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Office management of common anorectal problems.

Common anorectal problems can often be treated in the office setting. Hemorrhoids are usually relieved with use of bulk laxatives or stool softeners; if this fails, coagulation or rubber band ligation may be effective. Surgical therapy is still preferred for third- and fourth-degree hemorrhoids. Perirectal and perianal abscesses are treated by drainage, but in up to 30% of cases a fistula occurs following treatment. Surgical evaluation is appropriate when a fistula is suspected. Acute anal fissures often heal with conservative management; sphincterotomy may be needed for chronic fissures. Anal warts tend to recur and require several treatment sessions with use of ablative techniques.

Aged

Office management of the draining ear.

Otorrhea is one of the most common ear complaints and is usually responsive to office treatment. The various causes of this condition are discussed and appropriate treatment options are detailed in this article. Topics include otorrhea from typanostomy tubes, chronic otitis media, external otitis and otorrhea, otorrhea after trauma, congenital anomalies and otorrhea, and neoplastic otorrhea.

Ambulatory Care

Pediatrics: office management of diabetes mellitus in children.

For children with diabetes and their families, education should start immediately upon diagnosis of the disease or recovery from the initial episode of ketoacidosis and should be directed specifically toward childhood diabetes. The physician or nurse should be accessible by phone at all times in case of severe hypoglycemia or ketoacidosis. Nonemergency problems are handled during routine office visits, which should be scheduled regularly every three months. Measures important to good control include accurate daily testing of urine, proper choice and careful regulation of insulin, and maintenance of a well-balanced diet consistent in total intake and meal and snack times. Children who stay involved with peer groups and activities maintain a healthier attitude toward living with their disease.

Ambulatory Care