Many new therapies for the management of gallstone disease have been pioneered in the past decade. The object of this review is to equip the surgeon with the answers to all of the questions a patient will ask about gallstone therapy; the review is therefore didactic as well as comprehensive.

OBJECTIVE: To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN: A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists of patients in a ...

Serological results for Borrelia burgdorferi were examined for one year. The results suggest a 'pocket' of infection in one Highland general practice. In this practice, most of the patients had exposure to tick bites and rashes were frequent. There were difficulties in relating serological results to clinical features and management ...

We managed 32 neonates and infants with temporary vesicostomy and delayed valve ablation. The criterion on which successful management was gauged was estimated creatinine clearance. Renal failure or death occurred in 30% of the patients and 7% required transplantation. There was no apparent difference between our patients managed initially with ...

In this article the author describes the salient features of Carakatattvapradipika, a commentary on the Caraka Samhita by Sivadasa sena and highlights his theory and practice of medicine.

Successful management of a contemporary pharmacy department requires a unique blend of skills. Perhaps one way to concisely describe the principal role of a manager of a clinical department is as one of advocacy. The manager must be an advocate for the patient, as a member of a clinical profession. ...

The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. Although there is a finite number of pieces and types of equipment, pharmacologic adjuncts, and manual techniques, the last two components are variable. For purposes of brevity ...

In a questionnaire study at a university hospital in Norway, 227 of 444 patients with atopic dermatitis (51.1%) and 215 of 506 patients with psoriasis (42.5%) reported previous or current use of one or more forms of alternative medicine. Homoeopathy, health food preparations and herbal remedies were used most. Use ...

The GDP, in liaison with medical colleagues, has much to offer patients who suffer BMS. It is important that the history is gained in an unhurried and sympathetic clinical environment, along with subsequent investigations. With such an approach, it is possible to successfully treat the majority of patients with BMS, ...

This article summarizes the theoretical basis and practical applications of the fluid management of shock in critically-ill patients. It also draws attention to the differences in the aetiology and management of fluid disturbances in adult and paediatric practice. Some evidence suggests that colloidal solutions alone may be superior to crystalloid ...

Tactful management of difficult situations can avoid the risks of violence. Being aware of non-verbal signals and using counselling skills helps GPs handle highly emotional patients. In the street or in the home, common sense steps will help protect doctors visiting patients. Recognising our own feelings is important too.

Posttraumatic hydrocephalus is a vital subject for the practitioner caring for patients with traumatic encephalopathy, as a large number of brain trauma patients develop ventricular enlargement. The managing physician should understand which ventriculomegalic patients are suffering from hydrocephalus, which have cerebral atrophy and which stand a reasonable chance of improvement ...

The focus of the nutritional management in liver disease has swung from micronutrients with the supplementation of vitamins back to the problems of the macronutrients and especially the importance of protein metabolism. Whether the considerable activity in this area in the last few years, particularly in patients with acute alcoholic ...

Over 25,000 people in Britain now have pacemakers, and the number is increasing steadily. Anaesthetists encounter patients with pacemakers regularly. Knowledge about the increasingly wide range of pacemakers available is necessary to ensure safe management of these patients, many of whom are frail and elderly. This review outlines the indications ...

Rising receivables and slowed cash flow have put a greater emphasis on the position of patient accounts manager. As the patient accounts manager becomes increasingly important to the long-term viability of hospitals, the person filling that role is placed in the spotlight. In the first survey of its kind, HFMA ...

A study day for general practitioners was arranged on the subject of managing the difficult patient. Participants were asked to supply written details of their most difficult patient and the problems they associated with him or her. The issues raised were addressed in a number of formal presentations and formed ...

One of the most troublesome complications in the rehabilitation of hemiplegic patients is inferior subluxation of the glenohumeral joint. The purpose of this study was to determine which of two shoulder supports, the Bobath shoulder roll or the Henderson shoulder ring, would be more effective in the management of hemiplegic ...

The management of anaesthesia for transsphenoidal removal of a pituitary adenoma in a true pituitary giant with acromegaly is described. Problems which may be anticipated in such a patient and an approach to their management are discussed, with particular emphasis upon the need for thorough preoperative assessment of the upper ...

