The effects of therapeutic touch on patients with osteoarthritis of the knee.

Background: The purpose of this study was to determine if therapeutic touch, an alternative medicine modality, is effective in the treatment of osteoarthritis of the knee.

Methods: A single-blinded randomized control trial was conducted in a family practice center of a community hospital family practice residency program in Pennsylvania. The patients were between the ages of 40 and 80, had been given a diagnosis of osteoarthritis of at least one knee, had not had knee replacement, and had no other connective tissue disease.

Pharyngitis.

This article reviews the commonly encountered agents causing acute inflammation of the pharynx and tonsils, with special attention to a practical approach for identifying and dealing with the group A beta-hemolytic streptococcus. Ubiquitous viral agents such as Epstein-Barr virus, rhinovirus, and adenovirus are reviewed. Some agents such as group A beta-hemolytic streptococcus and Epstein-Barr virus are susceptible to treatment.

Five-year follow-up of a nurse-initiated intervention to improve mammography recommendation.

Background: In a previous study we found immediate effectiveness of a nurse-initiated intervention on improving mammography recommendation rates in a family practice residency program. To determine the long-term effectiveness of this ongoing intervention, we performed a chart audit study on two different groups of charts 5 years after the institution of the intervention.

Methods: Chart audits for mammogram recommendation and completion rates were conducted on an original cohort group of women aged 40 years and older (n = 91) and a new 5-year postintervention group of women aged 53 years and older (n = 189).

Tick-borne infections. What starts as a tiny bite may have a serious outcome.

Tick-borne illnesses are being reported increasingly often. Unlike Lyme disease, which tends to be indolent, Rocky Mountain spotted fever and ehrlichiosis can kill and so must be recognized and treated promptly. These diseases require clinical diagnosis, because laboratory confirmation with antibody tests takes too long.

Infectious arthritis.

Infectious arthritis should be suspected in any patient with a swollen joint but especially in children, debilitated patients, immunocompromised persons, those with infection elsewhere (even if on antibiotics), and those with other types of arthritis or a prosthetic joint. Diagnosis depends on obtaining joint fluid for culture and Gram stain. Initial appropriate broad spectrum antibiotics are best narrowed to suit the individual organism, which 2 to 6 weeks of therapy can eradicate.

Radiology of arthritis.

The radiographic evaluation of the arthritides still relies primarily on the plain films that are readily available to every practicing clinician. The radiographic examination serves primarily to confirm the clinician's diagnosis based on the history, clinical findings, and laboratory studies and to document the severity of the arthritic changes. On occasion, the radiographic studies will be diagnostic when other findings are equivocal and the diagnosis is in question.

Joint and soft-tissue arthrocentesis.

Diagnostic arthrocentesis and therapeutic joint and soft tissue injections are important components in the treatment of musculoskeletal complaints for the primary care physician. Proper knowledge of joint architecture anatomic landmarks, indications, contraindications, and complications of injection will enable the physician to provide the patient with a maximum of benefit with a minimum of risk.

Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion.

Ninety of 110 consecutive patients with rheumatoid deformities of the cervical spine surgically treated had associated neurologic deficits. Fifty-five patients had atlantoaxial subluxation. In this group, there were 16 Ranawat Class I patients (normal), 21 Class II (weakness, hyperreflexia, dysesthesia), 13 Class IIIA (paresis and long-tract findings but can ambulate), and five Class IIIB (quadriparesis and inability to ambulate).

Prolonged delirium tremens requiring massive doses of medication.

Delirium tremens might last for weeks and treatment requires massive benzodiazepine doses, yet it is possible to manage patients with this condition successfully. In this case of delirium tremens, standard agents at the usual recommended doses were not sufficient to achieve control of confusion and agitation or to stabilize neurologic and cardiovascular parameters. The patient required extraordinarily high doses of central nervous system depressants for an extended period.

Survey and evaluation of newsletters marketed to family physicians.

Background: Newsletters are marketed to physicians to provide a concise, accurate, and timely overview of the medical literature. The goal of these newsletters seems to be to present information that can be a suitable substitute for reading the original article. The purpose of this paper is to describe and evaluate newsletters pertinent to family physicians.

Recurrence of cervical spine instability in rheumatoid arthritis following previous fusion: can disease progression be prevented by early surgery?

In a retrospective study, 110 patients with rheumatoid arthritis who had cervical spine fusion were evaluated for recurrence of cervical spine instability and resultant need for further surgery. Recurrence of cervical instability was correlated with initial radiographic abnormality, primary surgical procedure and interval between the 2 surgeries. There were 55 patients who had atlantoaxial subluxation (AAS) and required C1-C2 fusion as primary surgery.

The triglyceride connection in atherosclerosis.

Objective: To examine the proposed mechanism of triglyceride-induced atherogenesis, to address the controversy surrounding serum triglycerides as a coronary heart disease (CHD) risk factor, and to recommend an appropriate therapeutic approach to hypertriglyceridemia.

Data Sources: Studies, review articles, and editorials published since 1976. A MEDLINE search of English-language literature was conducted using the terms triglyceride and hypertriglyceridemia.

An approach to pediatric upper respiratory infections.

Upper respiratory tract infections are the most common diseases encountered in office pediatrics. The majority of these illnesses, including the common cold and pharyngitis, are viral in etiology, present with rhinitis and fever, and are self-limited and benign. Management consists of fluids, rest, saltwater nose drops and analgesics.

Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions.

A retrospective study of 79 patients with rheumatoid arthritis was undertaken to determine the incidence of subaxial subluxation after upper cervical fusions. Fifty-five patients had isolated axial subluxation and underwent atlantoaxial fusion. Twenty-four underwent occipitocervical fusion for atlantoaxial subluxation and superior migration of the odontoid.

Management of common finger injuries.

Family physicians can manage most finger injuries, including uncomplicated fractures, proximal interphalangeal joint dislocations, closed tendon injuries and ligament sprains. Finger injuries that can cause long-term morbidity may present as minor sprains. Diagnosis requires a thorough history, systematic examination and radiographic evaluation.