Family Practice International

CLINICAL INFORMATION FROM THE INTERNATIONAL FAMILY MEDICINE LITERATURE



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Am Fam Physician. 2001 Jan 15;63(2):374.

Rubella (German Measles)

(Australia—Australian Family Physician, July 2000, p. 631.) While immunization has greatly reduced the incidence of rubella, physicians must still be aware that this disease can be disastrous during pregnancy. The infection is frequently subclinical; if symptoms occur, they may be vague and difficult to diagnose. Lymphadenopathy behind the ears and in the occipital area is common and is followed in five to 10 days by a fine, pink rash that starts on the face and spreads to the rest of the body. Adults may have additional symptoms, including arthralgia, arthritis and conjunctivitis. Because several viruses can cause similar syndromes, IgG and IgM antibody titers are recommended to identify cases and begin appropriate public health measures.

Diagnosis and Treatment of Hemospermia

(Great Britain—The Practitioner, September 2000, p. 778.) Hemospermia usually presents as acute, fresh blood staining of the ejaculate and causes considerable concern for patients. It can occur in men of any age and can be caused by a number of conditions, such as inflammation, previous surgery or instrumentation, benign or malignant tumors, ductal obstruction and cysts, vascular abnormalities, and systemic diseases or medications. A thorough history may indicate the cause. The patient should be asked how the hemospermia was observed, because bleeding that originates in the sexual partner can be misinterpreted as hemospermia. A test in which the ejaculate is collected in a condom may be necessary to verify that the ejaculate contains blood. Physical examination should be directed to the potential local and systemic causes of hemospermia and should include genital and rectal examination. Targeted testing of the blood and urine is generally performed. If a cause is not found, other investigational tools, such as transrectal ultrasound examination, may be used. Treatment and prognosis of hemospermia depend on the cause. Many cases remain idiopathic and resolve spontaneously.

Treatment of Diabetic Retinopathy

(Great Britain—The Practitioner, August 2000, p. 696.) Retinal changes are present at diagnosis in most older patients with type 2 diabetes mellitus (formerly known as non–insulin-dependent diabetes mellitus), and 15 years after diagnosis, 95 percent of patients with type 1 diabetes mellitus (formerly known as insulin-dependent diabetes mellitus) have pathologic changes in the eye. The prevalence and severity of diabetic eye disease can be reduced with good glycemic control in both types of diabetes. Appropriate laser treatment can reduce the risk of blindness from retinopathy in up to 95 percent of patients. Laser therapy is less effective for maculopathy and prevents blindness in only 60 to 70 percent of patients. Aspirin and ticlopidine have been shown to slow pathologic changes in retinopathy, but clinical trials have had disappointing results. Other medications that have been studied but have not shown therapeutic benefit in patients with diabetic retinopathy include aminoguanidines, aldose-reductase inhibitors and antioxidants. Growth hormone antagonists and antihypertensives, angiotensin-converting enzyme inhibitors and beta blockers are currently being studied. Pending new treatments, the mainstay of prevention and management of diabetic eye disease remains screening and appropriate glycemic control.

Metformin Therapy for PCOS

(Great Britain—The Practitioner, August 2000, p. 679.) Approximately 6 percent of women develop polycystic ovarian syndrome (PCOS) during their reproductive years, making it the most common endocrine condition affecting this group. Patients with PCOS have increased concentrations of free testosterone, raised levels of serum luteinizing hormone and markedly decreased sensitivity to insulin. Many patients develop high body mass indexes, increased insulin resistance, impaired glucose tolerance and overt diabetes mellitus. As insulin increases the secretion of androgen by stimulating ovarian stromal growth and augments the action of luteinizing hormone, treating insulin resistance could improve ovarian function and address the problems in glucose metabolism. One study of metformin therapy in women with PCOS found that insulin sensitivity increased, levels of serum testosterone and insulin decreased, and frequency of menstrual function was restored in those who were treated with metformin, while no changes occurred in the women who received placebo. Metformin could become an important part of the management of PCOS in addition to weight loss, anti-androgens and oral contraceptive agents.



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