American family physician
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Latrodectus mactans has now invaded towns and cities. The spider's venom is a neurotoxin that causes little local reaction but produces pain and spasm in large skeletal muscle groups within 30 minutes to three hours after the bite. ⋯ Muscle relaxants are useful in treatment, as is calcium gluconate. Antivenin is indicated for high-risk victims, such as those with hypertension and persons younger than 16 or older than 60 years of age.
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Hemorrhoids are frequently seen by family physicians. Prolapse and painless bleeding are the symptoms most commonly experienced by patients with internal hemorrhoids. ⋯ The procedure is safe and effective, and can be performed in the physician's office. Contraindications include infection, chronic liver or bowel disease, clotting disorders and significant thrombosis.