Postgraduate medicine
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External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.
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Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. ⋯ Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.
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In a case of rheumatic disease, the patient's history and a careful physical examination should yield most of the information needed to identify the specific disorder present. A convenient classification is based on four differentiating features: number of joints affected, acuteness or chronicity of disease, absence of joint involvement, and anatomic distribution.
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Postgraduate medicine · Nov 1976
Office treatment of eye injury. 2. Injury from sharp instruments or blunt trauma.
Eye injuries caused by sharp instruments range from superficial scratches of the corneal epithelium to serious lacerations of the globe of the eye. Scratches, conjunctival lacerations, and some eyelid lacerations can be dealth with by the primary physician in the office, but damage to the globe requires immediate referral to an ophthalmologist. ⋯ The primary physician may be the first to examine a patient with serious head injury. For future reference the status of each eye should be carefully documented as soon as possible after injury.