OBJECTIVE: To determine the prevalence and nature of orofacial and dental problems in 2 family medicine practices. DESIGN: Prospective, cross-sectional analysis of consecutive patient visits. SETTING: Urban and rural family medicine practices. PATIENTS AND PARTICIPANTS: Four hundred seventy-two patients between age 10 and 86 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prevalence and nature of patient visits to family medicine practices that were either initiated by problems in the region of the oral cavity or that involved questions raised by the patient concerning oral or perioral sites. RESULTS: Twenty-one patients (4.5%) of 472 met the inclusion criteria, 16 (76%) of whom had an oral problem as the primary or secondary reason for their visit. Perioral pain and mucosal ulcerations were the most common problems, and gingival tissue was the most common location. Almost two thirds of these patients had bacterial, fungal, or viral infections. Regarding treatment, 13 (62%) of these patients received advice, 10 (48%) received prescriptions, and 3 (15%) were referred to a dentist or another medical specialist. CONCLUSIONS: Oral and perioral problems are common in the practice of family medicine, which suggests the desirability for specific oral medicine topics in the training and continuing education of primary care physicians. Arch Fam Med. 2000;9:1009-1012

Adolescent↗

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Social workers' responsibilities in heart transplantation programs.

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Adaptation, Psychological↗

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Oral contraceptives and antibiotics: important considerations for dental practice.

This paper considers the possible interactions between oral contraceptive pills and antibiotics, in the context of modern dental practice. A review of the literature on such interactions leads to the conclusion that current national guidelines on the use of alternative contraceptive measures during a course of broad spectrum antibiotics in women also using the oral contraceptive pill should be emphasised and encouraged as part of good clinical practice. A patient information leaflet may be considered as a useful way of presenting such advice to female patients.

Anti-Bacterial Agents↗

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Thiomersal sensitivity in health care workers.

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Dermatitis, Allergic Contact↗

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Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors.

To assess the differences in proteolytic activity of acute and chronic wound environments, wound fluids were collected from acute surgical wounds (22 samples) and chronic wounds (25 samples) of various etiologies, including mixed vessel disease ulcers, decubiti and diabetic foot ulcers. Matrix metalloproteinase (MMP) activity measured using the Azocoll assay was significantly elevated by 30 fold in chronic wounds (median 22.8 microg MMP Eq/ml) compared to acute wounds (median 0.76 microg MMP Eq/ml) (p < 0.001). The addition of the matrix metalloproteinase inhibitor Illomostat decreased the matrix metalloproteinase activity by approximately 90% in all samples, confirming that the majority of the activity measured was due to matrix metalloproteinases. Gelatin zymograms indicated predominantly elevated matrix metalloproteinase-9 with smaller elevations of matrix metalloproteinase-2. In addition tissue inhibitor of metalloproteinase-1 levels were analyzed in a small subset of acute and chronic wounds. When tissue inhibitor of metalloproteinase-1 levels were compared to protease levels there was an inverse correlation (p = 0.02, r = - 0.78). In vitro degradation of epidermal growth factor was measured by addition of 125I labelled epidermal growth factor to acute and chronic wound fluid samples. There was significantly higher degradation of epidermal growth factor in chronic wound fluid samples (mean 28.1%) compared to acute samples (mean 0.6%). This also correlated to the epidermal growth factor activity of these wound fluid samples (p < 0. 001, r = 0.64). Additionally, the levels of proteases were assayed in wound fluid collected from 15 venous leg ulcers during a nonhealing and healing phase using a unique model of chronic wound healing in humans. Patients with nonhealing venous leg ulcers were admitted to the hospital for bed rest and wound fluid samples were collected on admission (nonhealing phase) and after 2 weeks (healing phase) when the ulcers had begun to heal as evidenced by a reduction in size (median 12%). These data showed that the elevated levels of matrix metalloproteinase activity decreased significantly as healing occurs in chronic leg ulcers (p < 0.01). This parallels the processes observed in normally healing acute wounds. This data also supports the case for the addition of protease inhibitors in chronic wounds in conjunction with any treatments using growth factors.

Acute Disease↗

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Positive direct antiglobulin test in acute leukemia at presentation.

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Acute Disease↗

PubMedDate not supplied

Lipoprotein metabolism in nonresponders to increased dietary cholesterol.

We have studied the effect of increased dietary cholesterol on production and degradation of plasma very low density lipoproteins and low density lipoproteins. We studied five unselected normal volunteers who were on weight-maintaining diets consisting of 45% carbohydrate, 40% fat, and 15% protein with a ratio of polyunsaturated to saturated fat of 0.4. Cholesterol content was 150 mg/1000 kcal in Period A and 500 mg/1000 kcal in Period B. Subjects were fed each diet for 4 to 5 weeks. The turnover of apoproteins B in very low density and low density lipoproteins and of triglyceride in very low density lipoproteins were measured during the last 2 weeks of each study period using 131I-labeled very low density lipoproteins and 125I-labeled low density lipoproteins and 2-3H-glycerol, respectively. There was no significant change in plasma total cholesterol or triglycerides or in low density lipoprotein cholesterol levels during the high cholesterol versus the low cholesterol diet. Similarly, high cholesterol intake had no effect on the rate of production or clearance of apo B in very low density and low density lipoproteins or of triglyceride in very low density lipoproteins. These data indicate that the flux of very low density lipoproteins does not change in nonresponders to high cholesterol diets.

Adult↗

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A medical diagnostic index for rehabilitation.

This paper records the developments of a computerized database suitable for recording the history, signs and symptoms of handicapping conditions, monitoring recovery, and measuring the impact of different forms of treatment. The original model described was designed for stroke and the paper describes its integration into the routine use of a stroke and rehabilitation unit in a district general hospital.

Activities of Daily Living↗

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Lower limb amputation.

The decision to amputate is a difficult one, but in some cases, amputation can greatly improve the patient's quality of life. Jo Gibson discusses the nursing care of patients undergoing amputation, with a view to helping them adjust to their changed circumstances.

Adaptation, Psychological↗

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