Nonsyndromic craniosynostosis: current treatment options.

The significance and etiology of abnormal skull shape have been under investigation since ancient times. Nonsyndromic, or isolated, craniosynostosis predominates and is defined as suture fusion that creates functional impairments related to local effects of the fusion. The purpose of this article is to present our current approach to patients with nonsyndromic craniosynostosis, outlining the place of both open, conventional approaches and newer, minimally invasive, endoscopic assisted craniosynostosis correction.     

Paraphimosis: current treatment options

Paraphimosis is a urologic emergency, occurring in uncircumcised males, in which the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue. Often iatrogenically induced, paraphimosis can be prevented by returning the prepuce to cover the glans following penile manipulation. Treatment often begins with reduction of edema, followed by a variety of options, including mechanical compression, pharmacologic therapy, puncture technique and dorsal slit. Prevention and early intervention are key elements in the management of paraphimosis.     

Onychomycosis: current treatment options

PURPOSE: To describe current evidence regarding the treatment of clients with onychomycosis who have one or more chronic illnesses. DATA SOURCES: Current review of research articles, standard pharmaceutical texts, and case studies. CONCLUSIONS: Onychomycosis is often considered only as a cosmetic diagnosis. Treatment is based on factors such as the client's willingness to pay for expensive therapy and the ability to physically comply with daily regimens; however, treatment of onychomycosis in clients with chronic illnesses including diabetes and peripheral vascular disease should be strongly encouraged. For these clients, onychomycosis is not just a cosmetic diagnosis because it has the potential to decrease mobility and blood flow to the affected digits if left untreated. IMPLICATIONS FOR PRACTICE: The primary care clinician's successful management of client's with chronic illnesses such as diabetes and peripheral vascular disease should include the treatment of onychomycosis. Recognizing the best treatment is a crucial decision.     

Tardive dyskinesia: a review and current treatment options.

Tardive dyskinesia (TD) is a source of great concern in psychiatric practice because of the iatrogenic nature of the disorder. It is a serious adverse reaction associated with neuroleptic drug therapy and is characterized by abnormal, involuntary, irregular, repetitive movements of the face and limbs that are purposeless in nature. It develops during exposure to or withdrawal from neuroleptics in patients with a history of neuroleptic use for at least 3 months, or 1 month in patients 60 years or older. To date, the structural or chemical pathology, etiology, and pathophysiology are not well understood, and no consistently effective pharmacological treatment is available. Numerous agents have been used in the management of TD; however, at the present time there are no safe and effective treatments for TD. A review of various agents used in managing TD is presented. Improvements in research design and methodology have been applied to clinical trials, and as a result, the stage has been set for advancement in this area of clinical psychiatry.     

Tularemia: current diagnosis and treatment options

Tularemia is an infection caused by Francisella tularensis with a worldwide distribution and diverse clinical manifestations. Limitations in both culture and serologic testing have led to substantial research into new diagnostic techniques and their clinical application, with PCR testing as the best example. This review focuses on the utility of culture, PCR and serologic testing for tularemia. In addition, we also review the evidence to support different therapeutic options for tularemia, highlighting both the most effective supporting evidence for therapeutic recommendations as well as gaps in current knowledge. We conclude the article with suggestions regarding potential areas for future research.     

Rationing critical care medicine: recent studies and current trends

PURPOSE OF REVIEW: This paper reviews the literature on the rationing of critical care resources. RECENT FINDINGS: Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. SUMMARY: There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.     

Breast cancer: initial diagnosis and current treatment options

Topics discussed in this article are breast cancer versus benign breast conditions, the importance of physical examination used in conjunction with screening mammography in the detection of abnormalities, imaging options, diagnosis, treatment options, and the importance of follow-up care.     

Ocular bacterial infections: current and future treatment options

In this article, common ocular bacterial infections are reviewed, examining bacterial pathogens, antibiotics and antibacterial resistant trends in light of current and future treatment options. Ophthalmologists are fortunate to be able to choose between an array of old and new antibiotics in order to treat bacterial ocular infections. Ophthalmic infections are primarily treated with topical antibiotics applied directly to the eye. Since there are no in vitro susceptibility standards for interpreting ocular bacterial susceptibility, systemic standards are used. There is no immediate need for new ophthalmic antibiotics, but increasing resistance is being seen with the widely used fluoroquinolone antibiotics.     

Tuberculosis: current trends in diagnosis and treatment

Among communicable diseases, tuberculosis (TB) is the second leading cause of death worldwide, killing nearly 2 million people each year. It is estimated that about one-third of the world population are infected with TB (2 billion people) and about 10% of this figure will progress to disease state. Most cases are in the less-developed countries of the world. Tuberculosis incidence has been on the increase in Africa, mainly as a result of the burden of HIV infection. Definitive diagnosis of tuberculosis remains based on culture for Mycobacterium tuberculosis, but rapid diagnosis of infectious tuberculosis by simple sputum smear for acid fast bacilli remains an important tool, as more rapid molecular techniques are being developed. Treatment with several drugs for 6 months or more can cure more than 95% of patients. Direct observation of treatment, a component of the recommended five-element DOTS strategy, is judged to be the standard of care by most authorities. Currently only a third of cases worldwide are treated using this approach. There may be need to modify the treatment modalities especially with the choice of drugs and duration of therapy when TB infection occurs in special situation like pregnancy, liver disease, renal failure or even in coexistence with HlV/AIDS or the drug resistant state.     

