American family physician
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Sarcoidosis is a multisystemic disorder of unknown etiology that most commonly affects adults between 20 and 40 years of age. Patients with sarcoidosis frequently present with bilateral hilar lymphadenopathy and pulmonary infiltration, and often with ocular and skin lesions. ⋯ Sarcoidosis is also characterized by distinctive laboratory abnormalities, including hyperglobulinemia, an elevated serum angiotensin converting enzyme level, evidence of depressed cellular immunity manifested by cutaneous anergy and, occasionally, hypercalcemia and hypercalciuria. Glucocorticoids remain the mainstay of therapy when treatment is required, although other anti-inflammatory agents are being used increasingly often.
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American family physician · Nov 1998
ReviewAcute sinusitis: a cost-effective approach to diagnosis and treatment.
Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. The diagnosis is based on the patient's history of a biphasic illness ("double sickening"), purulent rhinorrhea, maxillary toothache, pain on leaning forward, pain with a unilateral prominence and a poor response to decongestant therapy. Radiographs and computed tomographic scans of the sinuses generally are not useful in making the initial diagnosis. ⋯ First-line antibiotics such as amoxicillin or trimethoprim-sulfamethoxazole are as effective in the treatment of sinusitis as the more expensive antibiotics. Little evidence supports the use of adjunctive treatments such as nasal corticosteroids and systemic decongestants. Patients with recurrent or chronic sinusitis require referral to an otolaryngologist for consideration of functional endoscopic sinus surgery.
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American family physician · Nov 1998
Editorial CommentComplications of epidural analgesia during labor.
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Epidural analgesia is a commonly employed technique of providing pain relief during labor. The number of parturients given intrapartum epidural analgesia is reported to be over 50 percent at many institutions in the United States. The procedure has few contraindications, the primary ones being patient refusal, maternal hemorrhage and coagulopathy. ⋯ Retrospective studies have demonstrated an association between epidural analgesia and increases in duration of labor, instrumental vaginal delivery and cesarean section for labor. However, several recent prospective studies have concluded that epidural analgesia does not adversely affect the progress of labor or increase the rate of cesarean section. These remain controversial issues among practicing physicians.