March 15, 1999

Control of hypertension, increased physical activity and smoking cessation should be goals for all patients. Patients who are at high risk for coronary heart disease should also undergo therapy aimed at reducing cholesterol levels.

Current recommendations for the diagnosis, evaluation and management of urinary tract infections and vesicoureteral reflux in children are reviewed.

Amyotrophic lateral sclerosis is an idiopathic, progressive neuromuscular disease that usually presents with minor problems in gait, dexterity, speech or swallowing.

Although most patients with suicidal ideation do not ultimately commit suicide, the family physician must determine the extent of ideation, including the presence of a plan and the means to commit suicide.

Adult circumcision is generally performed in an outpatient setting under local anesthesia. Two common techniques include the dorsal slit and the sleeve method.

Taking a nutrition history is essential for improving patients' dietary habits and offering nutritional guidance. The practical approach outlined here helps physicians incorporate nutrition into a standard medical history and raise their patients' awareness of the importance of…

Flexible sigmoidoscopy is a valuable screening procedure that family physicians can perform in their practices.

Vulvodynia is a syndrome of unexplained vulvar pain frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The pain has an acute onset and usually becomes a chronic problem lasting months to years.

If drug therapy fails to control tremor, thalamic stimulation may be a consideration in patients with essential tremor, as well as patients with Parkinson's disease.

Strategies to reduce the occurrence of child abuse that may be implemented by family physicians include helping parents meet their basic needs, identifying problems of substance abuse and spousal abuse, and educating parents about childhood behavior, discipline, safety and…

Deficiencies of iron, vitamin B12 and folic acid are among the most common causes of anemia. Once a definitive diagnosis is made, patients with these forms of anemia can be readily managed in the ambulatory setting.

Low-molecular-weight heparin has been determined to be as effective as standard heparin or warfarin for prophylaxis and treatment of deep venous thrombosis. It does not require monitoring of the activated partial thromboplastin time or International Normalized Ratio and can be…

Many potential authors ask how they should go about getting published in AFP. If you are thinking of writing a clinical review article, you might begin by doing a little groundwork. A good place to start is the “Information to Authors” section in each issue (see page 1698…

Selected policy and health issues news briefs from AAFP News Now.

Most contact lens wearers have occasionally lost a lens, but it usually either turns up right away or is gone forever. However, one lost lens had a different twist of fate. Six years after one woman lost her contact lens, an ophthalmologist found it intact and uninfected…

The June 1998 issue of FP Report contained a special section on end-of-life care that was essentially a plea for family physicians to fill the end-of-life care void.1 We increasingly hear that the process of dying is not optimal in America.2 As life expectancy increases, high…

This morning, while diagnosing and treating a patient with acute bronchitis, JTL used the occasion to counsel this young father about the benefits of quitting smoking. “That sure would make my little boy happy, since he's been hounding me so much!” remarked the patient. After…

(26th Annual Meeting of the North American Primary Care Research Group) An office-based program that offers collaborative care with a primary care physician, a nurse and a social worker to elderly patients with chronic conditions and functional deficits living in the community…

(Great Britain—The Practitioner, November 1998, p. 743.) Symptoms of rheumatoid arthritis may present suddenly or may take years to develop into a full clinical picture. The distinction between rheumatoid arthritis and degenerative arthritis is based on the pattern of joint…

New guidelines for women with epilepsy have been issued by the American Academy of Neurology (AAN). A summary statement of the practice parameter was published in the October 1998 issue of Neurology. It is accompanied by a review of the literature referable to the management of…

New guidelines from the Centers for Disease Control and Prevention (CDC) outline the proper evaluation and treatment of tuberculosis in individuals infected with human immunodeficiency virus (HIV). These guidelines update previous CDC recommendations for the diagnosis…

In an educational bulletin published in the October 1998 issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists (ACOG) discusses the management of adolescent victims of sexual assault (ACOG Educational Bulletin No. 252). The report covers…

A technology assessment report from the Agency for Health Care Policy and Research (AHCPR) concludes that several testosterone-suppressing drugs used in the treatment of advanced prostate cancer have similar outcomes. The drugs, known as luteinizing hormone-releasing hormone…

Letter

Coronary heart disease (also called CHD) is sometimes also called coronary artery disease. Arteries carry blood to your heart. When fatty material builds up in the arteries, it blocks or slows the flow of blood and oxygen. This can happen in any artery, but when it happens in…

A urinary tract infection (called “UTI” for short) refers to an infection anywhere in the urinary tract. The urinary tract is made up of the kidneys, the ureters (tubes that drain urine from the kidneys to the bladder), the bladder and the urethra. The kidneys remove waste from…

Good health comes from eating a well-balanced diet. This means making sure you regularly eat foods that have a lot of vitamins and minerals in them, as well as foods that are not high in fat. You should drink milk every day to give your bones the calcium that makes them strong…

Vulvodynia (say: vul-vo-din-ee-a) is the word for pain in the vulva. The vulva is the external genital area in women—the area around the vagina. The pain is usually described as a burning, stinging, itching, irritating or raw feeling. Sexual intercourse, walking, sitting or…

Being a parent can be a joy, but it's also a tough job. No parent is perfect. We all make mistakes. Even loving parents sometimes do things they don't mean to do, like slap a child or call a child a bad name. But if you think you're having trouble controlling yourself, get help…