Abstract:
:Ovulatory dysfunctional uterine bleeding (DUB), a disease prevalent in the latter half of the reproductive years, is diagnosed when organic causes for bleeding have been excluded by clinical, laboratory, and surgical diagnostic means. Disordered prostaglandin metabolism within the endometrium explains most cases of DUB. Nonsteroidal antiinflammatory drugs, oral contraceptives, and oral progestin are effective medical alternatives for women who wish to retain their uterus or to avoid surgery. Hysterectomy is a rapid cure for DUB and is a therapy that is acceptable to many, if not most, women. :Dysfunctional uterine bleeding (DUB), menstrual bleeding not explained by organic pathology in the pelvis or systemic deseases that exacerbate bleeding, is suspected when a reproductive-aged woman has excessive menstrual flow. Ovulatory DUB is most common in parous women aged 30-45 years. Cycles are regular and predictable and menstrual flows are preceded by breas soreness, mood or energy changes, or pelvic discomfort. Hypochronic microcytic anemia may result from the amount, rapidity, and duration of bleeding. Current evidence supports the hypothesis that DUB is associated with an increased total amount of prostaglandin in the uterus. Prostacyclin appears to be a likely cause of menorrhagia because it is locally produced within the intima of vessels and is a powerful vasodilator and effective inhibitor of platelet aggregation. DUB diagnosis requires careful exclusion of organic pathology through a detailed history, complete physical examination, and a complete blood count. A beta-human chorionic gonadotrophin measurement to rule out obstetric accident, curettage, hysteroscopy, biopsy, or laparoscopic visualization may be appropriate under different conditions. Curettage, thyroid hormone administration, ergot alkaloids, vitamin and mineral preparations, and iron therapy do little to correct the basic problem. Aspirin should be avoided in the week before and on the days of flow since in analgesic doses it inhibits the platelet thromboxanes that promote platelet agggregation and local vasoconstriction. Bed rest or reduced physical activity on days of flow is also advisable. Nonsteroidal antiinflammatory drugs are effective in reducing blood loss in women with DUB. The durgs are prostaglandin synthetase inhibitors, but the biochemical modifications causing an improved bleeding pattern are not well understood. All such drugs are effective, but some women experience greater relief with 1 formulation than another. Medroxyprogesterone acetate, 10 mg dialy for 7 days before the onset of flow, reduces bleeding in some women although the mechanism of action is unclear. Oral contraceptives (OCs) containing progestins derived from 19-nortestosterone inhibit endometrial proliferation, so ther is little tissue to be shed and little local prostaglandin to stimulate bleeding. Nonsmoking women under 40 years old with DUB who desire reversible contraception are excellent candidates for OCs. Aminocaproic acid is very expensive and has annoying gastrointestinal side effects. but is cost-effective for women with chronic anemia or life threatening uterine hemorrhage who wish to avoid hysterectomy. Danazol is of little usefulness because of its expense and side effects. Hysterectomy is an acceptable therapeutic option for many women.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Strickler RCdoi
10.1080/00325481.1985.11698855subject
Has Abstractpub_date
1985-01-01 00:00:00pages
235-7, 240-3, 246issue
1eissn
0032-5481issn
1941-9260journal_volume
77pub_type
杂志文章abstract::Knee and elbow injuries are seen frequently by the primary care physician and require prompt and careful treatment in order to prevent infection, preserve joint function, and avoid scarring. A thorough history and physical examination help to rule out more significant damage to the related joint, nerves, or tendons. I...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700678
更新日期:1989-04-01 00:00:00
abstract::Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.07.2573
更新日期:2012-07-01 00:00:00
abstract::Two distinct subpopulations in the pediatric age-group are particularly at risk for poisoning, and the substances likely to be ingested by each group differ. The method of critical care given here incorporates consideration of specific types of poisoning into an overall plan of general diagnostic and therapeutic measu...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716152
更新日期:1982-08-01 00:00:00
abstract::If frostbite is to be treated successfully, direct and indirect effects of injury must be understood. Rapid rewarming helps to preserve tissue by limiting the amount of direct cellular injury. Selective management of blisters helps protect the subdermal plexus, and application of Aloe vera cream (eg, Dermaide Aloe Cre...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11704769
更新日期:1990-12-01 00:00:00
