Abstract:
:Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be severely impaired, nonfunctional, and bedridden or housebound. To help characterize these individuals and develop treatment strategies for them, a serum hormone profile consisting of adrenocorticotropin, cortisol, pregnenolone, progesterone, dehydroepiandrosterone, and testosterone was obtained on 61 chronic pain patients who failed standard treatments; 49 patients (80.3%) demonstrated ≥ 1 hormone abnormality defined as a serum concentration or level above or below the normal range, and 7 patients (11.5%) showed a severe pituitary-adrenal-gonadal deficiency as indicated by deficient serum levels of adrenocorticotropin and ≥ 2 adrenal-gonadal hormones. Hormone serum abnormalities are biomarkers of severe, uncontrolled pain, and, in a patient who has failed standard treatment, they are an indicator that enhanced analgesia is required and that hormone replacement may be indicated.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Tennant Fdoi
10.1080/00325481.2014.996110subject
Has Abstractpub_date
2015-01-01 00:00:00pages
1-4issue
1eissn
0032-5481issn
1941-9260pii
10.1080/00325481.2014.996110journal_volume
127pub_type
杂志文章abstract::Patients "lucky" enough to have a nondisabling transient ischemic attack as a warning sign of impending stroke deserve the best possible prophylactic treatment in an attempt to avert that catastrophe. Dr Edmeads provides a step-by-step discussion of diagnostic studies and therapeutic regimens that help avoid stroke in...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701427
更新日期:1992-08-01 00:00:00
abstract::Phencyclidine (PCP) is a dissociative anesthetic whose abuse is a growing problem. Historically, its effects have been considered remarkably like those of the schizophrenic state, but in vitro and in vivo neuropharmacologic data are somewhat inconsistent with the dopaminergic hypothesis of schizophrenia. The physiolog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715603
更新日期:1980-11-01 00:00:00
abstract::Autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations, including cardiac arrhythmias, sudden death, anginal chest pain, neurogenic pulmonary edema, and symptoms of pheochromocytoma. Either generalized or focal seizures may generate such signs and symptoms. A...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11716430
更新日期:1990-11-01 00:00:00
abstract:PURPOSE:To evaluate patient access, provider productivity, and patient satisfaction during a 24-month redesign process of an academic medical center, which requires balance between clinical and educational missions. METHODS:A series of activities were conducted to optimize primary care across 17 attending physicians, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1773685
更新日期:2020-09-01 00:00:00
abstract::The prognosis for patients with obsessive-compulsive disorder has improved dramatically in recent years. Primary care physicians, who may be the first healthcare professionals to consult with these patients, can often provide appropriate treatment or therapeutic guidance. Psychiatric consultations and the implementati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.12.807
更新日期:1999-12-01 00:00:00
abstract::Asthma is treated by avoiding the precipitants of symptoms, by a trial of hyposensitization (immunotherapy) if the precipitant cannot be avoided, and principally by pharmacologic therapy. Acute attacks have been most widely treated with epinephrine, but adrenergic aerosol bronchodilators and aminophylline are being us...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714330
更新日期:1976-04-01 00:00:00
abstract::Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are o...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::Platelets play a key role in the initiation of hemostatic mechanisms during vascular injury. When contemplating prescription of antiplatelet agents (APAs) for patients as primary prevention for cardiovascular events, the physician should carefully weigh the potential benefits of cardiovascular risk reduction with the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.09.2694
更新日期:2013-09-01 00:00:00
abstract::During the last few years, the number, variety, and complexity of nuclear medical examinations that can be performed in children have increased impressively, due partly to recent accomplishments in radiopharmaceutical development and the availability of gamma scintillation cameras and computer systems for acquisition,...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1975.11713991
更新日期:1975-03-01 00:00:00
abstract::Prompt and accurate diagnosis of patients presenting with symptoms suggestive of pulmonary arterial hypertension (PAH) is of outmost importance as delays in identifying this clinical entity have detrimental effects on both morbidity and mortality. Initial noninvasive assessment of these patients has traditionally incl...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1115715
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe practice patterns of US psychiatrists with regard to the diagnosis and management of depression in adults with bipolar I disorder and to identify relevant gaps in clinical knowledge and competence. METHODS:Two focus groups were conducted using nominal group technique...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2013.01.2606
更新日期:2013-01-01 00:00:00