Ranulas or mucoceles of the floor of the mouth are uncommon but do occur in approximately 5% of patients undergoing submandibular duct relocation for the management of uncontrollable sialorrhea. Review of our experience with 26 patients over 12 years ending in 1986 substantiated a concept previously advocated by other authors ...

Increased demands placed on patient accounts managers for a much faster payment turnaround are forcing these managers to operate their departments more like a business. In this article, a select group of patient accounts managers was surveyed to determine what management techniques they use to run their departments more efficiently. ...

Between January 1979 and October 1986, 349 patients with epiglottitis were admitted to the Royal Children's Hospital, Melbourne, Australia. Forty-five (13%) patients were not intubated, 291 (83%) were managed by nasotracheal intubation and spontaneous respiration without sedation, three (1%) received continuous positive airway pressure, and ten (3%) were ventilated. The ...

"Conservative" management of splenic rupture in patients with mononucleosis has not been adequately evaluated because of its infrequent occurrence. Splenic rupture can be lethal in this setting and is the most common cause of death from mononucleosis. We report a case of spontaneous splenic rupture in a young girl with ...

With the rising cost of medical services, it was decided to reassess the relevance of routine bacteriology investigations to the management of the individual patient with pyoderma. In both prospective and retrospective studies, it was found that laboratory reports were simply confirmatory and did not contribute to the management of ...

Aortic thrombosis occurring after blunt abdominal trauma is a rare but recognized event. Most of these patients present with progressive and profound neurologic compromise. Successful management requires early diagnosis, maintenance of hemodynamic stability, and prompt revascularization. Despite appropriate management a large percentage of these patients (unprotected by heparin or collateral ...

This report enquiring into patients' attitudes to their urine being coloured by rifampicin has shown that many of them regarded it as evidence of the potency of their medicine or of the elimination of the disease. Attention is drawn to the value of the coloured urine as a reminder to ...

The purpose of this study was to develop a management protocol for patients with long-term tracheotomies and aspiration, in order to develop clinical criteria for extubation and reduction of aspiration-related complications. We studied 39 patients with tracheotomies in place for over 3 months, 28 of whom completed management. Patients were ...

This paper presents our experience with 500 patients with intractable tinnitus who were referred to our tinnitus clinic during the past 10 years. We propose a management plan based on identification and classification of three types of tinnitus. We describe what a tinnitus clinic adds to patient care, with emphasis ...

Neodymium:YAG laser intraocular lens damage results in opacities in the pseudophakos. When located in the visual axis, these opacities may cause glare and image degradation. In this paper, we report a patient who experienced disabling glare sufficient to require the explanation of the YAG-damaged intraocular lens. The patient, her management ...

People who are recovered from chemical dependency are frequently seen in dental practice. They have special needs, especially in pain management. Understanding chemical dependency and establishing a good pretreatment rapport with the patient will assist the dentist in reducing the need for postoperative analgesics. The practitioner should rely highly on ...

The anaesthetic management of a parturient with mitral stenosis is presented and discussed. In particular, the beneficial effects of epidural anaesthesia for vaginal delivery are described with respect to the significant improvement noted in haemodynamic parameters. The information derived from the pulmonary artery catheter greatly assisted the management of the ...

Oral wounds and burns may result in microstomia with significant management problems. An important early management decision involves the selection of an appliance capable of applying forces that will halt and reverse the condition. A selection appropriate to the patient may be based on the need for teeth suitably placed ...

A review of the management of 34 patients with subdural empyema treated at the Derbyshire Royal Infirmary has been undertaken. It is concluded that craniotomy has little part to play in the management of patients with this condition. With modern, improved antimicrobials and prompt burr hole lavage complete recovery should ...

The tendency for the index finger to pronate after implant arthroplasty of the metacarpophalangeal joint is often a problem for the surgeon and hand therapist. The three splinting methods described correct this problem and yet allow the patient to participate in the full postoperative protocol during the early encapsulation phase. ...

We report on the results of a pilot study using transdermal scopolamine in the management of detrusor instability (DI). Numerous agents have been used for the management of DI, however, many are associated with poor patient compliance and significant side effects. We have successfully used transdermal scopolamine on 3 patients ...

