Isr Med Assoc J
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Spontaneous pneumomediastinum is a rare entity that usually occurs in young males without any apparent precipitating factor. Several case series have been published focusing on clinical features, workup and prognosis. Due to the rarity of this entity, there is no consensus on the most appropriate treatment. ⋯ SPM is a rare entity that should be considered in patients with pleuritic chest pain. Treatment is supportive, and if no clues for esophageal rupture are present, investigations other than chest X-ray are probably not warranted. It is safe to discharge the patient within 24 hours provided that symptomatic improvement is achieved.
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Controlled Clinical Trial
Perineal massage during pregnancy: a prospective controlled trial.
Women frequently suffer perineal trauma while giving birth. Interventions to increase the possibility for an intact perineum are needed. ⋯ The practice of antenatal perineal massage showed neither a protective nor a detrimental significant effect on the occurrence of perineal trauma.
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Research in the acquisition of patient interviewing skills by medical students has dealt mostly with the evaluation of the effectiveness of various teaching programs and techniques. The educational approaches (i.e., the tutor-learner relationship and learning atmosphere) have rarely been discussed. These approaches may be grouped into: a) "teacher-centered" (didactic), in which the students are passive recipients of instruction; b) "learner-centered," in which the tutor functions as a facilitator of small group learning, whose task is not to teach but rather to ensure that all students participate in the discussions and share knowledge with other students; and c) "integrated learner-and teacher-centered" or "experiential learning," which consists of an ongoing dialogue between the tutor and the students. ⋯ It would appear that until the 1960s, medical students acquired interviewing skills without any expert guidance. On the other hand, since the 1970s, there has been a tendency to offer and upgrade undergraduate programs aimed at imparting communication skills to medical students. Initially, these programs were didactic; however, during the last decade, there has been an increasing shift to teaching interviewing skills by promoting experiential learning.
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Clinical Trial
Low dose methotrexate therapy is effective in late-onset atopic dermatitis and idiopathic eczema.
Atopic dermatitis or atopic eczema is an itchy inflammatory skin condition with a predilection of the skin flexures. Most cases start in children although some have been reported in adults. Patients with moderate to severe disease refractory to topical corticosteroid or calcineurin inhibitors may require second-line treatment such as phototherapy or systemic immunosuppressants. Methotrexate therapy has been suggested as a useful immunosuppressant in adult atopic dermatitis. ⋯ Low dose methotrexate is an effective therapeutic alternative for late-onset atopic dermatitis or idiopathic eczema in patients unresponsive to local and other systemic therapies.
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Dupuytren's disease is a fibroproliferative disorder of the palmar fascia that can cause disabling digital contractures. The pathogensis of the disease is still unclear, and it afflicts predominantly white males of northern European origin. Gender-related differences of Dupuytren's disease and the distinctive characteristics of the disease in females are not yet well defined. ⋯ Further investigations are needed to assess the potential role of androgens in the pathogenesis of Dupuytren's disease, and a possible protective role of estrogenic hormones, rendering Dupuytren's contracture a postmenopausal affliction.