Bacterial meningitis: current therapy and possible future treatment options

Despite targeted therapy, case-fatality rates and neurologic sequelae of bacterial meningitis remain unacceptably high. The poor outcome is mainly due to secondary systemic and intracranial complications. These complications seem to be both a consequence of the inflammatory response to the invading pathogen and release of bacterial components by the pathogen itself. Therefore, within the last decades, research has focused on the mechanism underlying immune regulation and the inhibition of bacterial lysis in order to identify new targets for adjuvant therapy. The scope of this article is to give an overview on current treatment strategies of bacterial meningitis, to summarize new insights on the pathophysiology of bacterial meningitis, and to give an outlook on new treatment strategies derived from experimental models.     

Bacterial meningitis: current therapy and possible future treatment options

Despite targeted therapy, case–fatality rates and neurologic sequelae of bacterial meningitis remain unacceptably high. The poor outcome is mainly due to secondary systemic and intracranial complications. These complications seem to be both a consequence of the inflammatory response to the invading pathogen and release of bacterial components by the pathogen itself. Therefore, within the last decades, research has focused on the mechanism underlying immune regulation and the inhibition of bacterial lysis in order to identify new targets for adjuvant therapy. The scope of this article is to give an overview on current treatment strategies of bacterial meningitis, to summarize new insights on the pathophysiology of bacterial meningitis, and to give an outlook on new treatment strategies derived from experimental models.     

General medicine in France and in Germany: current situation and future trends]

The health care system has been built up, both in France and Germany, on the same Bismarckian model: health insurance is financed by contributions from employers and employees, ambulatory care is provided by GPs and specialists in private practice ... etc... Since the 90's, in both countries, there has been a move to strengthen the prestige of GPs and broaden their functions in view of lowering the cost of the health system. However, cost containment has not been the single objective. Several laws have been voted for initiating the gatekeeping function of GPs, controlling the installation of specialists in ambulatory care (private practice), reducing the free choice of care providers by the patients... At the same time, post-graduate training in general practice has been strengthened. Due to historical and cultural reasons, several differences appear in the two countries. For example, confidentiality is strictly observed in Germany and health ID appears only in the French system. We are at the start of a long process. Its success will depend on two conditions: the generalization of the gatekeeping function (which should be entrusted to GPs) and the separation of physicians' income level from the amount of the services they provide to the patients.     

Hypertension: current trends and choices in pharmacotherapeutics.

Many new choices exist in the management of hypertension. Armed with a basic understanding of the definition and causes of hypertension, the pharmacotherapeutics, and special patient populations, health care professionals should be able to optimally educate, treat, and follow up patients with hypertension. In the step-care approach, four different classes of agents may be used as Step 1 choices. Selection is determined by concurrent illnesses, patient age, or concomitant drug therapy. In emergency situations, additional choices exist. Tailoring therapy in hypertensive crises may prevent or minimize end-organ damage. These areas are reviewed, and guidelines for patient assessment and education are presented.     

Mid-portion Achilles tendinopathy – current options for treatment

Purpose. To report on the present option for management of tendinopathy of the main body of the Achilles tendon.

Background. Tendinopathy of the main body of tendo Achillis affects athletic and sedentary patients. Mechanical loading is thought to be a major causative factor. However, the exact mechanical loading conditions which cause tendinopathy are poorly defined. Repetitive mechanical loading induces a non-inflammatory pathology, and repetitive microtrauma ultimately exceeds the healing response. The management of Achilles tendinopathy is primarily conservative. Although many non-operative options are available, few have been tested under controlled conditions. This review article specifically focuses on eccentric training, and on shock wave therapy. Surgical intervention can be successful in refractory cases. However, surgery does not usually completely eliminate symptoms and complications are not rare.

Conclusions. Further studies are needed to discern the optimal non-operative and surgical management of midsubstance Achilles tendinopathy.     

Cholelithiasis: diagnosis and current therapeutic options

More than 20 million people in the United States have gallstones and some 500,000 cholecystectomies are done annually. The cost to the American public is approximately 1.5 billion dollars per year. Biliary pain or "colic" is the classic presenting symptom in gallstone disease, occurring in 5 to 10 percent of symptomatic patients. Of significance is that 10 to 30 percent of symptomatic patients will present with atypical complaints, while 80 percent of people with gallstones are asymptomatic. It is crucial that a detailed history of clients' symptoms be ascertained to ensure an accurate diagnosis. New treatment modalities for cholelithiasis recently have been developed. These include oral bile salt therapy and gallstone lithotripsy. Knowledge of these options and their applications to symptomatic clients will enable health care providers to better formulate plans of education and intervention for clients with gallstone disease.