A new method of management of the extruding cardiac pacemaker is proposed. The technique involves placement of the pacemaker and its leads in a subpectoral pocket. The technique has been studied in 13 patients with a success rate of 84.6 percent, perioperative complication rate of 7.7 percent, and late extrusion ...

A comprehensive model of tinnitus management is proposed. As it is rarely possible to abolish the symptom, management of the tinnitus patient must aim at precipitating the habituation process. The model is split into 'evaluation' and 'remediation' sections. In each section the various aspects of management are discussed. Together with ...

Management of hemophiliac patients with inhibitors can be a difficult problem. We report here a patient with severe hemophilia A, a high titer inhibitor, and an abdominal abscess requiring surgery. Despite significant cross reactivity of the inhibitor with porcine FVIII, he was successfully managed with plasmapheresis and porcine FVIII infusions. ...

In an informal survey, patient accounts managers described the present practices taking place in their institutions regarding patient accounts management. In the areas of admitting, billing, credit and collection, and accounting and management, patient accounts managers are finding methods and techniques to respond to the changes created by DRGs and ...

Anemia is a common finding among the elderly. The clinical evaluation and management of anemia in the older patient is substantially similar to management in the general population. There are, nevertheless, notable differences in the prevalence of certain disorders, in the ability of the patient to tolerate the consequences of ...

Patient accounts management today is facing new challenges. And the patient accounts manager is beseiged by a multitude of threats and opportunities, forcing the manager to seek ways to improve productivity, maintain cash flow, and enhance working relationships. In response, HFMA conducted a roundtable discussion with patient accounts managers from ...

The use of lung function tests and sequential radiography appear to be suitable complementary methods of contrasting the effectiveness of obturator prostheses provided in the management of maxillectomy patients. The creation of an oral seal, demonstrable by normal subjects during swallowing and in the production of certain speech sounds, appears ...

Although surgical removal is generally regarded as the management strategy of choice for acoustic tumors, there remains a small group of patients usually with small or intracanalicular tumors in whom nonoperative management may be a desirable alternative to operation. The authors present a series of six such cases and discuss ...

Dentists participating in a health screening at the 1983 ADA annual session were asked to complete a brief questionnaire concerning their attitudes and methods of managing anxious patients. Most dentists see patient fear as an extremely important dimension of their practice and believe it to be the most important impediment ...

The experience acquired in an anticoagulation clinic during 4 1/2 years is reviewed to demonstrate the effectiveness of such a clinic and to provide the practicing physician with guidelines for managing outpatient oral anticoagulation therapy. The experience is based on anticoagulant therapy in 141 patients during 1,264 patient-months. The patient ...

In this paper the authors attempt to clarify the botanical identity of Tamalaki, a controversial herb used in Kerala, in Ayurvedic medicine.

In order to establish a protocol for the anesthetic management of patients undergoing lithium therapy, one must consider the mechanisms of lithium action. Many proposals for different mechanisms appear in the literature which attempt to explain the pharmacology, physiology, metabolism, administration, dosage and adverse effects of lithium. This paper reviews ...

It has been suggested that up to 20 per cent of patients do not cash their prescriptions. To investigate this possibility, the rate of uncashed prescriptions in a group practice was measured. Out of 1,395 prescriptions studied, 89 (6.4 per cent) were uncashed. An association between having to pay prescription ...

Stone retention after duodenoscopic sphincterotomy may occur despite an adequate and well-performed sphincterotomy. We have identified factors contributing to stone retention in 26 patients. In 22 of these patients, the stones have been effectively managed with a biliary endoprosthesis in a manner which traps the stone proximally and maintains patency ...

Tantra and Ayurveda are interrelated, particularly during medieval period, Tantra had great impact on the theory and practice of Ayurveda. Hitherto this aspect of history is not sufficiently explored. In this paper, influence of Tantra on Sarngadhara, a representative author of the medieval period, has been vividly brought out.

From a review of numerous studies and reports of management of pediatric illness by telephone, it is concluded that innovative methods of teaching effective diagnosis and management by telephone still need to be explored. More research should be done on patient outcomes to assess the adequacy of the initial decision-making ...