Postgraduate medicine
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Postgraduate medicine · Mar 2000
Management of cancer pain. Safe, adequate analgesia to improve quality of life.
Pain is one of the most common problems for cancer patients, and its management is often hindered by barriers created by patients and physicians alike. By avoiding potential barriers and understanding the principles of pain management and drug selection and titration provided here by Dr Hartmann and colleagues, physicians can safely administer adequate pain relief to their patients in need.
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Postgraduate medicine · Feb 2000
ReviewFever without source in children. Recommendations for outpatient care in those up to 3.
It is the author's goal to reduce risk to a minimum in children with fever without source at a reasonable cost with guidelines that are practical for office-based physicians. Recommendations are as follows: All febrile infants and children up to 36 months of age who have toxic manifestations are to be hospitalized for parenteral antibiotic therapy after an expeditious evaluation of their condition that includes cultures of blood, urine, and cerebrospinal fluid. All febrile infants 7 days of age or less should be hospitalized for empirical antibiotic therapy after a complete evaluation for sepsis and meningitis has been done. ⋯ A child with a fever of 39 degrees C or above can also be treated as an outpatient without antibiotics if close follow-up is ensured. Otherwise, a WBC count or ANC should be done. In those whose WBC count is 15,000/mm3 or more or whose ANC is 10,000 cells/mm3 or more, a blood culture should be done, and pending results, a single injection of ceftriaxone, 50 mg/kg, should be given.
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Postgraduate medicine · Dec 1999
ReviewIdentifying structural hip and knee problems. Patient age, history, and limited examination may be all that's needed.
A likely identification of a given structural disorder of the hip or knee can be suggested by the patient's age. In the hip, developmental dysplasia is usually found in infants, Legg-Calvé-Perthes disease in children of 4 to 10 years, slipped capital femoral epiphysis in somewhat older children, osteonecrosis in young to middle-aged adults, and degenerative joint disease and hip fracture in older adults. In the knee, Blount's disease is usually found in children aged 3 to 8, patellofemoral disease during the teens and early 20s, meniscal tears from the early teens through the mid-50s, ligament injuries from the teens to the 40s, and osteoarthritis throughout adulthood. With relatively little additional information, a useful diagnosis can be made so appropriate therapy can be started or referral made.
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Postgraduate medicine · Nov 1999
Neonatal jaundice. Strategies to reduce bilirubin-induced complications.
Neonatal hyperbilirubinemia is the most common reason for hospital readmission in the first 2 weeks of life. Kernicterus is still relatively uncommon but has been on the rise with the institution in the 1990's of aggressive early postnatal discharge policies. Bilirubin-induced complications can be prevented by instituting a neonatal jaundice protocol to identify infants at risk for significant hyperbilirubinemia, by ensuring adequate parental education and preparedness, and by implementing a good neonatal tracking system for follow-up care. Hyperbilirubinemia is easily treated with phototherapy, which can be administered at home in selected infants.
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Postgraduate medicine · Nov 1999
Case ReportsFollowing the clues to neuropathic pain. Distribution and other leads reveal the cause and the treatment approach.
Neuropathic pain can seem enigmatic at first because it can last indefinitely and often a cause is not evident. However, heightened awareness of typical characteristics, such as the following, makes identification fairly easy: The presence of certain accompanying conditions (e.g., diabetes, HIV or herpes zoster infection, multiple sclerosis) Pain described as shooting, stabbing, lancinating, burning, or searing Pain worse at night Pain following anatomic nerve distribution Pain in a numb or insensate site The presence of allodynia Neuropathic pain responds poorly to standard pain therapies and usually requires specialized medications (e.g., anticonvulsants, tricyclic antidepressants, opioid analgesics) for optimal control. Successful pain control is enhanced with use of a systematic approach consisting of disease modification, local or regional measures, and systemic therapy.