Postgraduate medicine
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Postgraduate medicine · Sep 1985
Transcutaneous electrical nerve stimulation. Practical aspects and applications.
Transcutaneous electrical nerve stimulation (TENS) is a commonly used method of treating patients with pain, both acute and chronic. Although several hypotheses have been proposed, the mechanism by which TENS alters pain perception is still unknown. Symptomatic relief of pain adjunctive to a comprehensive program of pain management is the only justified indication for TENS use.
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Postgraduate medicine · Sep 1985
Oncologic emergencies in primary care. Five malignancy-associated conditions to watch for.
Acute problems requiring emergency management may occur in association with malignancy. The most common are superior vena cava syndrome, compression of the spinal cord or cauda equina, hypercalcemia, tumor lysis syndrome, and fever in the neutropenic patient. Successful management requires that the physician be aware of the potential for such an emergency in a cancer patient and give priority to treatment, based on clinical evidence and a few essential studies, over definitive diagnosis.
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Postgraduate medicine · Jun 1985
Polymyalgia rheumatica and giant cell arteritis. The dilemma of therapy.
Polymyalgia rheumatica, next to rheumatoid arthritis the most common inflammatory rheumatic disorder of the elderly, is a nonspecific clinical syndrome involving pain in the shoulder and pelvic girdles. Giant cell arteritis appears to localize in elastin-containing arteries and can cause similar myalgias. ⋯ The key decision in therapy, therefore, concerns the dose and duration of use of steroid for polymyalgic symptoms. In this decision, prevention of the catastrophic complications of giant cell arteritis and avoidance of needless side effects of high-dose steroid therapy in the elderly are competing considerations.
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Postgraduate medicine · May 1985
Historical ArticleCancer chemotherapy. Historical aspects and future considerations.
Effective cancer chemotherapeutic agents were developed rapidly during the 1940s, 1950s, and 1960s. With recognition of the curability with chemotherapy of certain selected advanced cancers the emphasis of treatment has changed from a palliative to a curative mode. ⋯ Other major conceptual changes, such as the recognition that regional lymph nodes are not effective barriers to tumor spread, have also had a major impact on the course of cancer treatment. The 1980s will be as productive as the preceding decades, but it is difficult at this time to determine if biologic response modifiers, monoclonal antibodies, differentiating agents, or some other as yet unrecognized therapy will be the major advance.
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The two types of dysphagia, oropharyngeal and esophageal, involve different phases of swallowing, are accompanied by different symptom complexes, and have different etiologies. They can usually be distinguished by history, which often will also suggest the specific cause. ⋯ The initial evaluation for esophageal dysphagia entails barium esophagography and fiberoptic endoscopy. Esophageal manometry is indicated when a motor disorder is suspected.