The Journal of family practice
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The prevalence of symptoms related to fibrositis was investigated for patients seen in a primary care setting. Of 692 adult patients evaluated, 33 (4.6 percent) had symptoms of unexplained, chronic, diffuse muscular pain. ⋯ The percentages of these patients who met the fibrositis criteria ranged from 17 to 55 percent. These results suggest that unexplained, diffuse muscular aching is a common problem, that it is rarely diagnosed, and that the use of several criteria to define fibrositis excludes many patients with the typical primary symptoms.
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This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. ⋯ Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.
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The case presented here is typical of the localized fibrous mesotheliomas reviewed in the literature. It had a disastrous impact on an otherwise unremarkable pregnancy. There is no discussion in the literature of humeral factors related to localized fibrous mesotheliomas, but the fever, chills, and rheumatoid complaints in some patients may suggest such factors. ⋯ Anticoagulation led to hemorrhage from the thin-walled vascular areas of the tumor. This acute bleeding produced the hypovolemic shock on the third postpartum day, with a cascade of events leading to adult respiratory distress syndrome and the patient's ultimate death. This case underscores the importance of broad differential diagnosis as a continuing challenge in the practice of medicine.
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Successful treatment of pain syndromes is one of the most common and most difficult problems facing family physicians. Frequently analgesics provide inadequate treatment, and clinicians are forced to consider alternatives. This article reviews the neurophysiologic similarities between depression and the chronic pain syndromes and describes several well-designed double-blinded studies that give evidence for the efficacy of antidepressants in chronic pain syndromes. ⋯ For chronic pain, antidepressants should be started at a low dosage and increased in a stepwise manner until an improvement in the pain occurs or intolerable side effects intervene. Side effects are a bothersome aspect of antidepressant therapy but are more tolerable at the doses generally needed for pain relief than at antidepressive doses. At least three weeks of antidepressant therapy is generally needed to gain significant relief of symptoms.