October 1, 1999

Determining the cause of abnormal uterine bleeding requires a systematic approach based on the most probable differential diagnosis for premenopausal, perimenopausal and postmenopausal age groups.

This two-part article reviews Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases. In part I, recommendations for treatment of genital ulcer diseases, urethritis and cervicitis are discussed.

Pigmented villonodular synovitis is an uncommon disease process characterized by joint effusion, elevation of the capsule, hyperplastic synovium and low signal intensity on magnetic resonance imaging. The diagnosis is confirmed through biopsy.

Clinical features of systemic vasculitis depend on the organs involved and, in turn, organ involvement is largely influenced by the size of the affected blood vessels.

Chronic insomnia often has multiple concurrent causes. Most patients benefit from behavioral approaches that focus on good sleep habits.

The erythrocyte sedimentation rate remains useful in the diagnosis and monitoring of a few conditions but should not be used as a general screening tool or as an indicator of occult disease in the absence of clinical evidence.

Although parvovirus B19 infection usually causes only mild illness, it can cause arthropathy, aplastic anemia, hydrops fetalis and fetal death.

The blood sample for phenylketonuria (PKU) screening should be obtained at least 12 hours after delivery.

In patients with uncontrolled diabetes, an altered state of consciousness is almost always due to severe hyperosmolar hyperglycemia. Treatment is the prompt, rapid administration of crystalloids, with tonicity appropriate to the level of hyperosmolarity.

Well-planned home visits can lead to improved medical care through the discovery of unmet health care needs. A simple mnemonic device can help physicians remember the areas to assess during these visits.

“The Home Visit,” by Brian K. Unwin, MAJ, MC, USA, and Anthony F. Jerant, M.D., on page 1481 of this issue, represents the first in a new series of articles wearing the “Practical Therapeutics” label. Each year, two different medical faculties contribute articles to this series…

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

Did you know that education shapes your figure as well as your future? The Harris Poll, cited in USA Today, found that people who don't have a high school diploma are more likely to weigh 20 percent or more above the recommended weight for their height. And, those who possess…

In this issue of American Family Physician, the treatment of sexually transmitted diseases (STDs) is concisely reviewed by Woodward and Fisher,1 who used for reference the “1998 Guidelines for Treatment of Sexually Transmitted Diseases,” published in January 1998 by the Centers…

Home care has enjoyed a resurgence over the past 10 years. The growth in home care has been fueled by several factors: the growth of managed care and Medicare's Prospective Payment System, which have reduced the length of hospital stays; liberalization of Medicare coverage…

“Dr. Hartman, will you see an emergency?” was the urgent request. “Sure, what is it?” JRH replied. “A young girl is wearing a ring, and the finger is starting to swell.” Thus began an interesting episode in the daily excitement of a family physician's office. The young girl…

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

(Canada—Canadian Family Physician, May 1999, p. 1229.) Bipolar disease is uncommon in community-based elderly persons, but it is associated with significant morbidity and mortality. The prevalence in this group is estimated to be less than 0.1 percent, compared with at least 1…

Denial is a common coping mechanism for those facing a terminal illness—most people use denial to one degree or another, denying some aspects of their illness at least some of the time.

The American College of Cardiology (ACC), the American Heart Association (AHA) and the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) have developed recommendations for the management of chronic stable angina. The new guidelines encourage…

No strong evidence is available to recommend routine cord blood banking for an infant's future use, according to a policy statement from the American Academy of Pediatrics (AAP) that was published in the July 1999 issue of Pediatrics. The AAP states that no accurate estimates…

Often, I tell my friends and classmates that anything I do somehow relates to either flying or medicine. Before I decided to become a family physician, I enjoyed a minor career as an Army pilot. As I pursue my medical career, I am often surprised at how many situations relate…

Also Received

In many women, a hormone imbalance causes bleeding. These women may have too much estrogen or not enough progesterone. Polyps or fibroids (small and large growths) in the uterus can also cause bleeding. Cancer of the uterus and infection of the cervix are other causes of…

Pigmented villonodular synovitis (called PVNS for short) is a joint problem that usually affects the hip or knee. It can also occur in the shoulder, ankle, elbow, hand or foot.

Sleep is a necessary part of life, like food and water. Your body refreshes itself during sleep, so it can work well during the day. The word “insomnia” means “unable to sleep.”