The Medical clinics of North America
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Med. Clin. North Am. · Jan 1999
ReviewRhinosinusitis. Current concepts in evaluation and management.
Sinusitis is one of the most common health complaints leading to a physician office visit in the United States. Recently standardized terminology with diagnostic parameters are outlined. Following this is a detailed discussion of the basics of relevant history and physical examinations, laboratory and radiology testing, the appropriate selection of pharmacotherapy, and the indications for surgical intervention.
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Dizziness is a complex and frustrating symptom of potentially numerous causes. The history and physical examination can elicit the category that best characterizes the dizziness: vertigo, presyncope, dysequilibrium, or lightheadedness. ⋯ Surgery for vertigo includes conservative and destructive procedures. Rehabilitation is often a useful adjunct in the treatment of many types of dizziness.
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The importance of glycemic control in reducing the microvascular complications of type 1 diabetes has been clearly demonstrated with a long-term prospective, randomized interventional trial. The data are not as strong with regards to type 2 diabetes. The results of several prospective studies and one interventional study, however, all report benefits of improved glycemic indices on reducing microvascular complications. ⋯ Lastly, estimates on the economic benefits of reducing long-term microvascular and macrovascular complications in populations are staggering. Based on the available literature, all patients with diabetes should be educated and have access to an appropriate individualized treatment regimen with the goal to normalize or near-normalize glycemic control. This should be the standard of care until proven otherwise.
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Med. Clin. North Am. · May 1998
Review Practice Guideline GuidelineInternational consensus recommendations. Summary statement and additional suggested guidelines. European Consensus Conference, November 1991. American College of Chest Physicians consensus statement of 1995. International Consensus Statement, 1997.
Since the NIH Consensus Conference in 1986, the developments in the field of prevention and treatment of venous thromboembolism were mainly characterized by a more specific and extended use of new prophylactic agents such as low-molecular-weight heparins as well as the perception that out-patients may be at risk for thromboembolic complications, too. Therefore, in 1991 and 1995, consensus conferences were held in Europe and North America in order to analyze the risk constellation of various patient populations and to give recommendations for primary prophylaxis and treatment of thromboembolic complications. The most recent, the 1997 International Consensus Recommendations are also discussed.
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At least 43 million (24%) adults in the general population of the United States have hypertension. The prevalence of hypertension increases with age and is higher among African-Americans compared to other ethnic groups. ⋯ To achieve the final goal of eliminating all blood pressure-related disease in the community, detection and treatment of hypertension must be complemented by equally energetic approaches directed at primary prevention of hypertension. A small downward shift in the entire distribution of blood pressure in the general population will not only reduce the incidence of hypertension, but substantially diminish the burden of blood pressure in the general population.