Evaluation of syncope

Syncope is not an uncommon condition. The evaluation can be as frustrating as the treatment. The role of a detailed history and physical examination cannot be underestimated and both remain a cornerstone in the evaluation of syncope. A systematic approach may not only lead to correct diagnosis in most cases, but also ultimately will be cost effective. This review emphasizes the systematic approach for the evaluation of this challenging problem.     

Evaluation of osteoporosis

Physical examination, bone densitometry and x-ray are the mainstay in the evaluation of osteoporosis. A limited number of simple blood tests are sufficient to discriminate most secondary forms of osteoporosis and to exclude osteomalacia. Bone-specific biochemical markers play an increasing role in monitoring osteoporosis therapy. They may also play a role in treatment decision in the coming years. Bone biopsies are helpful if findings are unclear or inconsistent. The present review gives a summary of the opportunities and limitations of the above diagnostic procedures.     

Evaluation methodology

The results of several large methadone maintenance programs are reviewed and the outcome measures used are analyzed. Criteria measures were often vague and sometimes not defined. Many studies base their findings on unverified patient self-reports because costs for more reliable and systematic data collection are prohibitive. Available data does not allow for resolution of the pro- or antimethadone maintenance views for treatment of heroin addiction.     

Evaluation of propranolol-glucagon test

A propranolol-glucagon test was evaluated in 24 control normal children, 21 pituitary dwarfs, 15 patients with constitutional short stature, 2 with chromosome aberration and 4 with miscellaneous diseases. The dose of glucagon enough for the stimulation of human growth hormone (HGH) secretion is more than 20 microgram/kg of body weight. During the test in the control subjects the serum HGH level increased from 2.3 +/- 1.2 ng/ml to a maximum level of 30.0 +/- 15.1 ng/ml, when 10 mg propranolol, regardless of body weight and 30 microgram glucagon per kg of body weight are given. The dose of propranolol administered ranged from 0.2 to 1.0 mg/kg of body weight in normal children studied. Serum 11-OHCS also increased significantly from 14.5 +/- 11.2 microgram/100 ml to 30.1 +/- 15.5 microgram/100 ml (P less than 0.01). There was no difference in the maximum level of urinary total catecholamines in propranolol-glucagon test between 7 pituitary dwarfs and 7 control subjects. The mechanism of HGH response to propranolol-glucagon administration is unknown, but propranolol-glucagon administration is a sensitive and reliable provocative test for HGH secretion, since false negative response of HGH are not observed in patients with non-pituitary disease.     

Evaluation of ectodermal dysplasia

This case series report outlines possible cranio-maxillofacial deformation consequences associated with ectodermal dysplasia (ED) and embryonic malformations, including dental agenesis. Also described are the oral aspects and rehabilitation. A total of 14 ED patients (7 males and 7 females, aged 5-45 years) underwent clinical examination before assessment and treatment. Lateral cephalometric radiography, Steiner's analysis, and respiratory capacity tests were performed. Most of the patients had sparse or absent hair, a short face with an unusual facial concavity, a maxillary retrusion, and a relative mandible protrusion. Depending on age and orthopedic abnormalities, patients were treated with prosthodontic and orthodontic approaches or implant treatment. Therapists should take a comprehensive and multidisciplinary approach with these patients to improve their dental, masticatory, growth, and orthognathic conditions, as well as esthetic appearance.