Family physicians frequently encounter patients who somatize psychosocial turmoil. In this article, three cases are presented, and the recognition, classification and management of these often difficult patients are discussed.

An opportunistic rubella screening programme in a general practice is described. Self-adhesive stickers placed on the medical records envelope were used to alert staff and to record information on rubella status. Out of the total target population of women aged between 10 and 40 years, three sample cohorts were audited: ...

The issue of appropriate management for thyroid neoplasms remains unsettled. Confusion concerning histology and classification, controversy as to appropriate therapy, the relative indolence of most differentiated thyroid tumors, and various levels of surgical skill have contributed to the prejudice of various approaches to the management of such neoplasms. It appears ...

Emesis and lavage often are ineffective in providing complete emptying of the stomach after an ingestion. With a locally corrosive and systemically toxic agent such as iron, surgical intervention with emergency gastrotomy may be required. We recently treated a 19-year-old man in the ED and in the departments of surgery ...

This essay examines several recent philosophical attempts to define 'disease'. Two prominent ones are considered in detail, an objective approach by Christopher Boorse and a normative approach by Caroline Whitbeck. Both are found to be inadequate for a variety of reasons, though Whitbeck's is superior because of her careful preliminary ...

A conceptual framework is articulated which clarifies the importance of psychotherapy as part of the treatment armamentarium in working with individuals carrying schizophrenic diagnoses. The author looks at the goals and appropriate role relationships for understanding and treating schizophrenic individuals from multiple psychotherapeutic perspectives. The goal is to present an ...

The pathogenesis of psychosomatic distress is considered. This emphasises interest in aetiology of distress rather than solely of disease. The influence of psychological aspects is as important whether the disease is of known or unknown aetiology, and can be of greater importance in poorer socio-economic circumstances. The doctor's role is ...

Two babies with total colonic aganglionosis treated by a modified Martin-Duhamel procedure are described. Ileostomy, long side-to-side ileocolic anastomosis and Duhamel's pull-through were the sequence of steps in this staged management. Neonatal ileostomy followed by ileocoloplasty proximal to the ileostomy facilitates home management of the new born patient who then ...

A 5-year-old boy with purpura fulminans (PF) was successfully managed with a protocol in which fresh frozen plasma (FFP) was administered, followed by a trial of certain therapeutic agents. This approach was based upon combined experience both with the reference patient and with a subject with a chronic form of ...

Reports on fluctuating fetal heart rate (FHR) patterns, which have been called sinusoidal FHR patterns in the literature, have been critically reviewed. Based on this analysis, stricter criteria are presented whereby the true sinusoidal pattern can be diagnosed and distinguished from the pseudosinusoidal pattern. A practical approach to the interpretation ...

In a series of 74 nasal dermoids, 45 (61%) were of the simple variety involving skin only. Twenty nine (39%) were of the complex variety with deeper tissue involvement requiring more extensive surgery. Of the 29 complex dermoids, 9 (31%) extended to the cribriform plate region but only 3 (10%) ...

The traditional incremental approach to computerization presents substantial problems as systems develop and grow. The Data Base Management System approach to computerization was developed to overcome the problems resulting from implementing computer applications one at a time. The authors describe the applications approach and the alternative Data Base Management System ...

This article presents a case study of the successful anesthesia management in the birth of quadruplets at Aultman Hospital in Canton, Ohio. A review of recent literature is also provided. With the increasing use of fertility drugs, multiple births will inevitably cease to be viewed as a rare phenomenon. Anesthesia ...

A new approach for the management of the short-pedicled undescended testicle is presented. It was used in four patients with the testicle lying deep to the internal inguinal ring after all methods of cord elongation failed to bring the testicle down to the scrotum. The technique consists of passing the ...

The adult respiratory distress syndrome is a reaction of the lung to a variety of severe direct or indirect pulmonary insults. It is characterized by acute respiratory distress, severe hypoxemia requiring high oxygen fractions, and "stiff lungs" requiring approaches to ventilatory management cited elsewhere in this issue of Clinics in ...

Two distinct types of retinal angiomas are currently recognized. Capillary hemangiomas occur most characteristically as part of the von Hippel-Lindau syndrome. The retinal capillary hemangiomas typically appear as globular red-orange tumors with dilated and tortuous afferent arterioles and efferent venules. Cavernous hemangiomas typically appear as grape-like clusters of dilated vascular ...

