April 1, 1999

Clinical manifestations of gout include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis of this disease is based on the identification of zuric acid crystals in joints, tissues or body fluids.

Radiographic imaging during pregnancy is often necessary for the health of the mother and has an acceptable safety profile. Nonurgent radiologic testing, however, should be avoided between 10 and 17 weeks of gestation, the most sensitive time for central nervous system…

Some common presentations of chronic abdominal pain in children are reviewed, with special emphasis on etiology and management of functional abdominal pain, constipation and peptic disease.

In addition to screening for cancer, cerebrovascular disease and cardiovascular disorders, women over 65 years of age should undergo recommended health screening for hearing and vision loss, functional impairment, osteoporosis, depression and other conditions that contribute to…

Adhesive capsulitis is an idiopathic condition that restricts shoulder movement. Nonsteroidal anti-inflammatory drugs, physical therapy and local injections remain the mainstay of treatment and may improve the functional outcome.

Feeding difficulties in association with tachypnea, sweating and subcostal recession, or severe growth impairment should raise the index of suspicion for congenital heart disease.

Topical agents remain the mainstay of glaucoma therapy. Dorzolamide, brinzolamide, brimonidine and latanoprost are promising new agents.

Multiple myeloma is the most common primary bone cancer in adults. Patients with multiple myeloma commonly present with bone pain, but a pathologic fracture is the presenting feature in up to 30 percent of cases.

Ischemic rest pain is typically described as burning pain in the arch or distal foot that occurs while the patient is recumbent. An ankle-brachial index of 0.4 or less suggests the presence of critical limb ischemia.

Despite a variety of potential etiologies, insomnia can be successfully treated with pharmacologic or behavior interventions.

Dr. Jay Siwek, AFP's editor, and his wife, Linda, posing in front of the Emperor's palace in the Forbidden City, Beijing, during a recent tour with the National Symphony Orchestra.

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

Black physicians tend to die an average of eight years earlier than white physicians, according to information cited in Family Practice News. The main causes of death in black physicians are myocardial infarction, stroke, cancer, homicide, alcohol and drug abuse, accidents and…

Providing appropriate preventive care for elderly persons is a growing challenge for family physicians. In the year 2000, persons over age 65 will constitute 12.7 percent of the total U.S. population, and persons over age 85 will make up 1.5 percent of the population.1 Among…

A local family physician who is a tai chi master has taught WLL and some of our patients about the health benefits of this ancient Chinese martial art. WLL became interested in tai chi after one of his elderly patients had several falls and a broken hip. Her daughter had read a…

Photo Quiz presents readers with a clinical challenge based on a photograph or other image.

(Australia—Australian Family Physician, November 1998, p. 1041.) The cough reflex generates blasts of air with a velocity of up to 800 km per hour to clear the trachea and large bronchi. The reflex is activated by mechanical or chemical irritation of the respiratory epithelium…

Larry faces a challenging and increasingly common dilemma. As the population ages and extended families are scattered far apart, many of us will have aging parents who become ill while living a long distance away. I recently had an experience similar to Larry's as I cared for…

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has revised its recommendations for the prevention of human rabies in the United States. The previous recommendations on rabies prevention were published in 1991. The…

The Committee on Child Abuse and Neglect of the American Academy of Pediatrics (AAP) has updated the 1991 guidelines for the evaluation of children in whom sexual abuse is suspected. The guidelines are published in the January 1999 issue of Pediatrics. The following highlights…

Data from San Francisco's annual behavioral survey among men who have sex with men and disease reports from sexually transmitted disease clinics in San Francisco from 1994 to 1997 document significant increases in self-reporting of unprotected anal intercourse and in rates of…

A few years ago, in his president's address to the Association of American Medical Colleges, Dr. Jordan J. Cohen shared his vision of the future of academic medicine. Among the points he stressed were the importance of establishing true partnerships between medical schools and…

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Gout is a kind of arthritis caused by too much uric acid in the joints. The acid causes joint pain.

Yes, x-rays are generally safe in pregnancy. If your doctor finds you need x-rays for a medical problem or injury, it's OK to have them. It's better for your baby that you be healthy. In fact, your medical problem may be more harmful to your baby than the x-rays.

If you can't move your shoulder around like you used to, you could have adhesive capsulitis (say: add-he-sive cap-sool-eye-tis). When it hurts to move your shoulder or you don't have as much movement in your shoulder as before, your shoulder may become “frozen.” Because of this…

A congenital heart disease is one that a baby is born with.

Glaucoma eyedrops are generally safe, but be sure to tell all your doctors that you're using them. These eyedrops are medicines. Like most medicines, they can have side effects (like dizziness or troubled breathing), or they might not work well with other medicines you may take…

Multiple myeloma (say: mull-tip-ul my-el-oh-ma) is a kind of cancer. It's caused when cells in the bone, called “plasma cells,” grow too much. When this happens, the plasma cells kill the bone around them. The plasma cells also make too much of something called “immunoglobulins…

This handout describes some simple things that you can do to help your insomnia. Follow these tips each night. Don't be worried if it takes a week or two before you can tell a difference.