Evaluation and Treatment of Osteoporosis.

As the population ages, the rates of osteoporotic fractures will increase, with postmenopausal women incurring most of these fractures. Diagnosis and treatment of osteoporosis are extremely important. Dual-energy x-ray absorptiometry scan screening is recommended in all women more than 65 years of age or in women aged 50 to 64 years with certain risk factors. Treatment should be considered if osteoporosis is present, there is a history of fragility fracture, or in the setting of osteopenia plus high risk for fracture.

Female sexual dysfunction.

Female sexual dysfunction is a common patient concern. After providing an overview regarding the various types of female sexual dysfunction, we will focus on history taking and treatment options for desire, arousal, orgasm, and pain disorders. Testosterone therapy and management of selective serotonin reuptake inhibitor-associated sexual dysfunction are reviewed. Treatments for atrophic vaginitis are appraised. Patient cases lead the discussion, providing the reader with clinically relevant information.

Common dermatologic conditions.

When assessing a patient with a new dermatologic condition, developing a differential diagnosis is essential to ensure the condition is not elusive as a workup and potential therapy are considered. Subsequent narrowing of that differential based on history and physical examination can allow a more targeted approach to diagnostic testing and triage, and hasten an effective treatment and resolution. The authors hope to have provided useful historical and clinical clues to aid in the rapid differentiation of the more common diagnoses for alopecias and rashes of the face, intertriginous areas, and legs.

Fatigue.

Fatigue is a common symptom in primary care with many causes ranging from benign to life threatening. Appropriate evaluation and management are guided by the patient's history, which provides valuable clues as to the source of the patient's symptoms. Ultimately a diagnosis may not be identified for many patients presenting with fatigue, and in these patients management is the most challenging. This article offers guidance in the management of patients presenting with fatigue including key aspects of the patient's history of present illness, the building of a differential diagnosis, rational evaluation in a patient with a nondiagnostic history, and management in the setting of a nondiagnostic work-up.

Herpes zoster.

Herpes zoster is a common condition that significantly affects health-related quality of life. Most cases occur in immunocompetent individuals older than 60 years; however, immunosuppressed patients are at particularly high risk. Post-herpetic neuralgia is the most common serious complication of herpes zoster, and is much more common in the very elderly. Vaccination with the zoster vaccine is recommended for most people older than 60, and reduces the incidence of herpes zoster and the occurrence of post-herpetic neuralgia.

Varicella zoster with extended prodrome: a case series.

BACKGROUND: Traditionally, varicella zoster (herpes zoster) is believed to have a prodrome of 1-3 days. The objective of our article is to emphasize the importance of including herpes zoster in the differential diagnosis of unilateral pain syndromes without vesicular lesions present for >3 days. METHODS/RESULTS: We report a case series from one primary care physician's practice at a tertiary-care teaching hospital documenting herpes zoster prodromes of 6-18 days. CONCLUSIONS: Our findings expand the clinical picture of herpes zoster, which hopefully will lead to cases of improved diagnoses that translate into the timely and cost-effective implementation of appropriate treatment.

An unusual case of knee pain: pseudogout and Abiotrophia defectiva infection.

A 90-year-old man was diagnosed with monoarticular arthritis due to pseudogout and Abiotrophia defectiva infection. A. defectiva is recognized as a cause of endocarditis, but is rarely described in septic arthritis. To our knowledge, this is one of the few case reports of septic arthritis due to this organism, and the first in association with pseudogout. This report supports the routine culture of synovial fluid and is further evidence for the role of A. defectiva in septic arthritis.

Management of melanocytic lesions in the primary care setting.

As the incidence of melanoma continues to increase, the role of primary care physicians in managing suspect melanocytic lesions will become increasingly important. The management of suspect melanocytic lesions in the primary care setting can be challenging, and a missed diagnosis of melanoma can have devastating consequences. This review focuses on practical aspects of the evaluation of melanocytic lesions, including patient history, physical examination findings, and the natural history of nevi and melanoma. It also discusses melanocytic lesions that warrant special attention and outlines information that should be provided on the pathology requisition form. Finally, it addresses the potential difficulties in interpreting pathology reports and reviews the implications of pathology results for patient counseling, education, and follow-up.

Interaction between active motion and exogenous transforming growth factor Beta during tibial fracture repair.

OBJECTIVE: Evaluate the effects of axial motion and transforming growth factor beta (TGF-beta) on callus formation and fracture healing.DESIGN Prospective experimental design with a 39-day postfracture recovery. SETTING: Unrestricted cage activity with weight bearing as tolerated. ANIMALS: Twenty-two skeletally mature, female New Zealand White rabbits. INTERVENTIONS: Displaced, closed tibial fractures were reduced and stabilized in external fixators on the fourth day following fracture. Half of the fixators were locked for the duration of healing. The other fixators were locked for one week, then unlocked for the remaining four weeks. Half of the fractures in each fixator group received two injections of recombinant human TGF-beta1 (rhTGF-beta1). One injection was administered at the time of reduction, and the second was given 48 hours later. MAIN OUTCOME MEASUREMENTS: Interfragmentary axial motion was measured during floor activity. Biomechanical properties were measured during a torsion test to failure. Callus area and the distribution of tissues within the callus were determined by computer-aided histomorphometry. RESULTS: The administration of TGF-beta1 did not alter callus size, mechanical properties, or the distribution of tissues in the callus of fractures that were stabilized in locked external fixators. Recoverable axial motion fixation increased callus size, quantity of mineralized bone bridging the fracture, and maximum torque relative to locked fixation. The injection of TGF-beta1 negated the beneficial effects of axial motion by promoting the formation of a peripheral callus bridged by fibrous tissue rather than mineralized trabecular bone. CONCLUSIONS: Injection of rhTGF-beta1 during the first postfracture week does not provide a biologic boost that improves fracture healing. Injection of TGF-beta1 may be detrimental to healing under conditions when fracture motion is present. The results suggest that there is a tendency for exposure to TGF-beta1 to inhibit the normal development of peripheral callus in response to axial interfragmentary motion.