1/5. Waxing and waning gynecomastia: an indication of noncompliant use of prescribed medication.We present two cases of recurrent gynecomastia in men enrolled in a placebo-controlled trial evaluating the efficacy of finasteride in treating benign prostatic hyperplasia. When the pharmacologic records were examined, it was apparent that the breast tissue hyperplasia diminished when the patients become noncompliant with their study medication and then resumed therapy. Because of the difficulty in obtaining accurate data on an individual's ability to maintain a consistent pharmacologic regimen, we believe that observing such "waxing and waning gynecomastia" may provide the physician with a clue regarding a patient's actual compliance with certain medications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.The significant increase in the use of alternative medicine in general and the herbal and dietary supplement in particular represents a challenge to the health care professionals. Because of their unregulated use, physicians are encountering increasing numbers of toxicities and untoward events. We report a case of severe intraoperative haemorrhage in a patient who was taking the herb Saw Palmetto. His bleeding time which was prolonged, normalized few days after he stopped the herb. This case should increase the awareness of physicians to such possible complications and encourage them to enquire thoroughly about the use of any dietary supplement in all their patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/5. "Alphabet soup" and the prostate: LUTS, BPH, BPE, and BOO.The patient described, though not typical, is one among many of those of the aging male population in whom their primary care physicians will increasingly diagnose diseases affecting the prostate gland. Primary care physicians then will offer first-line therapy not only for prostatic diseases but also for concurrent sexual and erectile dysfunction. This brief primer for primary care physicians "unscrambles" the alphabet in a "soup" of initialisms and acronyms for lower urinary tract symptoms, benign prostatic hyperplasia, benign prostatic enlargement, and bladder outlet obstruction.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/5. Managing patients with benign prostatic hyperplasia.Benign prostatic hyperplasia is the usual cause of prostatism--irritative and obstructive urinary symptoms. Steps in making the diagnosis include a focused neurologic examination, urinalysis, serum creatinine determination and, possibly, catheterization to detect urinary retention. It is difficult to predict the likelihood of future complications, such as complete urinary obstruction, even for patients with severe symptoms. The natural course of prostatism is a waxing and waning of symptoms. Treatment options are watchful waiting, medication, transurethral prostatectomy, and newer surgical treatments such as microwave thermopathy and laser ablation. The family physician can counsel patients about the potential side effects of these treatments as well as the problems incurred by simply adjusting to the disabilities associated with benign prostatic hyperplasia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Fatal and nonfatal hepatotoxicity associated with flutamide.OBJECTIVE: To identify and describe patients with hepatotoxicity possibly caused by flutamide, an antiandrogen drug. DESIGN: Case series of reports, submitted to the Adverse Drug Event Reporting System of the food and Drug Administration. SETTING: Outpatient clinics and physicians' offices in the united states. patients: Nineteen patients treated with flutamide for prostate cancer or benign prostatic hypertrophy (for Investigation of a New Drug or off-label use). MEASUREMENTS: Evidence of increased liver enzyme levels, hyperbilirubinemia, associated clinical symptoms, and diagnoses of cholestatic hepatitis. autopsy reports were used when available. RESULTS: From the time of marketing of flutamide in February 1989 through March 1991, the food and Drug Administration received reports of 19 patients in the united states who developed serious hepatotoxicity while using flutamide. Fourteen patients had resolution of abnormal liver function test results after discontinuing or decreasing the dose of flutamide, but five patients died of progressive liver disease. autopsy reports from three patients and abnormal pathologic results from three other patients (reported to the food and Drug Administration or in the medical literature) showed hepatocellular necrosis and possibly cholestasis. Thorough work-ups excluded other possible causes than flutamide. CONCLUSIONS: flutamide appears to cause hepatotoxic effects in certain patients. Physicians should tell patients to immediately report to physicians nausea, vomiting, fatigue, jaundice, and other signs and symptoms of liver injury.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |