Archives of family medicine
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The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. ⋯ This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives.
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Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal. Diagnosis and treatment of cervical ectopic pregnancy has changed dramatically in the last 15 years. Before 1980, the diagnosis commonly was made when dilation and curettage for presumed incomplete abortion resulted in unexpected hemorrhage. ⋯ The family physician practicing obstetrics must consider the diagnosis of cervical ectopic pregnancy in women with first-trimester vaginal bleeding or pelvic pain to permit early diagnosis and fertility-saving treatment. A case report of diagnosis and successful medical management of a cervical ectopic pregnancy is presented. The literature on the epidemiology, causes, diagnosis, and treatment of cervical ectopic pregnancy is reviewed.
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In June 1997, the US Supreme Court unanimously decided that competent, terminally ill patients have no general constitutional right to commit suicide or to obtain assistance in committing suicide. Thus, the broad prohibitions against any kind of suicide assistance that almost every state has enacted do not violate the constitution. ⋯ For example, the Court concluded that a physician's intent can distinguish permissible acts of aggressive pain relief from impermissible acts of hastening death. This distinction has clinical uses and can help physicians develop ethical guidelines and practice standards to improve palliative care near the end of life.
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Randomized Controlled Trial Clinical Trial
Loperamide-simethicone vs loperamide alone, simethicone alone, and placebo in the treatment of acute diarrhea with gas-related abdominal discomfort. A randomized controlled trial.
Acute diarrhea with gas-related abdominal discomfort is a common, usually self-limited disorder with substantial social and economic impact. ⋯ The loperamide-simethicone combination chewable product provides faster and more complete relief of acute nonspecific diarrhea and associated gas-related abdominal discomfort (gas pain, cramps, gas pressure, and bloating) than either of its components or placebo. The combination is well tolerated.