American family physician
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Advanced abdominal pregnancy is an ominous occurrence. The diagnosis is usually made when the physician considers this possibility as the answer to a puzzling obstetric problem. Marked, unexplained anemia, associated with unusual second- and third-trimester signs and symptoms, should warn the physician of the possibility of a near-term abdominal pregnancy.
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Prompt defibrillation with lower energy levels (200 joules) initially is now recommended. Epinephrine is effective when instilled intratracheally and remains the treatment of choice for restoring cardiac rhythm. ⋯ Sodium bicarbonate and atropine are now used more cautiously. Bretylium and verapamil have improved the treatment of refractory ventricular fibrillation and paroxysmal supraventricular tachycardia, respectively.
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Otitis externa, green nail syndrome, toe web infections, hot tub folliculitis, superinfections in chronic antibiotic-treated acne and infectious eczematoid dermatitis are examples of mild cutaneous infections due to Pseudomonas aeruginosa. These may occur in otherwise healthy persons. In persons with lowered resistance, more severe infections such as malignant otitis externa, blastomycosis-like pyoderma and necrotizing fasciitis are observed. Ecthyma gangrenosum, the pathognomonic skin sign of Pseudomonas septicemia, occurs in debilitated or terminally ill patients and must be treated immediately.
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Home monitoring of blood glucose is an important new tool in the management of patients with diabetes mellitus. Current monitoring techniques are safe, reliable and reproducible, and they enable diabetics to participate in their own care. There are no contraindications to home glucose monitoring, but some consideration must be given to cost and maintenance. The physician can evaluate the effectiveness of home monitoring by determining the glycosylated hemoglobin level.
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Peripheral nerve entrapment syndromes must be identified early through careful clinical examination and appropriate diagnostic studies. These neuropathies cause significant pain and disability, but the impairment of nerve function is usually reversible in the early stages. Electromyography and nerve conduction studies are helpful in the differential diagnosis and in localizing the site of entrapment. The carpal tunnel is the most common site of median nerve entrapment, and the cubital tunnel is the most frequent site of ulnar nerve compression.