American family physician
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American family physician · Jan 1996
ReviewRecognizing primary biliary cirrhosis and primary sclerosing cholangitis.
Nonsuppurative cholangiopathies such as primary biliary cirrhosis and primary sclerosing cholangitis are chronic cholestatic liver diseases that result from inflammation of the biliary system. Recent advances in management options for patients with primary biliary cirrhosis and primary sclerosing cholangitis have facilitated treatment by family physicians. Patients with significant laboratory abnormalities on liver tests for cholestasis should be evaluated for possible primary biliary cirrhosis or primary sclerosing cholangitis. Investigation with liver biopsy and endoscopic retrograde cholangiopancreatography should be considered if abnormal biochemical findings remain unexplained after a careful history and physical examination are performed, a thorough medication history is obtained and abdominal ultrasonography is conducted to search for biliary obstruction.
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American family physician · Dec 1995
Glaucoma: early detection and therapy for prevention of vision loss.
Glaucoma is the second most common cause of permanent blindness in the United States and the most common cause of blindness among blacks. It is characterized by optic atrophy and vision loss, resulting from intraocular pressure that is too high to allow normal function of the optic nerve. ⋯ Although glaucoma is a chronic disease, ocular complications can be prevented and sight may be preserved if the disease is detected early. A combination of antiglaucoma medications, laser treatment and filtration surgery is used to maintain intraocular pressure at a level sufficient to halt progression of optic nerve injury and prevent further vision loss.
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American family physician · Dec 1995
ACOG issues technical bulletin on domestic violence. American College of Obstetricians and Gynecologists.
Physicians should attempt to identify individuals who are the victims of abuse and to help them understand the dynamics of their relationship and the dangers facing them and their children. Information about available community, social and legal resources, their legal rights and a plan for dealing with the abusive situation should be made available to these women. The physician must remain caring and supportive of the patient as she works through these crises, even if she chooses to follow advice or courses of action other than leaving the relationship.
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American family physician · Dec 1995
Management of patients with atypical and low-grade Pap smear abnormalities.
Family physicians frequently encounter patients with atypical and low-grade Papanicolaou (Pap) smear findings. While near consensus exists regarding the evaluation and management of patients with high-grade dysplasia and carcinoma detected on Pap smear, the appropriate management of patients with atypical and low-grade abnormalities continues to be controversial. ⋯ It is unlikely that an approach including a conservative diagnostic strategy and careful follow-up will result in an increase in the number of missed cases of cervical cancer. This assumption needs to be assessed by prospective clinical trials.