The Journal of family practice
-
The diagnosis of acute pelvic pain in the woman of reproductive age represents a major clinical challenge. In approaching such a patient, the clinician must differentiate between pregnancy-related causes, gynecologic disorders, and nonreproductive tract causes. ⋯ Diagnostic laparoscopy represents the reference standard for diagnosis of many of its possible causes and can obviate the need for exploratory laparotomy. Once competing diagnoses have been adequately excluded, an empiric trial of antibiotic therapy for acute pelvic inflammatory disease, coupled with close clinical follow-up, should be considered in patients with acute pelvic pain found to have cervical motion tenderness and bilateral adnexal tenderness on examination.
-
A 75-year-old woman in accelerated-phase chronic myeloid leukemia with hyperleukocytosis presented with acute respiratory distress syndrome. Despite early and aggressive pulmonary support and cytoreductive chemotherapy, the patient died. Autopsy confirmed the presence of the leukostasis syndrome. The clinical, radiologic, pathophysiologic, and therapeutic aspects of this entity are reviewed.
-
Productive research environments are important for the development of academic family medicine, yet many of the current family medicine chairs have had little research training or experience and have rated research skills as a low priority for themselves. The younger chairs, however, representing the next generation of academic leadership, may have more traditional academic values, including the promotion of research. ⋯ Younger chairs appear to have a greater appreciation for the importance of research, having received more formal training and valuing research skills in themselves and potential replacements. With the impending large turnover in family medicine leadership, there will be an opportunity to recruit chair replacements with similar viewpoints toward research, thus improving the outlook for research in academic family medicine.