Primary care physicians should be familiar with the effects and appropriate uses of retinoids. Topical tretinoin (Retin-A) can reverse photoaging of the skin, although some transient, undesirable side effects usually occur. In patients with acne vulgaris, topical tretinoin and systemic isotretinoin (Accutane) are the only agents that act upon the apparent underlying causes. Recurrence is unlikely after successful results are achieved. Chronic hypervitaminosis A presents insidiously, and physicians must maintain a high index of suspicion. Complete history taking should always include questions about the patient's use of vitamin supplements.

Acne Vulgaris↗

PubMed1990

Elevated cholesterol levels. How to individualize treatment.

Each of the three case studies represents a common presentation of a patient with elevated lipid levels. By categorizing patients using the guidelines of the National Cholesterol Education Program and considering the high-density lipoprotein cholesterol level, clinicians can more reliably assess response to treatment. An elevated total cholesterol level is only one of several important risk factors for coronary artery disease that must be confronted.

Adult↗

PubMed1990

Serologic tests for syphilis.

Not since the early 1950s has the number of new cases of syphilis been as high as it is now. The infectious agent, Treponema pallidum, is extremely difficult to culture in vitro and almost impossible to see by conventional light microscopy. A nonspecific antibody test is used for screening and a specific treponemal antibody test for confirmation. Because of the complexity of the disease, the sensitivity and specificity of a given test can vary according to disease stage. The physician must understand the limits imposed on testing by the disease process and the special circumstances that prevail in testing patients for prenatal and congenital syphilis as well as neurosyphilis. With early detection and treatment, cure can be achieved and long-term complications avoided.

False Negative Reactions↗

PubMed1990

Vacation diarrhea. How should it be managed?

Traveler's diarrhea in North America is most often a self-limited disease that requires little medical intervention unless the course is prolonged or especially severe. Diagnosis is almost always made by a stool examination or culture. The most common causative organisms are Campylobacter jejuni and Giardia lamblia. Enterotoxigenic Escherichia coli is a less frequent cause. Patients should be advised regarding the need for fluid replacement. Antibiotic therapy should be considered only in rare circumstances.

Adult↗

PubMed1989

Chlamydial infections. Gaining control of a growing epidemic.

Infections caused by Chlamydia trachomatis are wide-spread, costly, and damaging. Consequences are harshest for women because of the adverse effects on the reproductive system. Newborns of infected mothers may also be affected. Screening of sexually active patients is important, because many infected patients are asymptomatic. Newer, improved laboratory techniques are available. Treatment with doxycycline, tetracycline, or erythromycin is preferred. Simultaneous treatment of sexual partners is vital.

Adolescent↗

PubMed1989

Using erythromycin. Some helpful observations.

Erythromycin is a very safe antibiotic that is effective against a wide variety of common and uncommon bacterial infections. Several formulations are available, each with a different absorption rate and dosing profile. The most common side effect of erythromycin is gastrointestinal intolerance, which appears to be related to disruption of intestinal motility. Gastrointestinal tolerance may be improved by limiting daily doses to less than 4 g; temporarily decreasing the total daily dose; using small doses of liquid suspension every 2, 3, or 4 hours; taking the medication with milk or food; and drinking water every 15 minutes two or three times after each dose. These measures may, in turn, improve compliance and efficacy in affected patients.

Drug Interactions↗

PubMedDate not supplied

Are benign cellular changes on a Papanicolaou smear really benign? A prospective cohort study.

OBJECTIVES: To determine the underlying prevalence of cervical intraepithelial neoplasia (CIN) in women with benign cellular changes on a Papanicolaou smear, and to evaluate follow-up strategies to identify women at high risk for serious underlying pathology. METHODS: Nonpregnant women aged 18 to 75 years with benign cellular changes on a Papanicolaou smear were recruited from primary care clinics of an urban teaching hospital. The subjects (N = 132) were tested at baseline for the presence of human papillomavirus using the polymerase chain reaction technique, and underwent repeated cervicovaginal smears at 3, 6, and 9 months. At 12 months colposcopy was performed. The main study outcome was the proportion of subjects with CIN as determined by colposcopic biopsy specimens. We determined the sensitivity, specificity, and predictive values of historical risk factor information, human papillomavirus testing, and repeated cervicovaginal smears for the detection of CIN. RESULTS: Cervical intraepithelial neoplasia was found in 30 of 132 women, of whom 27 (20%) had low-grade CIN (CIN I) and 3 (2%) had high-grade CIN (CIN II). Underlying CIN was significantly more common in women younger than 35 years or who had a history of Trichomonas infection or venereal warts, a positive human papillomavirus test result, or abnormal follow-up smears. However, no follow-up strategy combined high sensitivity with a low referral rate for colposcopy. CONCLUSIONS: The prevalence of underlying high-grade CIN in women with benign cellular changes is low. However, further prospective studies in other settings are needed before routine follow-up can unequivocally be recommended.

Adult↗