• Articles

    Abnormal Uterine Bleeding

    KATHLEEN A. ORIEL, SARINA SCHRAGER

    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.

    Drug Treatment of Common STDs: Part I. Herpes, Syphilis, Urethritis, Chlamydia and Gonorrhea

    CAROL WOODWARD, MELANIE A. FISHER

    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 of the Hip and Knee

    FRANK J. FRASSICA, MEENESH A. BHIMANI, EDWARD F. MCCARTHY, JAMES WENZ

    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.

    An Approach to Diagnosis and Initial Management of Systemic Vasculitis

    DOUGLAS W. ROANE, DONALD R. GRIGER

    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: A Practical Review

    VIJAY RAJPUT, STEVEN M. BROMLEY

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

    Clinical Utility of the Erythrocyte Sedimentation Rate

    MALCOLM L. BRIGDEN

    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.

    Parvovirus B19 Infections

    CAMILLE SABELLA, JOHANNA GOLDFARB

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

    Issues in Newborn Screening for Phenylketonuria

    RICHARD K. KOCH

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

    Management of the Hyperosmolar Hyperglycemic Syndrome

    ROBERT MATZ

    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.

    The Home Visit

    BRIAN K. UNWIN, ANTHONY F. JERANT

    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.

    Inside AFP

    Contributions for ‘Practical Therapeutics’ from a Military-Based Residency

    Janis Wright

    “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...

    AAFP News Now: AFP Edition

    Newsletter

    Rosemarie Sweeney, Verna L. Rose

    Lanny Copeland, M.D., president of the American Academy of Family Physicians (AAFP), joined President Bill Clinton and Health and Human Services Secretary Donna Shalala at a White House event in September. The purpose of the event, held on the day Congress returned from its...

    Quantum Sufficit

    Quantum Sufficit

    Monica A. Preboth

    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...

    Editorials

    Thinking About Sexually Transmitted Diseases

    GEORGE SCHMID

    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...

    Medical Care in the Home

    GEORGE TALER

    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...

    Diary from a Week in Practice

    Diary from a Week in Practice

    “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

    White Patch on Back

    Marc S. Berger, SYLVIA HSU

    A 42-year-old man presented with a life-long history of an asymptomatic white patch on the left side of his back (see the accompanying figure). He stated that the patch was more prominent after exercise. On physical examination, a large, nonscaly, pale patch on his back was...

    Tips from Other Journals

    Does Soy Protein Provide the Same Benefits as Estrogen?

    BARBARA APGAR

    Small Breast Carcinoma and Lymph Node Dissection

    KARL E. MILLER

    Effect of Thyroid Hormone Treatment on Bone Density

    RICHARD SADOVSKY

    Prevention of First Stroke: Current Recommendations

    GRACE BROOKE HUFFMAN

    Single-Dose Ceftriaxone for Acute Otitis Media

    RICHARD SADOVSKY

    Adverse Effects of Inhaled Corticosteroid Therapy

    BARBARA APGAR

    Evaluating Bruising in Toddlers and Infants

    JEFFREY T. KIRCHNER

    Oxybutynin in the Treatment of Urge Incontinence

    KARL E. MILLER

    Considering Futility of Care: Report of a Fair Process

    GRACE BROOKE HUFFMAN

    Varicella-Zoster Virus Infection: Recent Advances

    RICHARD SADOVSKY

    Diagnosing and Treating Lichen Sclerosus

    ANNE D. WALLING

    Comparing Therapies for Chronic Plaque-Like Psoriasis

    BARBARA APGAR

    Is Asymmetric Breast Tissue a Sign of Malignancy?

    BARBARA APGAR

    How Safe and Effective Are Sunscreen Products?

    BARBARA APGAR

    Digital Rectal Examination in Children with Constipation

    JEFFREY T. KIRCHNER

    Selecting an Antibiotic for Acute UTI in Women

    GRACE BROOKE HUFFMAN

    Diagnosing Pneumonia Using Physical Examination

    BARBARA APGAR

    Detection of Intrauterine Pathology Before HRT

    BARBARA APGAR

    Dehydroepiandrosterone Replacement in Older Patients

    RICHARD SADOVSKY

    Managing Low High-Density Lipoprotein Cholesterol Levels

    RICHARD SADOVSKY

    Should We Revise Anemia Parameters for the Elderly?

    GRACE BROOKE HUFFMAN

    Bedrails in the Hospital: Are They a Necessary Evil?

    GRACE BROOKE HUFFMAN

    Combination Therapy for Rheumatoid Arthritis

    ANNE D. WALLING

    An Overall Review of Functional Somatic Syndromes

    RICHARD SADOVSKY

    Vertical Transmission of HIV and Mode of Delivery

    JEFFREY T. KIRCHNER

    Family Practice International

    Family Practice International

    Anne D. Walling

    (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...

    Curbside Consultation

    Approaching a Terminally Ill Patient in Denial

    KAREN OGLE

    I met the patient, a 57-year-old farmer with end-stage cancer, while covering for a colleague on leave. The patient, accompanied by his wife, had been making frequent office visits for the management of severe pain and progressive weakness. He was seething with anger at his...

    Special Medical Reports

    ACC, AHA and ACP–ASIM Develop Guidelines for Angina

    Sharon Scott Morey

    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...

    Clinical Briefs

    Clinical Briefs

    Verna L. Rose

    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...

    Resident and Student Voice

    ‘Be the Doctor, Always’

    JAMES D. TOOMBS

    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...

    Physician's Bookshelf

    Book Reviews

    NINA R. BIRNBAUM, SYLVIA M. DOBO

    Also Received

    Letters to the Editor

    Clinical Criteria as a Preliminary Screen for Cervical Spine Injury

    Speech and Language Problems in International Adoptees

    Information from Your Family Doctor

    When You Have Abnormal Uterine Bleeding

    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

    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.

    When You Can't Sleep

    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.”

    Corrections

    Corrections

    Corrections

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    Disclosure

    All editors in a position to control content for this activity, AFP journal, are required to disclose any relevant financial relationships. View disclosures.


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