Primary care
-
Although herpes zoster is not a fatal disease, its legacy of postherpetic neuralgia gives rise to a great deal of misery and distress, especially in elderly patients. Furthermore, in the immunocompromised patient herpes zoster is an important complication. The management of the sequelae of herpes zoster continues to be extremely difficult. Although work on agents to control viral replication holds promise for the future, at present meticulous management of the pain and depression in the early phases and much patience and understanding in the later phases of the condition are necessary.
-
The countercurrent immunoelectrophoresis and latex particle agglutination tests are rapid, do not require expensive apparatus, and are easy to perform if specific antigens and antisera are available. Both tests have been shown to be of value in the diagnosis of bacterial infections (such as those caused by H. influenzae, Streptococcus pneumoniae, N. meningitidis, E. coli, Staphylococcus aureus and group B streptococcus) and of viral infections (HRVLA and hepatitis B); they may also be of value in fungal and parasitic infections. Etiologic diagnosis of commonly seen clinical conditions (such as pneumonia, meningitis, cellulitis, osteomyelitis, lymphadenitis, and arthritis) by practicing physicians can be made using these tests to detect antigens in various body fluids in a hospital laboratory.
-
Acute peritendinitis calcarea, adhesive capsulitis, and anterior acromion impingement syndrome are common problems of the shoulder. Needle and drug therapy are indicated to relieve pain in the treatment of acute cases, with a regular home program of exercise essential for successful results in all cases. Surgery is recommended only if the nonoperative approach is unsuccessful.
-
Spontaneous subarachnoid hemorrhage is most frequently caused by rupture of an aneurysm or arteriovenous malformation. Early clinical diagnosis is important to avert fatal hemorrhage. Surgical treatment should be carried out in patients in good neurologic condition.