Urinary incontinence is one of the most common chronic medical conditions seen in primary care practice. It is more prevalent than diabetes, Alzheimer's disease, and many other conditions that receive considerably more attention. Incontinence is an expensive problem, generating more costs each year than coronary artery bypass surgery and renal dialysis combined. (1,2) Women have higher rates of urinary incontinence than men. Prevalence increases with age; one third of women older than 65 years ...Jan 15, 2005 / [ Details... ]
What are the pelvic floor muscles? Pelvic floor muscles help prevent urinary incontinence. Incontinence happens when the pelvic floor muscles get weak and cause you to leak urine. Pregnancy, childbirth, and being overweight can weaken pelvic floor muscles in women. In men, surgery for prostate cancer is usually the cause. Why should I do pelvic floor muscle exercises? Urinary incontinence is embarrassing, but it can be treated. Pelvic floor muscles are like other muscles--exerci...Jan 15, 2005 / [ Details... ]
Patients with severe vitamin D deficiency and hypocalcemia present with classic findings of neuromuscular irritability, including numbness, paresthesias, muscle cramps, laryngospasm, Chvostek's sign, Trousseau's phenomenon, tetany, and seizures. (1) By contrast, patients with mild vitamin D deficiency present with more subtle complaints such as muscle weakness or pain. Finding only a modest reduction in a patient's calcium or phosphate level should not reassure the physician that all is well. When vita...Jan 15, 2005 / [ Details... ]
This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for visual impairment in children younger than five years and the supporting evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, second edition. (1) In 1996, the USPSTF recommended vision screening for amblyopia and strabismus in all children before they enter school (B recommendation). 1 Since then, the USPSTF criteria to rate the strength of the evid...Jan 15, 2005 / [ Details... ]
Statins can significantly decrease serum lipid levels and have become a major tool in the effort to decrease rates of cardiovascular disease in high-risk patients. Statins occasionally cause muscle and liver toxicity, although these adverse events are rare. Liver toxicity usually is signaled by an asymptomatic increase in transaminase levels, but rare episodes of severe hepatotoxicity and liver damage have been reported. For this reason, statins have been contraindicated in patients with active liver d...Jan 15, 2005 / [ Details... ]
Exposure to environmental and medical radiation has been associated with increased risk of delivery of low-birth-weight (LBW) infants, mediated through the hypothalamicpituitary-thyroid axis or possibly a direct effect on the reproductive organs. Because dental radiography directly irradiates only the hypothalamic-pituitary-thyroid axis, it provides an opportunity to identify the mechanism of action. Hujoel and associates therefore conducted a case-control study to determine whether dental radiography ...Jan 15, 2005 / [ Details... ]
The use of tumor necrosis factor (TNF) antagonists is steadily increasing in patients with chronic inflammatory conditions (e.g., rheumatoid arthritis). TNF is needed for granuloma formation, a key defense measure against intracellular pathogens, and use of TNF antagonists is associated with an increased risk of granulomatous infectious diseases (e.g., tuberculosis, histoplasmosis). Wallis and colleagues report on four years of data from the Adverse Event Reporting System (AERS) about infectious compli...Jan 15, 2005 / [ Details... ]
Recurrence of an inguinal hernia after surgical repair is fairly common. Tension-free repair of hernias using prosthetic mesh has been shown to reduce rates of recurrence compared with traditional tension-producing operative techniques. Laparoscopy is used increasingly for hernia repair and is associated with less postoperative pain and earlier return to normal activities. Laparoscopic repair requires the use of general anesthesia, however, and has higher reported rates of serious complications compare...Jan 15, 2005 / [ Details... ]
Hospitalization rates for heart failure are high, and six-month readmission rates approach 50 percent. Because volume expansion often leads to exacerbation, diuretics are the mainstay of therapy, but these drugs can have adverse effects and do not prolong survival. A medication that blocks arginine-vasopressin might have long-term pharmacologic benefits similar to those of other medications for congestive heart failure (CHF), such as angiotensin-converting enzyme inhibitors and beta blockers, but it al...Jan 15, 2005 / [ Details... ]
Coronary artery calcification determined by electron beam computed tomography correlates well with coronary atherosclerosis. Quantitative techniques, most notably the Agatston calcium score (ACS), have been suggested but have limited reproducibility. Serial imaging recently has been recommended by the American College of Cardiology/ American Heart Association Task Force to improve the predictive value. The volumetric calcium scoring (VCS) algorithm measures calcium by volume and compares the results wi...Jan 15, 2005 / [ Details... ]