abstract::Although Charcot's disease and its association with diabetes have been described many times in the literature, it is still often misdiagnosed and incorrectly treated as osteomyelitis, arthritis, or gout. The best safeguard is a high index of suspicion. A warm, swollen foot in a diabetic patient with long-standing neur...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700869
更新日期:1991-03-01 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::There are three key goals in current management of the diabetic pregnancy. Normal diabetes control before conception and during the first trimester in an attempt to reduce the incidence of congenital abnormalities. This implies that all diabetic women of childbearing age should have counseling before pregnancy. Routin...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698879
更新日期:1985-02-01 00:00:00
abstract::Suicide is a major public health problem in the United States. Psychiatric disorders that feature or lead to suicidal ideation may be overlooked in the primary care setting because patients are reluctant to broach the subject. In this article, Dr Hamilton describes how physicians can open a dialogue with patients so t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.11.1289
更新日期:2000-11-01 00:00:00
abstract::Granulomatous inflammation of the peritoneal surfaces resulting from exposure to cornstarch granules from surgical gloves produces a syndrome of abdominal pair, adynamic ileus, fever, peritonitis, variable white blood cell count, and inflammatory ascites. Symptoms develop three to four weeks after a routine abdominal ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11716541
更新日期:1976-01-01 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::Recurrent herpes simplex labialis (HSL), also known as orofacial herpes or cold sores, is a common clinical presentation of herpes simplex virus (HSV) infection. It may manifest as painful, distressing, and cosmetically displeasing vesicles on the lips, nose, and nasal septum. Although oral or topical treatment with a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.09.2216
更新日期:2010-09-01 00:00:00
abstract::Osteoblasts are mesenchymal cells that play a key role in maintaining bone homeostasis; they are responsible for the production of extracellular matrix proteins, regulation of matrix mineralization, control of bone remodeling and regulate osteoclast differentiation. Osteoblasts have an essential role in the pathogenes...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1362312
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:The objective was to assess the relative risk (RR) for cardiovascular (CV) events across all 8 randomized phase 2/3 trials evaluating saxagliptin in patients with type 2 diabetes mellitus. METHODS:Cardiovascular events (death, myocardial infarction [MI], stroke, revascularization procedures, and cardiac isch...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2010.05.2138
更新日期:2010-05-01 00:00:00
abstract::Remittent isolated palsy of peripheral or of upper cranial nerves in patients with diabetes mellitus is well documented, but paralysis of a lower cranial nerve or an isolated branch of any cranial nerve has not been previously reported. In the case described, temporary paralysis of the left recurrent laryngeal nerve c...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700420
更新日期:1988-09-15 00:00:00
abstract::Diagnosing acute otitis media (AOM) is quite challenging for physicians and especially other healthcare providers. Although the new guidelines from the American Academy of Pediatrics/American Academy of Family Physicians provide some guidance for making the correct diagnosis of AOM, overdiagnosis will still remain a p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2005.suppl42.215
更新日期:2005-12-01 00:00:00
abstract::Rheumatoid arthritis can cause joint erosion and deformity, pain, stiffness, and decreased function and range of motion. Early diagnosis is crucial to prevent permanent joint damage. In this article, Drs Williams and Fye discuss articular and extra-articular manifestations of rheumatoid arthritis as well as the evolvi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2003.11.1525
更新日期:2003-11-01 00:00:00
abstract::Pain is among the most common reasons patients seek medical attention, and the care of patients with pain is a significant problem in the United States. Acute pain (mild-to-moderate intensity) represents one of the most frequent complaints encountered by primary care physicians (PCPs) and accounts for nearly half of p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.03.2270
更新日期:2011-03-01 00:00:00
abstract::A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiograp...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716219
更新日期:1982-10-01 00:00:00
abstract::Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The cour...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699404
更新日期:1986-05-15 00:00:00
abstract::The evaluation of the bleeding patient starts with the integration of data from the history and physical examination. From this results either one probable explanation that can easily be substatniated by laboratory studies or, as more commonly occurs in practice, several possibilities that are reasonable and must be i...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11712257
更新日期:1977-07-01 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:BACKGROUND:Hypoglycemia and fear of hypoglycemia threaten individuals' ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients' continued ability to drive. METHODS:A cross-sectional survey of Dan...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2015.1045815
更新日期:2015-06-01 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