American family physician
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Paraphimosis is a urologic emergency, occurring in uncircumcised males, in which the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue. Often iatrogenically induced, paraphimosis can be prevented by returning the prepuce to cover the glans following penile manipulation. Treatment often begins with reduction of edema, followed by a variety of options, including mechanical compression, pharmacologic therapy, puncture technique and dorsal slit. Prevention and early intervention are key elements in the management of paraphimosis.
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Patients who provide care to family members or friends with dementia are likely to be in a family physician's practice. The caregiver role can be stressful, and identifying these patients can give the family physician opportunities to help patients cope with the challenges of the caregiver role. Family physicians have a systematic approach for assessing the degree of caregiver burden in these patients. ⋯ The caregiver's skill in managing behavioral problems in the family member with dementia should be assessed. If there are problems, family physicians should provide practical counseling about common caregiving stresses and about resources that benefit caregivers. Helping the caregiver learn strategies for coping with difficulties may help reduce some of the stress the caregiver is experiencing.
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American family physician · Dec 2000
Review Case ReportsMass psychogenic illness: role of the individual physician.
Mass psychogenic illness is characterized by symptoms, occurring among a group of persons with shared beliefs regarding those symptoms, that suggest organic illness but have no identifiable environmental cause and little clinical or laboratory evidence of disease. Mass psychogenic illness typically affects adolescents or children, groups under stress and females disproportionately more than males. ⋯ They can spread rapidly by apparent visual transmission, may be aggravated by a prominent emergency or media response, and frequently resolve after patients are separated from each other and removed from the environment in which the outbreak began. Physicians should consider this diagnosis when faced with a cluster of unexplained acute illness.
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Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. If these homeostatic mechanisms are overwhelmed by factors such as infection, the patient may decompensate into myxedema coma. ⋯ Most authorities recommend treatment with intravenous levothyroxine (T4) as opposed to intravenous liothyronine (T3). Hydrocortisone should be administered until coexisting adrenal insufficiency is ruled out. Family physicians are in an important position to prevent myxedema coma by maintaining a high level of suspicion for hypothyroidism.