American family physician
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Chronic pelvic pain in women may involve more than the gynecologic organ systems. Urologic, gastrointestinal, musculoskeletal and psychiatric disease processes may be contributing factors, the majority of which can be treated medically. A thorough history and physical examination are often all that is necessary to initiate effective treatment. A multidisciplinary approach to management will recognize the interactive process of the biopsychosocial model that may act to produce chronic pelvic pain.
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Although thrombolytic therapy is used in a variety of settings, it has gained the most prominence in the treatment of myocardial infarction. The effectiveness of thrombolytic agents in reducing mortality in patients who present with myocardial infarction has been clearly demonstrated by large-scale studies. ⋯ It is now recommended that all patients who have appropriate electrocardiographic changes and present within 12 hours of the onset of acute myocardial infarction be considered for thrombolytic therapy. Factors such as age and history of previous myocardial infarction are no longer viewed as barriers to treatment.
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Wide complex tachycardias are cardiac rhythm disorders with three or more consecutive beats, rates exceeding 100 beats per minute and a QRS duration of 120 msec (0.12 second) or greater. The width of the QRS complex should be verified in a number of leads, since the QRS complex often appears mistakenly narrower (i.e., a QRS duration of less than 120 msec) in one or two of the 12 leads. Most wide complex tachycardias are ventricular tachycardia, and they are managed with antiarrhythmic drugs and correction of serum potassium and magnesium levels. ⋯ The cause of a wide complex tachycardia must be identified, because certain therapies can result in potentially fatal arrhythmias. If the cause cannot be determined, a test dose of intravenous adenosine can be used. Another approach is intravenous administration of procainamide and a beta-adrenergic blocker.
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Transient synovitis is the most common cause of acute hip pain in children three to 10 years of age. Children with this condition typically present with hip pain for one to three days, accompanied by limping or the refusal to bear weight. Transient synovitis has an uncertain etiology and remains a diagnosis of exclusion. ⋯ Hip aspiration is the diagnostic procedure of choice if septic arthritis is suspected. Treatment of transient synovitis consists of bed rest and nonsteroidal anti-inflammatory drugs, with regular temperature checks to exclude the onset of fever. If significant pain and limping persist seven to 10 days after the initial presentation, the patient should be reevaluated.