American family physician
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American family physician · Dec 2013
ReviewTesticular torsion: diagnosis, evaluation, and management.
Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children, and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Prompt recognition and treatment are necessary for testicular salvage, and torsion must be excluded in all patients who present with acute scrotum. ⋯ If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. There is typically a four- to eight-hour window before permanent ischemic damage occurs. Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy.
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Smell and taste disorders can be challenging to diagnose because of the large number of potential etiologies. Patients are often unable to provide a clear history of symptoms, because they frequently cannot distinguish between difficulties with smell and taste. Standardized questionnaires may be helpful in diagnosis. ⋯ Additional assessment such as cognitive testing, nasal endoscopy, computed tomography of the sinuses or nose, or brain magnetic resonance imaging may be indicated. Up to one-half of patients with olfactory dysfunction improve over time. Improvement in olfactory function is inversely correlated with severity and duration of loss, age, smoking, and male sex.
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The phylum Arthropoda includes arachnids and insects. Although their bites typically cause only local reactions, some species are venomous or transmit disease. The two medically important spiders in the United States are widow spiders (Latrodectus), the bite of which causes intense muscle spasms, and the brown recluse (Loxosceles), which may cause skin necrosis. ⋯ Flea bites are usually on ankles, whereas mosquito bites are on exposed skin, and chigger bites tend to be along the sock and belt lines. Antihistamines are usually the only treatment required for insect bites; however, severe mosquito reactions (skeeter syndrome) may require prednisone. Applying insect repellent containing diethyltoluamide (DEET) 10% to 35% or picaridin 20% is the best method for preventing bites.
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American family physician · Dec 2013
ReviewAssessment of asymptomatic microscopic hematuria in adults.
Although routine screening for bladder cancer is not recommended, microscopic hematuria is often incidentally discovered by primary care physicians. The American Urological Association has published an updated guideline for the management of asymptomatic microscopic hematuria, which is defined as the presence of three or more red blood cells per high-power field visible in a properly collected urine specimen without evidence of infection. The most common causes of microscopic hematuria are urinary tract infection, benign prostatic hyperplasia, and urinary calculi. ⋯ The upper urinary tract is best evaluated with multiphasic computed tomography urography, which identifies hydronephrosis, urinary calculi, and renal and ureteral lesions. The lower urinary tract is best evaluated with cystoscopy for urethral stricture disease, benign prostatic hyperplasia, and bladder masses. Voided urine cytology is no longer recommended as part of the routine evaluation of asymptomatic microscopic hematuria, unless there are risk factors for malignancy.
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Child abuse is the third leading cause of death in children between one and four years of age, and almost 20% of child homicide victims have contact with a health care professional within a month of their death. Therefore, family physicians are in an ideal position to detect and intervene in cases of suspected child maltreatment. There is currently insufficient evidence that screening parents or guardians for child abuse reduces disability or premature death. ⋯ Detailed documentation is crucial, and includes photographing physical examination findings. Physicians are mandated by law to report child abuse to the local child protective services or law enforcement agency. After a report is made, the child protection process is initiated, which involves a multidisciplinary team approach.