The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Jul 2001
Case ReportsEvaluation of aminotransferase elevations in a bodybuilder using anabolic steroids: hepatitis or rhabdomyolysis?
The use of anabolic steroids among competitive athletes, particularly bodybuilders, is widespread. Numerous reports have noted "hepatic" dysfunction secondary to anabolic steroid use based on elevated serum aminotransferase levels. The authors' objective was to assess whether primary care physicians accurately distinguish between anabolic steroid-induced hepatotoxicity and serum aminotransferase elevations that are secondary to acute rhabdomyolysis resulting from intense resistance training. ⋯ Prior reports of anabolic steroid-induced hepatotoxicity that were based on aminotransferase elevations may have overstated the role of anabolic steroids. Correspondingly, the medical community may have been led to emphasize anabolic steroid-induced hepatotoxicity and disregard muscle damage when interpreting elevated aminotransferase levels. Therefore, when evaluating enzyme elevations in patients who use anabolic steroids, physicians should consider the CK and GGT levels as essential elements in distinguishing muscle damage from liver damage.
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Low back pain, a leading cause of disability in the United States, has a significant economic impact not only on lost productivity but also on healthcare expenditures. Approximately a fifth of patients will see multiple physicians in their quest for relief of low back pain. ⋯ This article reviews the diagnosis and assessment of pain levels and a triad system of therapy involving cortical, spinal, and peripheral levels. Options include antidepressants, neuroleptics, neurostimulants, and osteopathic manipulative treatment (OMT) (cortical level); opiates, tramadol hydrochloride, and transcutaneous electrical nerve stimulators (spinal level); and nonsteroidal anti-inflammatory drugs, epidural injections, spinal blocks, antispasmodics, physical therapy, muscle relaxants, exercise, and OMT (peripheral level), By choosing a modality directed at each level, the clinician may provide the patient with a pain management program that will maximize the chosen mode of therapy and restore function and mobility.
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Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is an important clinical diagnosis that every family practitioner should be able to recognize. Although penile Mondor's disease is rare, proper diagnosis and consequent reassurance can help to dissipate the anxiety typically experienced by patients with the disease. This article describes the symptomatology, diagnosis, and treatment of superficial thrombophlebitis of the dorsal vein of the penis.
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J Am Osteopath Assoc · Feb 2001
Comparative StudyPredicting factors of successful recovery from lumbar spine surgery among workers' compensation patients.
It is commonly believed that patients who are compensated for a work-related injury have less incentive to return to work. This study evaluated how various factors affected the outcomes of lumbar spine surgery in terms of pain relief, functional status, return to work, and general health. Eighty-seven workers' compensation patients had spinal fusion or microdiskectomy. ⋯ Overall, 55% of patients did return to work in some capacity, but the rate was 72% for microdiskectomy patients versus 43% for fusion patients. While outcomes significantly improved, postoperative scores remained severe. This did not correlate with return-to-work rates, suggesting that outcomes measures may not be effective.
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J Am Osteopath Assoc · Dec 2000
ReviewAcute gastrointestinal bleeding: clinical essentials for the initial evaluation and risk assessment by the primary care physician.
Acute gastrointestinal bleeding is a common medical emergency that frequently results in hospitalization. Rapid initial assessment of clinical parameters such as estimated volume of blood lost, appearance of expelled blood, hypotension, mental status changes, and coagulopathy should all be evaluated as part of the outcomes prediction equation. ⋯ Endoscopic therapy can reduce the rates of recurrent bleeding, surgery, and length of hospital stay in patient with these "stigmata of recent bleeding." Other endoscopic ulcer appearances such as brown or black pigment in the ulcer base or a clean ulcer base do not require endoscopic therapy, as rates of recurrent bleeding are very low for these lesions. Use of these clinical and endoscopic outcome predictors can also be useful in refining triage decisions as to which patients need to be in the intensive care unit, which need to be admitted to the hospital, and which can have early oral feeding and expedited hospital discharge or outpatient care.