By Z. Aschnu. Southampton College. 2018.
Obstetrics and Gynecology Obstetrics and gynecology (OB/GYN) is a specialty devoted entirely to women best 10 mg anafranil. It entails two parts: gynecology discount 10 mg anafranil otc, which treats diseases of the female reproductive system, including cancer; and 68 Opportunities in Physician Careers obstetrics, which deals with the care of women before, during, and after they give birth. Obstetricians/gynecologists have some interesting issues facing them in today’s medical environment. Biomedical research has pro- duced profound advances in obstetrical care. These advances have benefited patients, but have also led to higher, and perhaps unre- alistic, expectations among patients. The threat of a malpractice suit following a delivery is of such concern that it has led some OB/GYNs to give up the obstetrics part of their practices and prac- tice only gynecology. There is also competition from other profes- sional disciplines that deliver babies, notably family physicians and nurse-midwives. Another development is the relative maturity of women giving birth for the first time. This reflects trends of the second half of the twentieth century, when more women delayed having children until they were into their thirties or forties. OB/GYN specialists must therefore be equipped to deal with the issues of fertility and childbirth that these patients present. If they are pregnant, their OB/GYN participates in a very important experience and time in their lives. This is also a specialty with erratic hours, and it makes many demands on its practitioners. Conditions that an OB/GYN might treat other than prenatal care are yeast infections, pelvic pain, endometriosis, infertility, and cancer of the reproductive organs.
Patients with a pneumothorax will present clinically with chest pain order 75mg anafranil with amex, dyspnoea and cyanosis anafranil 75 mg with mastercard. Plain ﬁlm radiography of the chest will display increased radio- opaciﬁcation of the deﬂated lung, evidence of the lung edge medial to the wall of the thorax and increased radiolucency lateral to the lung. Treatment is typi- cally by insertion of a chest drain to remove the air from the pleural space and allow the lung to re-inﬂate. A small pneumothorax will generally resolve without medical intervention. The puncture wound acts like a valve allowing air into the pleural cavity on inspiration but closing to prevent air escaping on expiration thereby resulting in increasing pressure within the pleural cavity and compression of the lung and mediastinum. This condition requires immediate surgical intervention and diagnosis is based upon clinical examination. Post-interventional plain ﬁlm radiography of the chest may be required to assess lung re-expansion. Pneumomediastinum Pneumomediastinum is the presence of air within the mediastinum (Fig. The most common cause of pneumomediastinum in children is asthma and results from alveolar rupture (see Chapter 6). Pleural effusion Pleural effusion is deﬁned as ﬂuid within the pleural cavity and generally occurs as a reaction to another pathological condition (e. It may be identiﬁed on an erect chest radiograph (postero-anterior or lateral) as blunting of the costophrenic angles (Fig. The altered translucency of the lung, which occurs as a result of imaging a pleural effusion in the supine position, may be subtle and therefore, if a pleural effusion The chest and upper respiratory tract 43 Fig. Cystic ﬁbrosis Cystic ﬁbrosis is the most common, lethal, genetic disease affecting Caucasians and is reported to be present in 1:2500 live births in the UK2. It is a multi-system disease that affects the epithelial cells of all major organs, resulting in changes to their absorptive and secretory characteristics.
There is a blend in terminology between metaphyseal ﬁbrous defects of bone and nonossifying ﬁbroma discount anafranil 50mg online, but the behavior is clinically similar and the histology is identical 50mg anafranil with mastercard. The vast majority of the lesions lie within the distal metaphysis of the femur, and are usually cortical in nature. The next most common bone affected in a much smaller percentage of cases is the tibia. It is usually discovered during the ﬁrst decade of life and is generally Figure 6. Lateral radiograph of the foot demonstrating a large asymptomatic, unless a subsequent pathologic aneurysmal bone cyst within the calcaneus. The lesion is radiolucent and eccentrically placed, usually lying within the cortex of the metaphysis of a long bone, with a well-deﬁned sclerotic border (Figures 6. The lesions are clearly radiographically benign, and orthopedic management is indicated for those lesions presenting with a prior pathologic fracture or in which the defect size is of such magnitude as to warrant curettage and bone grafting to prevent additional fracturing. Anteroposterior (a) and lateral (b) radiographs showing the examination for other diseases, require only characteristic appearance of a nonossifying ﬁbroma. The lesions are believed to spontaneously resolve with skeletal maturation. The role of the primary care physician is for appropriate identiﬁcation and consultation and /or referral. Osteoid osteoma Osteoid osteoma is a benign reactive lesion of bone characterized by a central active nidus that is composed of a very highly vascular connective tissue centrum and surrounded by dense reactive bone. Although it has been traditionally taught that the lesions are non-neoplastic, non-inﬂammatory, or infectious, the behavior strongly mimics that of a localized inﬂammatory process. The lesion (a) (b) 143 Osteoid osteoma (a) clinically behaves like a low-grade localized infection of bone, which does not result in an abscess, or the more serious sequelae of other types of infection. It is likely that the true etiology will be debated for many years, but the condition is generally self-limiting, occurs more commonly in males, and most commonly affects a single bone. The clinical ﬁndings are usually characteristic, although may also be subtle in nature. Pain is the most signiﬁcant complaint, and very commonly occurs in the evening or at night, awakening the patient from sleep. If the lesion is sufﬁciently superﬁcial in location, localized tenderness may be present, and there may even be some local deformation from the reactive bone in the region of the lesion.