abstract::Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return t...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1992-08-03 00:00:00
abstract::Infective endocarditis refers to infection of the endocardium or heart valves by microbes, resulting in tissue destruction. Clinical presentation is quite variable, and a high level of suspicion is essential for recognition. Diagnosis is dependent on identification of the causative agent in blood cultures. Cultures th...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1993.11701672
更新日期:1993-04-01 00:00:00
abstract::The goals of therapy for congestive heart failure (CHF) are to improve quality of life and to prolong it. Improvement in patients with CHF can only be realized, however, if a multidisciplinary healthcare team can provide effective management in both the inpatient and outpatient settings. Inhibition of compensatory mec...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.01.143
更新日期:1997-01-01 00:00:00
abstract::Although leprosy is increasing in incidence in the United States, it is confined almost entirely to immigrants from developing countries and their close contacts. While the clinical disease has not changed, leprosy has diffused more widely throughout the United States as a result of migration. Primary care physicians ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698955
更新日期:1985-04-01 00:00:00
abstract::According to Cato Institute chairman William A. Niskanen, government-mandated managed competition will fail to control healthcare costs and will pose a serious threat to the quality of American medical care. Mr Niskanen elaborates on this viewpoint in the following remarks, which were originally delivered in a speech....
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945814
更新日期:1994-03-01 00:00:00
abstract::Chronic stable angina (CSA) impairs patient quality of life, is associated with increased patient mortality, and is a prominent symptom of coronary artery disease (CAD), the latter being prevalent worldwide in patients. Currently, therapeutic options for patients with CSA include β-blockers, calcium channel blockers, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.11.2711
更新日期:2013-11-01 00:00:00
abstract::Increasing evidence has contraindicated extended radical dissection of pancreatic adenocarcinoma (PC). With the recent improvement of perioperative management techniques and multimodal treatment strategy for PC, concomitant major vessel resection and reconstruction has thus been aggressively attempted in association w...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2015.1032180
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and cl...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.09.2800
更新日期:2014-09-01 00:00:00
abstract::The hydroxyl-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors of statin action are very effective and safe drugs, and they are widely used for the treatment of hyperlipidemia and the prevention of primary and secondary cardiovascular diseases (CVDs). However, recent meta-analyses of previous studies done with...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1292107
更新日期:2017-05-01 00:00:00
abstract::In most cases, the cause of facial paralysis can be determined on the basis of the clinical evaluation, and expensive diagnostic tests can be avoided. Because Bell's palsy is not always the cause, physicians need to be able to identify critical findings on history and physical examination that indicate an alternative ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.06.522
更新日期:1998-06-01 00:00:00
abstract::Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae, Staphylococcus aureus and ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2015.1074030
更新日期:2015-08-01 00:00:00
abstract::This paper compares the antifungal activity and efficacy of itraconazole and terbinafine in vitro with their experimental activity and efficacy in vivo in patients with superficial fungal infections (tinea pedis and onychomycosis). Onychomycosis and tinea pedis are often treated with oral antifungals. With the introdu...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1999-07-01 00:00:00
abstract::In the evaluation of male and female infertility the history, family history, physical examination, and endocrine and gonadal functional evaluations are the most informative measures. The cause of the infertility is never found in some 17.5% of couples and in almost one fourth of males. In over one third of cases male...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715204
更新日期:1979-07-01 00:00:00
abstract::Evidence indicates that preventive healthcare in childhood reduces healthcare costs and enhances health. Physicians can assume a leadership role in promoting children's health by incorporating health promotion measures into their everyday practice, serving as resource persons or leaders in community and school efforts...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699791
更新日期:1987-04-01 00:00:00
