
and disc pains etc.
10. Iatrogenic illnesses can mimic anything.
11. Hypo and hyperthyroidism can cause any of the
MSK like symptoms.
12. Osteomalacia can cause any of the MSK disease
symptoms.
13. Sarcoidosis/Hansen’s disease can also cause
any MSK disease symptoms.
14. Finally, a malignancy anywhere in the body can
present with common illnesses like DVT or MSK disease symptoms.
NOS
AND THE FAILING HEART
‘Altered regulation (of nitric oxide) may be important in
the pathophysiology of cardiac dysfunction in human congestive
heart failure’
Excessive myocardial production of nitric oxide (NO) derived from
nitric oxide synthase (NOS), has been postulated to contribute
to cardiac depression in congestive heart failure. Thibaud Damy
and colleagues investigated the role of myocardial neuronal NOS
in the pathophysiology of human congestive heart failure. The
investigators showed increased neuronal NOS in the failing human
heart providing evidence of its role in the pathophysiology of
cardiac dysfunction. Joshua Hare suggests that focusing on subcellular
localisation of NOS isoforms and their specific signalling effects
will continue to shed light on this confusing and controversial
topic.
Lancet, 2004; 4 : 1338,65. |
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital,
Mumbai 400 008.
