Canadian family physician Médecin de famille canadien
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The hemostatic system consists of the subcutaneous tissue/vessel wall/platelet system and the coagulation cascade. Hemostasis occurs initially through the interaction between circulating platelets and subendothelial collagen, so that a platelet plug is formed. ⋯ The presence of the fibrin in the plug results in permanent hemostasis. The five tests of hemostasis - platelet count, bleeding time, partial thromboplastin time, prothrombin time and Factor XIII assay - are described.
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Urinary tract infections in females are discussed, emphasizing the need for urine cultures in diagnosis, and the importance of follow-up cultures and investigation in most patients if we are to decrease the morbidity and complications. Antibiotic therapy for acute and complicated infections, the role of long-term therapy, and the risks of catheterization are discussed.
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Polyneuropathy is characterized by simultaneous bilateral symmetrical involvement of peripheral nerves. Clinical features in fully-developed cases are paresthesias, irregular 'glove and stocking' cutaneous sensory loss, loss of deep sensations, weakness of distal muscles of extremities, and absent deep tendon reflexes. The most common forms of neuropathy encountered in practice are -- alcohol-induced, Guillain-Barre syndrome, and that secondary to diabetes mellitus. Since PN has many causes, a scheme based on clinical features is presented so that the possibilities can be narrowed and pursued with further investigations.