August 1, 1999

Diabetic ketoacidosis remains a common cause of hospitalization. Use of treatment algorithms and flow sheets can prevent errors in the management of this “routine” medical emergency.

Family physicians should remain alert to the presence of unusual diseases in patients returning from travel outside the United States, including malaria, amebiasis and cutaneous larva migrans.

Current pharmacologic methods for cervical ripening and induction are reviewed, with a focus on the use of misoprostol.

Primary dysmenorrhea is a common problem in young women. Nonsteroidal anti-inflammatory drugs and oral contraceptives are the treatments of choice.

Reactive arthritis is the most common inflammatory polyarthritis in young men. Initial treatment consists of high dosages of potent nonsteroidal anti-inflammatory drugs.

The authors describe a patient with endogenous endophthalmitis caused by Staphylococcus aureus. A review of the literature is presented, with emphasis on diagnosis and management.

Every year, more than 3 million persons are injured in motor vehicle accidents. A number of victims have chronic post-traumatic stress symptoms. An awareness of patient characteristics and pre-accident functioning enhances evaluation of these symptoms.

Early identification and treatment of acute HIV syndrome may halt disease progression and restore immunocompetence.

In its early stages, Peyronie's disease may resolve spontaneously; however, patients with advanced disease should be referred for urologic consultation about surgical options.

Most children with heart murmurs do not have cardiac disease. A complete examination, including precordial palpation, auscultation of the two heart sounds and listening for systolic and diastolic murmurs, can determine patients who require referral or can be followed by the…

For the best outcome, a patient with a soft tissue sarcoma more than 5 cm in diameter or located in a difficult area should be sent to a cancer referral center.

Family physicians can help protect teenagers by counseling them about workplace health and safety issues.

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Society for Adolescent Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of…

This issue of AFP contains two special features: a new series of articles developed in collaboration with the American Diabetes Association (ADA), and a new department containing handy collections of patient information handouts. The cover article, “Management of Diabetic…

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

Businesses are beginning to purchase defibrillators to enhance their first-aid kits, according to The Wall Street Journal. These automated external defibrillators (AEDs) have voice prompts and offer a computerized analysis of the victim's condition. They come with drawings that…

In this issue of American Family Physician, Perlmutter and colleagues1 carefully discuss the diagnosis and treatment of persons newly infected with human immunodeficiency virus (HIV-1). Certain aspects of this topic merit additional comment.

On the surface, it seems reasonable to advise physicians to suspect early human immunodeficiency virus (HIV) infection when clinically indicated and to be prepared to intervene with antiretroviral therapy. However, this premise is fraught with pitfalls and challenges for…

In recent years, there has been recognition that if the cervix is unfavorable, labor will rarely progress successfully to a vaginal delivery. Bishop attempted to define parameters of successful or failed labor induction with a cervical scoring system. Successful outcomes of…

WLL has found that many patients who participate in outdoor activities do not take precautions against poison ivy, poison oak and poison sumac before they go into potentially contaminated areas. He has found that most patients do not realize that there are steps they can take…

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

(71st Annual Scientific Sessions of the American Heart Association) Results from the Atorvastatin Versus Revascularization Treatments (AVERT) trial revealed that patients with stable coronary artery disease receive significant cardiovascular benefit through aggressive reduction…

(Great Britain—The Practitioner, March 1999, p. 203.) Pruritus is common in older patients, with 29 to 50 percent of persons 75 years of age reporting chronic or recurrent skin irritation and itching. Localized pruritus in elderly patients usually involves the scalp, trunk…

Girls in Somalia are circumcised before the age of five years, usually by female family members, although it is also performed legally there in some hospitals. Uncircumcised women are seen as unclean.

The American Academy of Pediatrics (AAP) has released guidelines for the diagnosis, treatment and follow-up evaluation of urinary tract infections in infants and toddlers. Published in the April 1999 issue of Pediatrics, the recommendations apply specifically to children two…

The American Academy of Family Physicians (AAFP), the American Medical Association (AMA) and nine other medical societies have issued a joint health alert calling for more extensive use of immunization to combat increasingly resistant strains of bacteria that cause pneumonia…

The percentage of American teenagers who are practicing abstinence or who use condoms is increasing, according to a survey from the Centers for Disease Control and Prevention (CDC) published in the June 4, 1999, issue of Morbidity and Mortality Weekly Report. The CDC analyzed…

Book Review | Also Received

Sometimes it's safer to deliver your baby before you go into natural labor. Your doctor could use medicines to make your labor start “early,” so you can deliver your baby vaginally. This is called “labor induction.” Or it might be better for you not to go into labor at all and…

Reactive arthritis is an uncommon disease that can make your joints hurt and swell. It can also cause rash, fever, weight loss, heart problems, red eyes and blurry vision. Since pain in the joints is one of the most common symptoms, this condition is called reactive arthritis…

Each year over 3 million Americans have traffic accidents. If you've had an accident, you might have had a lot of reactions at the time of the accident and in the days following it. Some of these reactions might be:

HIV syndrome is a name for the early stage of HIV infection, when you first get infected with the HIV virus. HIV stands for human immunodeficiency virus. These are some of the symptoms of acute HIV syndrome:

Peyronie's disease is a big name for a curve in the penis. (Peyronie's is said this way: pay-roneees.) It can be painful at times, most often during sex. In some men, Peyronie's disease is a mild problem without symptoms. Other men with Peyronie's disease may have pain during…

A heart murmur is just a noise that the blood makes as it flows through the heart. It's like the noise water makes when it flows through a hose. Many healthy people have heart murmurs. About 80 percent of all children have a heart murmur at some time.

Yes, you may be. Every year about 70 teens in the United States die as a result of injuries at work. Another 70,000 teens are hurt on the job and have to go to a hospital or emergency department. Teens are often injured on the job because of unsafe equipment, because they were…

Diabetes is a disease that occurs when your body doesn't make enough insulin or doesn't use insulin the right way. Insulin is a hormone that helps your body use sugar (glucose) for energy. Because your body has a problem with insulin, sugar builds up in your blood. Your body…

Insulin is a hormone that controls the level of blood sugar (also called glucose) in your body. People with diabetes may not have enough insulin or may not be able to use it properly. The sugar builds up in the blood and overflows into the urine, passing out of your body unused…

Exercise can help control your weight and may lower your blood sugar level. It also lowers your risk of heart disease, which is common in people who have diabetes. Regular exercise can also improve your overall health and well-being.

What you eat affects your blood sugar level, so you need to make wise food choices. Work with your doctor to develop a diet that meets your needs. For most people, a healthy diet consists of 40 to 60% of calories from carbohydrates, 20% from protein, and 30% or less from fat.