1/4. Stress and distress in clinical practice: a mind-body approach.Primary care physicians are often taxed by patient complaints that do not seem to have a clear etiology, nor do the patients improve despite good medications and expensive procedures. Current studies show that stress or distress may have a significant effect on the onset, the course, and the management of many, if not all, diseases. Understanding patient's underlying stress physiology and coping mechanisms may enable physicians to better understand various clinical disorders and treat their manifested symptoms. Evidence is reviewed by which stress may exacerbate or cause illness and by which behavioral medicine interventions can improve clinical outcomes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. epididymitis after prostate brachytherapy.OBJECTIVES: To analyze the incidence, time-course, and potential predisposing factors for what was clinically diagnosed as postimplant epididymitis. methods: Of 517 patients randomized and treated on two treatment protocols, with a planned total accrual of 1200, 5 patients were identified who developed clinically diagnosed epididymitis after iodine-125 or pallidium-103 prostate brachytherapy. Implants were performed by standard techniques, using a modified peripheral loading pattern. Perioperative antibiotics (cefazolin and ciprofloxacin) were given to 258 patients, according to physician preference. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological Association (AUA) and radiation Therapy Oncology Group criteria at 1, 3, 6, 12, and 24 months. patients who did not respond to the mailed questionnaires were interviewed by telephone. Although the patients were not queried specifically regarding epididymitis, its occurrence was noted when discovered in the course of follow-up examinations. RESULTS: Postimplant epididymitis occurred in 5 (1%) of 517 consecutive brachytherapy patients. None of the 5 patients had had a prior history of orchitis, epididymitis, vasectomy, or preimplant catheterization. The symptoms of epididymitis first appeared at 4, 7, 10, 150, and 300 days after implantation. patients with epididymitis had prostate volumes, preimplant AUA scores, and ages typical of other implant patients. No association was apparent between postimplant epididymitis and the degree of implant-related prostate swelling or the number of seeds implanted. Only the preimplant AUA score predicted for epididymitis, but 2 of the 5 patients had low scores. Only 1 (0.4%) of the 258 patients who received perioperative antibiotics developed epididymitis, and 4 (1.5%) of the 259 patients with prophylactic antibiotics developed epididymitis. CONCLUSIONS: epididymitis is an uncommon postimplant complication occurring in 1% of a large patient cohort. That epididymitis patients had greater preimplant AUA scores is consistent with a retrograde infection route, at least in some cases.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/4. A febrile child with seizure and hemiparesis.Febrile seizures are the most common neurological disorders in children and are among the more common symptoms that lead to an emergency department visit. Although most febrile seizures are simple and benign, these seizures can infrequently create a diagnostic dilemma. The diagnosis of cerebral venous thrombosis is challenging to emergency physicians because it can mimic the presentation of many other disorders, including ischemic and hemorrhagic stroke, tumor, and abscess. In addition, the broad variety of signs and symptoms makes the clinical diagnosis difficult. The patients may be presented with signs of increased intracranial pressure or focal neurological deficits. It is an uncommon but potentially dangerous cause of hemiparesis after seizure. Early recognition of this condition and appropriate management may reduce the mortality rate. We present a young child with dural sinus thrombosis who presented with seizures associated with fever and subsequent hemiparesis, and explained a possible mechanism of focal neurological deficit.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/4. Dental treatment and management of a patient with a prosthetic heart valve.The american heart association committee recognizes that their regimens do not cover all situations. Each patient should be evaluated individually. The necessity for parenteral therapy or oral erythromycin to continue for 48 hours after all dental procedures should be reevaluated on a case-by-case basis. On the other hand, if the dental manipulation involves an infected site, perhaps antibiotic therapy should be continued until signs of the inflammation subside. dentists and physicians must use their clinical judgement in prescribing antibiotics. However, as Kaye proposed, any deviation in prescribing antibiotics should be in the direction of higher doses or more effective antibiotics. In addition, practitioners must provide adequate patient education and follow-up. Unfortunately, a negligent dentist, a physician giving poor or inadequate advice, or a patient not following instructions may turn a simple dental procedure into a life-threatening situation and potential tragedy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |