Family Practice International

CLINICAL INFORMATION FROM THE INTERNATIONAL FAMILY MEDICINE LITERATURE



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Am Fam Physician. 2000 Nov 1;62(9):2132.

Eales Disease

(Canada—Canadian Family Physician, April 2000, p. 805.) Primary idiopathic retinal vasculitis (Eales disease) is a rare condition that usually affects men between 20 and 45 years of age in developing countries. Patients present with floaters and diminished visual acuity. On examination, bilateral vitreous hemorrhage and peripheral neovascularization of the retina may be found. Although the cause is unknown, Eales disease may result from a lack of antioxidants in the diet. The underlying pathology is likely to be perivasculitis leading to retinal nonperfusion, capillary dropout and retinal ischemia. In turn, this stimulates the formation of new blood vessels; however, these new vessels are friable and tend to bleed easily. Patients with Eales disease are generally healthy and have no systemic disease. Eales disease is usually treated with laser photocoagulation, but patients must be followed regularly because other retinal complications such as vitreous hemorrhage, retinal detachment and neurovascular glaucoma may develop.

Are Male Gender Roles Unhealthy?

(Canada—Canadian Family Physician, May 2000, p. 1005.) Across cultures and countries, men have consistently poorer health and tend to die at younger ages than women. The average difference in longevity of seven years is often attributed to men's reluctance to seek health care and their tendency toward risk-taking behaviors. In Western societies, four prominent male roles are thought to contribute to poorer health among men. The “No Sissy Stuff ” role requires men to be less emotionally expressive than women and, in particular, to hide vulnerability or emotional distress. Although this role is becoming less dominant in North America, it inhibits men from seeking help, particularly for psychologic needs. The “Big Wheel” role emphasizes power, success and social status. This role is characterized by extreme aggressiveness, hostility and type A behavior, and has been linked to increased mortality, particularly from coronary artery disease. In the “Sturdy Oak” role, men deny pain and symptoms as part of a pattern of self-reliance and sturdiness. Finally, the “Give Them Hell” role advocates aggression and risk-taking and may be linked to multiple adverse health consequences.

Management of Heel Pain

(Great Britain—The Practitioner, May 2000, p. 472.) The most common causes of heel pain are related to repeated stretching of the plantar fascia in the calcaneal area. Recurrent trauma may cause microtears in the plantar fascia, leading to an inflammatory reaction and plantar thickening. A tight Achilles tendon can predispose to plantar strain and may result from pathology of the plantar fascia. Most cases of Achilles tendonitis and plantar fasciitis are resolved quickly with a combination of appropriate physician advice, stretching, heel support and possibly medication and other therapy. Patients should perform stretching exercises three to four times per day in 10-minute sessions. Preformed silicone heel pads designed to absorb shock and distribute weight can provide significant pain relief. Because patients may require analgesia and nonsteroidal anti-inflammatory drugs to reduce inflammation, they should be monitored for potential side effects such as gastrointestinal bleeding. Management of severe pain may require steroid injection, below-knee casting, physical therapy, radiation therapy or surgery.

Management of Agoraphobia

(Great Britain—The Practitioner, May 2000, p. 444.) The term agoraphobia was originally applied to the excessive fear of open spaces but now includes the fear of crowds, especially if the patient perceives that there is no escape. Another type of agoraphobia is driving phobia—the fear of being trapped in heavy traffic. The various forms of agoraphobia account for about one third of the cases of phobia and are second only to simple phobias in prevalence. Agoraphobia is frequently associated with panic attacks. Patients may experience significant physical symptoms in addition to anxiety and distress. Agoraphobia may lead to severe occupational and social limitations; some patients may even become housebound. Behavior therapies are the basis of treatment, but patients with associated anxiety or depression may benefit from medications specific to their conditions. Benzodiazepines can relieve the distress associated with agoraphobia but have only a temporary effect. Withdrawal from benzodiazepines will exacerbate the symptoms of agoraphobia.


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