American family physician
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Cutaneous malignant melanoma accounts for 5% of cancer diagnoses and is the fifth most common cancer diagnosed in the United States. Risk factors for cutaneous malignant melanoma include ultraviolet radiation from sun exposure, Fitzpatrick skin type I or II, a history of dysplastic nevi, indoor tanning, older age, and a personal or family history of melanoma. The U. ⋯ Thin lesions with a Breslow depth of less than 0.8 mm usually do not need further treatment after wide local excision and have an excellent prognosis. Lesions with a Breslow depth greater than 0.8 mm may need further diagnostic tests or procedures, including sentinel lymph node biopsy, complete lymph node dissection, gene mutation analysis, and possible treatment with systemic immunotherapy. Use of systemic immunotherapies has improved the prognosis for advanced melanoma (stages III and IV), with 5-year survival rates of 74.8% and 35%, respectively, compared with 62.6% and 16% from 1975 to 2011 before immunotherapy was available.
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Postterm pregnancy is defined as a pregnancy that has reached 42 weeks' gestation and late-term pregnancy includes 41 weeks' and 0 days' to 41 weeks' and 6 days' gestation. Accurate first-trimester dating is essential for determining or verifying gestational age. Ideal management of late-term and postterm pregnancy involves shared decision-making on timing of planned delivery based on risks and preferences. ⋯ Induction of labor before 42 weeks' gestation decreases the risk of stillbirth, perinatal mortality, and cesarean delivery compared with expectant management. The American College of Obstetricians and Gynecologists suggests considering an elective induction of labor in low-risk, nulliparous patients starting at 39 weeks' and 0 days' gestation and recommends induction of labor in all patients by 42 weeks' gestation. The American College of Obstetricians and Gynecologists recommends antepartum monitoring of pregnancies beginning at 41 weeks' gestation to mitigate the risks of perinatal morbidity and mortality.
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American family physician · Oct 2024
ReviewInjections of the Hand and Wrist: Part I. Trigger Finger, First Carpometacarpal Joint Osteoarthritis, and Palmar Fibromatosis.
Family physicians are well-positioned to provide injections for patients who have pain due to hand and finger conditions, especially when initial treatments such as splinting and nonsteroidal anti-inflammatory drugs are ineffective. Corticosteroid injections can offer pain relief; however, potential risks such as infection, cartilage damage, and skin depigmentation should be discussed. ⋯ To maximize benefits of corticosteroid injection for carpometacarpal joint osteoarthritis, topical nonsteroidal anti-inflammatory drugs and other conservative treatment modalities should be used concurrently. Because of the risks of disease recurrence and adverse effects, corticosteroid injections for palmar fibromatosis should be approached with caution in the context of shared decision-making.