Aortic Stenosis
Patients with aortic stenosis (AS) have an increased prevalence of coronary risk factors, coronary artery disease, and other atherosclerotic vascular disease and an increased incidence of coronary events and death. Statins may reduce the progression of AS. Angina pectoris, syncope or near syncope, and heart failure are the three classic manifestations of severe AS. Prolonged duration and late peaking of an aortic systolic ejection murmur best differentiate severe AS from mild AS on physical examination. Doppler echocardiography is used to diagnose the presence and severity of AS. Once symptoms develop, aortic valve replace...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Clinical Update on the Diagnosis and Treatment of Bacterial Endocarditis
Infective endocarditis (IE) represents the top of the pyramid of the relationship between humans and bacteria in that it is a less common form of infection than other localized infections in specific organ systems, but it may carry considerable morbidity and mortality. In a time when the practice of medicine is performed at the organ-system level through subspecialists, systemic diseases causing dysfunction in multiple organ systems like IE may be difficult to diagnose. The salient features of IE may present atypically or be obscured by the presence of preexisting and coexisting diseases. Early diagnosis of IE is important...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Management of Peripheral Arterial Disease of the Lower Extremities
Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in patients with peripheral arterial disease (PAD) of the lower extremities. Statins decrease the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation progr...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
CME Questions
(Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Pulmonary Arterial Hypertension
AbstractBetter recognition of primary pulmonary hypertension can produce better treatment by comprehensive therapists. (Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Radiation Therapy for Prostate Cancer: The Role for Dose Escalation
Recent technological advances in radiation treatment delivery have allowed relatively higher doses of radiation to be delivered safely to the prostate. Emerging data suggest improvements in disease control with higher doses of radiation in subsets of patients with prostate cancer. (Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Treatment of Heart Failure with Normal Left Ventricular Ejection Fraction
Underlying causes and precipitating causes of heart failure (HF) should be treated when possible. Persons with HF and normal left ventricular ejection fraction (LVEF) should have maintenance of sinus rhythm, treatment of hypertension, myocardial ischemia, dyslipidemia, and anemia, slowing of the ventricular rate below 90 bpm, and reduction of salt overload. First-line drug treatment in the management of these persons is the use of loop diuretics combined with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. If persons are unable to tolerate ACE inhibitors because of cough, angioneurotic edema, ras h, or ...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Diagnosis and Management of Pleural Effusions: A Practical Approach
Pleural effusion is defined as an abnormal amount of pleural fluid accumulation in the pleural space and is the result of an imbalance between excessive pleural fluid formation and pleural fluid absorption. Although the list of causes of pleural effusions is extensive, the great majority of the cases are caused by pneumonia, congestive heart failure, and malignancy. In this article, we provide an overview of the most common causes of pleural effusions likely to be encountered by the general practitioner, and a practical approach to the diagnosis and management of this common condition. (Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Posttraumatic Stress Disorder in Primary Care Patients
Posttraumatic stress disorder (PTSD) is a common psychiatric condition. PTSD patients can present with a wide variety of symptoms, and these patients are also at a higher risk of other physical, psychiatric, and substance abuse problems. Recent advances in the treatment of this condition can help the majority of patients with PTSD. Early detection, initiation of appropriate treatment, and timely referral are crucial in the proper management of PTSD. (Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Pulmonary Embolism —A State of the Clot Review
AbstractThe assessment for pulmonary emboli is still Stone Age. History and physical findings are not sensitive or specific making it difficult to establish the diagnosis. PE is still potentially fatal. Death most often results from the severity of the clot, although delay in treatment may play a role. Clots, including deep venous thrombosis and pulmonary emboli, are the first disease that falls clearly under the Hospitalist specialty. An argument over what imaging is ideal continues to rage on, without any clear leader at this point. The CT scan and Ventilation/Perfusion scan are the two modalities being used most often. ...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Book Reviews
(Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Editorial
(Source: Comprehensive Therapy)
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Aortic Stenosis
Patients with aortic stenosis (AS) have an increased prevalence of coronary risk factors, coronary artery disease, and other atherosclerotic vascular disease and an increased incidence of coronary events and death. Statins may reduce the progression of AS. Angina pectoris, syncope or near syncope, and heart failure are the three classic manifestations of severe AS. Prolonged duration and late peaking of an aortic systolic ejection murmur best differentiate severe AS from mild AS on physical examination. Doppler echocardiography is used to diagnose the presence and severity of AS. Once symptoms develop, aortic valve replace...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Clinical Update on the Diagnosis and Treatment of Bacterial Endocarditis
Infective endocarditis (IE) represents the top of the pyramid of the relationship between humans and bacteria in that it is a less common form of infection than other localized infections in specific organ systems, but it may carry considerable morbidity and mortality. In a time when the practice of medicine is performed at the organ-system level through subspecialists, systemic diseases causing dysfunction in multiple organ systems like IE may be difficult to diagnose. The salient features of IE may present atypically or be obscured by the presence of preexisting and coexisting diseases. Early diagnosis of IE is important...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
Management of Peripheral Arterial Disease of the Lower Extremities
Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in patients with peripheral arterial disease (PAD) of the lower extremities. Statins decrease the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation progr...
Source: Comprehensive Therapy - December 1, 2007 Category: Primary Care Source Type: research