We polled 582 physicians to determine what their approach would be to management of an asymptomatic murmur at the carotid bifurcation and to carotid-distribution transient ischemic attack. We discovered a great disparity in attitudes attributable to location and type of practice. However, there was no difference attributable to age, and ...

A practical approach for assessing patient education needs in the ambulatory care setting was developed, tested, and administered to 100 individuals with four non-acute clinical problems. The approach allowed collection, with a single instrument, of a range of information pertinent to the management of a wide mix of disorders. Knowledge ...

This study examined the influence of patient, resident, and environmental variables on the management of after-hours telephone calls. Twenty-one family medicine residents participated in the study; 299 telephone calls in a one-month period at three teaching units were analyzed.A number of variables were found to influence the decision to manage ...

NINE PRINCIPLES OF FAMILY MEDICINE CAN BE DESCRIBED: an open-ended commitment to patients; an understanding of the context of illness; the use of all visits for preventive purposes; the view of the practice as a population at risk; the use of a community-wide network of supports; the sharing with patients ...

The NHS is being urged to collaborate with the private health sector. In spite of the presence of many ex-NHS administrators, the approach to management is rather different, as Stanley Hill found when he talked to the people concerned with the embryonic Cromwell Hospital in London. This brings to a ...

The diagnosis and management of functional disease poses special problems for the family physician. This paper focuses on specific approaches and strategies that may be incorporated into the clinical style of any physician. Meticulous clinical method, careful planning and patient education are seen as the foundation for management of these ...

The weal and flare produced by monochromatic irradiation in solar urticaria may be treated as a classical dose-response. This has been used to investigate therapy with H1 and H2 antihistamines. The conventional H1 drug proved superior. But from the practical viewpoint, solar urticaria is difficult to suppress even with a ...

Transactional analysis (TA) is offered as one solution to the problems faced by doctors attempting to move away from the traditional Cartesian approach towards the holistic approach to medical practice. It can help to increase the doctor's understanding of, and insight into, the emotional and interactional components of his patients' ...

Yoga as therapy with psychosomatic disorders has been practiced for many centuries in India, and only recently has become utilized for this purpose in other countries. The yoga system evolved as a 'system of liberation' to allow man to discriminate between his ego-self and pure consciousness, and as such, its ...

Whether deficit or surfeit, sodium imbalance responds best to management based on an understanding of the underlying mechanisms that have gone awry. A review of the kidney's role in normal sodium homeostasis lays the groundwork for rational therapeutic approaches to correcting the pathophysiology of the major depletion and retention states. ...

A conservative approach to the management of the child and parent and to the treatment by the dentist for both digital sucking and tongue thrusting is advocated. Because the prevalence of both activities continues to decrease with age, various age ranges are selected as guidelines for the dentist in selecting ...

A systematic approach to the management of patients with pancreatic abscess is presented. The method includes an aggressive diagnostic approach relying on radiographic and ultrasound examinations, adequate transperitoneal drainage of the abscess, coupled with gastrostomy and feeding jejunostomy. The importance of nutritional support using an elemental diet administered through a ...

Consultation with law enforcement personnel in the area of conflict-management has typically been concerned with interpersonal rather than intrapersonal conflict. An approach to anger management that is based on cognitive self-control techniques is described as it has been used in the training of police officers. The approach follows a procedure ...

The importance of the diagnosis and treatment of non-hayfever atopy in the practice of otorhinolaryngology is emphasized. The clinical evaluation primarily includes a thorough history, physical examination, x-rays, routine laboratory work, screening allergen tests, and a selective allergic survey using the Rinkel technique of titration. A multilateral approach to treatment ...

This article presents an overview of the generally accepted diagnostic and clinical management features of common acute laryngeal obstruction, croup - laryngotracheobronchiolitis (LTB) and epiglottitis - an occasionally poorly diagnosed and frequently inappropriately managed disease. A review of recent literature suggests a more dogmatic and scientific management of the disease.

Psychosomatic medicine--and thus psychosomatic gynaecology--is presented as an approach to be used by doctors when meeting the patient. At the same time it is a method, a technique, trying to elucidate the mechanisms in the most complicated interplay between the psychological, somatic and social "parts of the whole". Some diagnostic ...

