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Am Fam Physician. 1998;57(7):1681

Adjuvant Therapy in Osteoarthritis

(Great Britain—The Practitioner, December 1997, p. 763.) Modern management of osteoarthritis emphasizes individualized exercise programs, judicious use of medications and, eventually, consideration of surgery. When the knee is affected, taping and injections may relieve symptoms. Patellar taping may be useful in patients with anterior knee pain and wasting of the quadriceps muscle. Athletic knee supports also may provide relief of localized anterior knee pain. The removal of effusion and intra-articular injection of lidocaine or corticosteroids, alone or in combination, may reduce symptoms but should not be used more than four times per joint per year. Bursitis can mimic or worsen osteoarthritis of the knee or hip. Management of bursitis with exercise, nonsteroidal anti-inflammatory drugs or lidocaine injections can relieve pain and improve function. In all patients with osteoarthritis, management of other health conditions such as obesity, hypertension and diabetes is important to improve health and prepare for eventual surgery.

Management of Acute Stroke

(Australia—Australian Family Physician, October 1997, p. 1151.) Approximately 30 percent of strokes are fatal, and up to another one third of strokes result in permanent disability. The expectant management strategies that have been implemented previously are being replaced by more aggressive treatment protocols in the hope of improving these outcomes. The early recognition and evaluation of stroke, specifically with the use of noncontrast computed tomographic (CT) scanning, is essential. Since up to one half of CT scans may be negative during the early stages of ischemic stroke, comprehensive expert evaluation of patients is required. Maintenance of appropriate oxygenation, hydration and glycemic level is important in early stroke, but aggressive lowering of blood pressure is contraindicated since higher pressures may assist cerebral perfusion. Brain swelling leading to raised intracranial pressure usually peaks around three to five days after acute stroke and should be treated with mannitol or decompression. Seizures are common, especially in the early stages of stroke, and most can be controlled with anticonvulsant medication. Studies of thrombolysis with streptokinase showed high rates of mortality and complications from hemorrhage, but thrombolysis may benefit the subset of patients who can undergo complete evaluation within three hours of the onset of symptoms and who have no evidence of hemorrhage or structural lesions. Antiplatelet and anticoagulant therapy may be used to prevent recurrent stroke in selected patients.

Incidence of Food Poisoning

(Great Britain—The Practitioner, December 1997, p. 752.) It is believed that food poisoning, while underreported, is becoming more common and that more serious new forms of the condition may be developing. Salmonella and Campylobacter are the most frequently implicated organisms in cases of food poisoning. Clostridium has been implicated in more than one half of outbreaks involving contaminated red meat. Various subtypes of Escherichia coli and viruses are also important pathogens. The incubation period depends on the organism and may last from a few hours to over a week. The clinical picture ranges from a subclinical or mild illness to severe illness and even death. In mild cases of food poisoning, only symptomatic and supportive therapy, particularly hydration, are necessary. Antimotility drugs are contraindicated in children and may delay toxin elimination in all patients. Microbiologic diagnosis is occasionally needed to guide therapy or in cases that are the subject of epidemiologic or legal investigation.

Management of Postpolio Syndrome

(Australia—Australian Family Physician, September 1997, p. 1055.) Patients who apparently recovered from acute polio more than 25 years ago may experience a new onset of symptoms. New pain in the thorax, back or soft tissues is a common complaint, as are muscle cramps that disturb sleep. Sleep disruption, which may be a result of multiple causes, is reported by 80 percent of patients. Patients also report excessive fatigue, muscle weakness, reduced exercise tolerance and hypersomnolence. Many patients have a morbid fear of respiratory failure. In addition to physical symptoms, psychologic distress is common and has been attributed to the combined effects of prolonged hospitalization at a young age, disability, fear of recurrent symptoms and other factors. Patients should be offered psychologic support and thorough investigation to identify the cause of symptoms and any comorbidities. They should then be offered individualized expert management strategies.

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