American family physician
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American family physician · Sep 2000
ReviewCervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons.
Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in older persons. The aging process results in degenerative changes in the cervical spine that, in advanced stages, can cause compression of the spinal cord. ⋯ The diagnosis is confirmed by magnetic resonance imaging that shows narrowing of the spinal canal caused by osteophytes, herniated discs and ligamentum flavum hypertrophy. Choice of treatment remains controversial, surgical procedures designed to decompress the spinal cord and, in some cases, stabilize the spine are successful in many patients.
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Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. ⋯ Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.
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Each year, a number of children and adolescents die suddenly from cardiac problems that are associated with a small subgroup of disorders and high-risk behaviors. While sudden cardiac death in any child or adolescent is distressing, it can be particularly devastating when it occurs in a seemingly healthy young athlete. ⋯ To prevent the occurrence of sudden death or cardiovascular disease progression in young athletes, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine have developed or endorsed recommendations for cardiovascular screening of student athletes as part of a comprehensive sports preparticipation physical evaluation (PPE). Knowledge and understanding of these recommendations can help physicians make informed decisions about the eligibility of an athlete to participate in a particular sport and encourage development of a more uniform PPE screening process.
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American family physician · Aug 2000
Review Case ReportsPolymyalgia rheumatica and temporal arthritis.
Polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions that affect different cellular targets in genetically predisposed persons. Compared with temporal arteritis, polymyalgla rheumatica is much more common, affecting one in 200 persons older than 50 years. Temporal arteritis, however, is more dangerous and can lead to sudden blindness. ⋯ Therapy is generally continued for six to 24 months. Throughout treatment, clinical condition is assessed periodically. Patients are instructed to see their physician immediately if symptoms recur or they develop new headache, jaw claudication or visual problems.