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 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
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PMID:Management of ectopic pregnancy. 218 38

"Topics in the Primary Care Medicine" Presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined sub-specialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies may be lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series discuss new tests and therapies and suggest reasonable approaches even when definitive studies are not available. Each article has several general references for suggested further reading. We hope this series is of interest and we welcome comments, criticisms and suggestions.
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PMID:Falls in the elderly: a clinical approach. 683 37

In this issue The Western Journal of Medicine begins a new series, "Topics in Primary Care Medicine," that will present articles on common diagnostic or therapeutic problems encountered in primary care practice. These articles will address such frequently occurring problems as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections. These problems usually do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies are often lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series will discuss new tests and therapies and suggest a reasonable approach even when definitive studies are not available. Each article will have several general references for suggested further reading. We hope this new series will be of interest and we welcome comments, criticisms and suggestions.
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PMID:The diagnosis of pulmonary embolus. 711 99

"Topics in Primary Care Medicine" presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies may be lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series discuss new tests and therapies and suggest reasonable approaches even when definitive studies are not available. Each article has several general references for suggested further reading. We hope this new series will be of interest and we welcome comments, criticisms and suggestions.
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PMID:The evaluation of anemia. 714 37

"Topics in Primary Care Medicine" presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies may be lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series discuss new tests and therapies and suggest reasonable approaches even when definitive studies are not available. Each article has several general references for suggested further reading. We hope this new series will be of interest and we welcome comments, criticisms and suggestions.
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PMID:Shoulder pain. 717 54

"Topics in Primary Care Medicine" presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined subspecialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies may be lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series discuss new tests and therapies and suggest reasonable approaches even when definitive studies are not available. Each article has several general references for suggested further reading. We hope this new series will be of interest and we welcome comments, criticisms and suggestions.
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PMID:Kicking the habit: benefits and methods of quitting cigarette smoking. 717 67

A questioning survey was carried out to determine the acceptability to patients of various aspects of day-case laparoscopy in Korle-Bu Teaching Hospital. One hundred consecutive patients were interviewed within 2 weeks after operation. Sources of dissatisfaction include inadequate explanation about the operation and its aftermath, hospital reporting time, the waiting times at various stages of the process, the mechanism for sending patients from the ward to the theatre and the total length of time spent in hospital. Almost half the patients felt they were not well enough to be sent home at the time of discharge. More than half would have preferred overnight stay postoperatively. The main causes of morbidity were dizziness, abdominal pain, shoulder pain, nausea and vomiting. To make day-case laparoscopy more acceptable to patients a dedicated day care surgery unit with formal anaesthetic cover should be established. The operation and its aftermath should be fully explained to patients well before the day of operation. Stricter criteria should be established for patient discharge, and where appropriate, patients should be allowed the option of overnight stay post-operatively.
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PMID:Day-case laparoscopy in a Ghanaian teaching hospital: the patient's perspective. 893 26

Algorithms for the diagnosis of ectopic pregnancy are applied independent of the patient population. However, patients may require care at various times of gestation or for different reasons. To examine the utility of the same diagnostic criteria for identifying an ectopic pregnancy in different patient populations, we evaluated women from the infertility clinic and the residents' gynecology clinic at Yale-New Haven Hospital. Sixty women with nonemergency ectopic pregnancies were identified, 38 from the infertility clinic and 22 from the residents' clinic. Although the most common symptoms were the same in both groups (abdominal pain, spotting/bleeding >3 days, dizziness, shoulder pain), they were significantly more frequent in women form the residents' clinic. Despite care by the same attending physicians, ruptured ectopic pregnancies were more than 3 times as likely to occur in the noninfertility patients, and half as likely to be treated laparoscopically (p<0.01). Patients from the residents' clinic also were more likely to have postoperative complications (p<0.5), and had over a threefold higher risk of receiving a blood transfusion. We conclude that criteria for diagnosis and intervention in ectopic pregnancy may have to be modified on the basis of characteristics of the patient population.
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PMID:Failure of standard criteria to diagnose nonemergency ectopic pregnancies in a noninfertility patient population. 905 Apr 75

Forty-three patients who underwent arthroscopic surgery for arthrogenous TMD were polled concerning the effect of surgery on the symptoms of headache, neck pain, shoulder pain, dizziness and tinnitus. Statistically significant levels of symptom reduction were recorded for all symptoms polled. This indicates that a substantial number of significant symptoms are produced by the influence of temporomandibular joint pathology on central neural processes. A model for the affect of temporomandibular joint pathology on cervical and masticatory musculature is proposed. This data implies that we cannot use muscle tenderness, hypertonicity and/or pain to differentiate arthrogenous from myogenous temporomandibular disorders. The characteristics of a population of whiplash onset TMD patients were compared to other TMD populations. The results indicate that whiplash induced TMD may differ from insidious onset TMD and even other trauma onset TMDs by prevalence of neck pain, intensity of neck pain and probability of concurrence of neck pain, shoulder pain, headache and jaw pain. These symptoms resolved within 24 hours of arthroscopic temporomandibular joint surgery indicating that the temporomandibular joint pathology was the perpetuating force behind, if not the cause of, these symptoms.
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PMID:A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus. 908 76

Existing therapies for major depressive disorder (MDD) have either limited efficacy and/or poor tolerability. The present study examined the effects of duloxetine, a potent and balanced dual reuptake inhibitor of serotonin (5-HT) and norepinephrine (NE), in patients with MDD. Adult patients (N = 267) with MDD were randomly assigned to receive duloxetine (60 mg/day) or placebo in this 9-week, multi-center, double-blind, parallel-group clinical trial. Efficacy was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD(17)), Visual Analog Scales (VAS) for pain, Clinical Global Impression of Severity (CGI-S), Patient's Global Impression of Improvement (PGI-I), and Quality of Life in Depression Scale (QLDS). Safety was evaluated by assessing discontinuation rates, adverse event rates, vital signs, and laboratory tests. Duloxetine (60 mg QD) significantly reduced the HAMD(17) total score compared with placebo at the end of 9-week therapy. Estimated probabilities of response and remission were 65 and 43%, respectively, for duloxetine compared with 42 and 28% for placebo. Duloxetine also reduced overall pain, back pain, shoulder pain and time in pain while awake significantly more than placebo. Global measures of improvement, including PGI-I and QLDS, were significantly improved by duloxetine compared with placebo. Discontinuations due to adverse events were more frequent for duloxetine-treated patients (12.5%) than for placebo-treated patients (4.3%). Nausea, dry mouth, dizziness, and constipation were more frequent for duloxetine than placebo. There was no significant incidence of hypertension, nor any other safety issues. Duloxetine 60 mg administered once daily appears to be a safe and effective treatment for MDD.
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PMID:Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression. 1239 7


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