End results in melanoma. A comparison of a University versus a private practice series.
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Our ability to function successfully as efficient physicians depends substantially on our employees who surround us in our practices. It is our office associates who initially come into contact with our patients, generally spend more time with them than we do, and clearly play the major role in the scheduling of, and preparation for, endoscopic examinations. In this article we discuss ways in which we can improve scheduling and preparation for endoscopic procedures.
BACKGROUND: Fatigue is a common symptom of depression, especially the bipolar type. Modafinil is a wake-promoting agent that can alleviate fatigue in depressed patients. Many stimulants used to treat fatigue carry the risk of a switch into mania or hypomania in bipolar patients as well as the risk for tolerance or abuse. METHOD: A retrospective chart review was performed on all patients currently being seen in a large outpatient practice who received modafinil at some point during their treatment. Data collected included patient demographics, MiniSCID diagnoses, clinical diagnoses including history of substance abuse, and length and dosage of treatment with modafinil. RESULTS: Of the 191 patients who were given modafinil at some point during their treatment, 105 patients remained on it for 2 months or more and 37% of these patients were bipolar (18 BPI and 21 BPII). In addition, 86 patients were on modafinil for less than 2 months and 31% of these patients were bipolar(16% BPI and 15% BPII). No patients in any group demonstrated a switch into mania or hypomania while on modafinil. There was also no significant difference in final modafinil dosage between patients who had a positive history of chemical abuse/dependence (290 mg/day) and those who did not (258 mg/day). LIMITATIONS: Retrospective chart review. CONCLUSIONS: Adult affective disorder patients, whether unipolar or bipolar, can use modafinil to relieve symptoms of depression, including fatigue and sleepiness, without risking a switch in their mood or developing tolerance or abuse of this medication.
Increasingly, more centers perform deep brain stimulation (DBS) for the treatment of movement disorders; however, the majority of publications focus on treatment outcomes at tertiary care centers. We retrospectively evaluated nine consecutive patients who were implanted with DBS, initially programmed at other centers, and eventually referred to a community practice for follow up.
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This is a study of 296 nulliparous women who used Copper IUD's as their method of contraception. At the time of first insertion the women had an average age of 21.6 years. The gross cumulative pregnancy rate rose to 11.8 over 5 years. The gross cumulative expulsion rate rose to 13.6 over 5 years and the removal rate for bleeding and pain to 20.4. The net rates were lower over 5 years (pregnancy 8.6, expulsion 11.2 and bleeding and pain 17.3). 29 women expelled their IUD's, of whom 20 underwent reinsertion. 43 women requested removal of their IUD's because of bleeding and pain, of whom 6 requested a reinsertion at a later date. Taking reinsertions into account, the continuation rate over 5 years was 55.2. Inability to insert the IUD was encountered in 28 women (8.6%). In 20 of the women cervical stenosis precluded the insertion of the IUD without local anesthetic, and in the other 8, the pain and/or syncope encountered during sounding the uterus precluded the continuation of the procedure. Insertion problems were encountered in 31 women (10.5%). Syncope occurred in 4 women and one of the women developed a 'grand mal' seizure. Clinically significant pelvic infection occurred within 30 days of insertion in 5 women (approximately 1% of insertions), and one woman developed pelvic infection from gonorrhoea.
Of two-hundred-sixty women seeking cervical cap contraception, exactly half subsequently used the Prentif cavity rim cap as their sole method of contraception. The one year continuation rate for these exclusive cap users was 56.7 per hundred. No major side effects related to the use of the Prentif cap were observed in the course of this study, involving 918 women-months in year 1. Pregnancy and dislodgement of the cap during use were the principal reasons for discontinuation of exclusive use, with gross rates of 19.1 and 12.9 per 100 at one year, respectively.
Eight hundred healthy female infants presenting for routine care were systematically screened for bacteriuria from early infancy to 2 years of age. The initial urinary tract infection was established in 29 infants, 3.6% of the series, at a median age of 9 months. Continued systematic screening of 25 of these 29 infants with bacteriuria to 6 years of age revealed recurrent infection in nine of them and the development of pyelonephritis in three. Recurrent episodes of infection occurred at close intervals of 2 weeks to 4 months in these nine infants and were clustered within an 18-month period. There were no recurrences after 3 years of age. Characteristically, both the initial and recurrent infections were asymptomatic. Lower urinary tract signs of infection, however, were evident to the "instructed parent," i.e., one instructed in the use of the urinary diary, a written log of the parents' observations of the infant's voiding habits. Pyelonephritis developed early in the children with recurrent infections; it was clinically inapparent and developed in infants with (initially) normal urinary tracts.
Forty-five psychiatric patients with chronic fatigue syndrome (CFS) were compared, using the case-control method, to two control groups selected from the same practice and matched on age, gender, and psychiatric diagnosis. The first control group (C-I, N=90) was selected on the basis of relatively good physical health. The second control group (C-II, N=45) was selected without regard to physical health. The reported family history of physical health revealed: the CFS mothers died at a younger age than the C-II mothers; both parents died before age 65 among the CFS parents more frequently than did the C-I parents; and the CFS parents had an increased prevalence of cancer, autoimmune disorders, and CFS-like conditions as compared to the families of one or both control groups. The reported family history of mental disorders revealed no significant differences in any of these conditions between the CFS patients and either control group.