Nuclear medicine encompasses the diagnostic use of unsealed sources of radiation in patient care, and is largely a diagnostic specialty. A variety of methods exist to assist in the diagnosis and management of patients with chest disease. Already the application of pulmonary perfusion scintigraphy makes a major contribution to the ...

Anorexia nervosa occurs predominantly in white, middle-class, adolescent females with perfectionistic tendencies. Their solution to the intense guilt induced by any sensory pleasure is to deny themselves the pleasure of eating. Amenorrhea is universal. Diagnostic criteria include a 25 percent weight loss. Therapies are long and involved different approaches. All ...

Sugar intolerance is a common problem in paediatric practice. The usual type is lactose intolerance following gastroenteritis, but it may also occur in a wide variety of disorders of the small bowel. Diagnosis depends upon identification of reducing substances in the stools. An approach to dietary management of lactose intolerance ...

Reconstruction of the rectum by a technic of combined abdominotranssacral proctocolectomy and proctocolostomy is presented as an alternative to the surgical conservatism that has been the time-honored approach to the management of radiation-injured rectum. The procedure has permitted safe accomplishment of rectal anastomosis with as little as a 1 cm ...

A Gamut is defined as a complete list of anything. As utilized here, it indicates a complete list of the possible causes of a particular scintigram finding. The procedure for developing a Gamut is discussed, ant its use as a tool for instructing residents in nuclear medicine is described. Sample ...

A new approach to monitoring of episodic but frequently recurring arrhythmias has been developed, consisting of condensation of electrocardiographic information on a special drum recorder, a programmer that permits selection of intervals and durations for monitoring, and a telemetry unit for transmission of the electrocardiographic signal. We used this system ...

We describe the use of a simple bedside sphinctermometer which has proved valuable and reliable in the practical evaluation and management of those patients with neurogenic bladder dysfunction.

In this paper we describe the use of punched feature cards in a general practice for 18 months. Its advantages are the low cost, speed of information retrieval, visible statistics, computer compatibility, accuracy, confidentiality, flexibility, and simplicity of setting up and collection of information. The system encourages the doctor to ...

Diseases increase in frequency with advancing age but clinical methods of recognizing them do not appear to keep pace. The complex interrelationship of multiple disease processes and their management confounds traditional diagnostic and therapeutic tactics, demanding a systematic approach for understanding and effectiveness. Problem orientation, rather than diagnostic formulation and ...

Masterarbeit Zweigbibliothek Forstwesen Signatur: Dipl 2729 Präsenzexemplar Freihand

Abschlussarbeit Zweigbibliothek Forstwesen Signatur: Dipl 2206 Präsenzexemplar Freihand

Thesis (M.L.A.)--University of Georgia, 2003.

Thesis (Ph. D.)--Dalhousie University, 1998.

Dyspepsia is a common presenting problem of patients in family medicine. Dyspepsia can be caused by a number of underlying conditions, from peptic ulcer disease to functional disorders. Primary-care physicians need to develop an approach to the investigation and treatment of dyspepsia which maximizes symptom relief while minimizing patient discomfort ...

Falls in the elderly constitute a major problem confronting physicians. Their cost to individual patients and to society in terms of incidence, morbidity, and mortality is enormous. This paper attempts to outline some of the common etiological factors related to falls and a practical approach to the diagnosis and management. ...

Diseases increase in frequency with advancing age but clinical methods of recognizing them do not appear to keep pace. The complex interrelationship of multiple disease processes and their management confounds traditional diagnostic and therapeutic tactics, demanding a systematic approach for understanding and effectiveness. Problem orientation, rather than diagnostic formulation and ...

The incidence of goiter (any swelling of the thyroid, either diffuse or localized) varies from five to ten percent in the adult population. Carcinoma of the thyroid is rare, occurring in approximately 2.5 per 100,000 population. The prognosis is generally good. Clinically patients usually present in one of four ways: ...

Hair loss may not be as serious as cancer or heart disease, but when patients lose one of their most treasured possessions, the psychological trauma can be extremely severe. Although the pathogenesis of alopecia may seem complicated, if one understands the basic physiology and the normal hair growth cycle and ...