By Stuart B. Mushlin MD, Harry L. Greene II MD
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Unintentional weight loss in the United States. Am J Epidemiol 1995;142:10. Sahyoun NR, Serdula MK, Galuska DA, et al. The epidemiology of recent involuntary weight loss in the United States population. J Nutr Health Aging 2004;8(6):510–517. Wise GR, Craig D. Evaluation of involuntary weight loss. Where do you start? Postgrad Med 1994;95:4. Yaari S, Goldbourt U. Voluntary and involuntary weight loss: associations with long term mortality in 9,228 middle-aged and elderly men. Am J Epidemiol 1998;148(6):546–555.
Patients with a positive history of lower extremity edema should undergo IPG, Doppler study, or venography of the lower extremity. Again, a positive study result may suggest venous thrombosis, with treatment for this. A negative study result may suggest lymphatic obstruction. This can be evaluated with lymphangiography. References Berczeller PH. Idiopathic edema. Hosp Pract (Off Ed) 1994;29:115. Braunwald E. Edema. In Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed.
In addition, the combination of FOBT and flexible sigmoidoscopy is preferable to either of these tests alone. The age of discontinuation is again not clear, but most organizations agree that it should be decided based on comorbid conditions that limit life expectancy. The Canadian guidelines recommend including annual or biennial FOBT (Grade A) and flexible sigmoidoscopy (Grade B) in the periodic health examination of patients >50 years. They do report that there is insufficient evidence to make recommendations about the combination of these screening tests or about the use of colonoscopy (Grade C).