abstract::The best treatment for adenocarcinoma of the prostate depends on the patient's age, general medical condition, life expectancy, and willingness to accept such side effects as impotence. Radical prostatectomy or full-dose radiation therapy are usually curative when cancer is confined to the gland. The technique of pros...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1988.11700490
更新日期:1988-11-15 00:00:00
abstract::Preview Congestive heart failure (CHF) is a common and serious problem, and its diagnosis and treatment should not be the exclusive province of the cardiologist. Primary care physicians can very adequately manage most cases in a cost-effective manner. In this article, Dr Seager gives guidelines for a standard approach...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11946074
更新日期:1995-11-01 00:00:00
abstract:INTRODUCTION:Over the past 2 decades, there has been a significant increase in the number of incidentally found small renal cortical neoplasms (RCNs). As more RCNs are being discovered in the elderly and infirmed patient populations, there has been a growing interest in the role of active surveillance (AS). Active surv...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.01.2251
更新日期:2011-01-01 00:00:00
abstract::Hypertension is a leading contributor to the burden of cardiovascular disease. The importance of lowering blood pressure (BP) to reduce the risk of cardiovascular events has been demonstrated in numerous clinical trials. Most patients require combination antihypertensive therapy utilizing agents from complementary dru...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2009.03.1974
更新日期:2009-03-01 00:00:00
abstract::Normalization of serum lipid levels should be initiated as soon as possible in patients with myocardial, cerebrovascular, or peripheral vascular disease. Clinical trials indicate that coronary artery disease and overall mortality rates can be reduced and atherosclerosis stabilized or reversed by lipid-lowering therapy...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700787
更新日期:1991-01-01 00:00:00
abstract::Evidence from epidemiologic, lipid intervention, and coronary angiographic studies demonstrates the importance of high-density lipoprotein cholesterol (HDL-C) in coronary artery disease (CAD) risk. Data from these studies strongly support the measurement of HDL-C in all patients screened for CAD. Patients with low lev...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1990.11704654
更新日期:1990-05-15 00:00:00
abstract::Scleroderma, psoriasis, lichen planus, and other skin disorders may signal a more serious internal disease. Physicians who recognize such clues can initiate early treatment while disease is in its early stages. The authors of this article describe several of the more common dermatologic conditions linked to systemic d...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.06.227
更新日期:1997-06-01 00:00:00
abstract::Although the link between cigarette smoking and its cardiovascular effects is well established, the mechanisms through which smoking raises blood pressure remain to be clarified. Possible mechanisms include nicotine-induced peripheral and central sympathetic nervous system stimulation, persisting levels of nicotine in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1996.11.114
更新日期:1996-11-01 00:00:00
abstract::Nasal congestion is considered the most bothersome of allergic rhinitis (AR) symptoms and can significantly impair ability to function at work, home, and school. Effective management of AR-related nasal congestion depends on accurate diagnosis and appropriate treatment. Many individuals with AR and AR-related congesti...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2009.01.1961
更新日期:2009-01-01 00:00:00
abstract::Acute intermittent porphyria is an unusual syndrome that may be very difficult to differentiate from acute intraabdominal processes. Diagnosis requires the documentation of increased urinary porphobilinogen. Failure to perform appropriate tests early in the attack may necessitate diagnostic laparotomy to rule out intr...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704454
更新日期:1989-10-01 00:00:00
abstract::Objective: Abnormal pro-inflammatory regulation of the immune system might contribute to the pathogenesis of hyperglycemia during pregnancy. We examined the correlations of neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with disease severity and assessed their predictive values. Methods: This re...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1764235
更新日期:2020-11-01 00:00:00
abstract::The association of depression and erectile dysfunction (ED) has been firmly established, but it may be difficult to distinguish between cause and effect--whether ED causes the depression or the depression causes ED--in an individual patient. In most patients who have major depression, successful reversal of the depres...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.5.15.2000.suppl5.29
更新日期:2000-05-01 00:00:00