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8801. Osteoporosis (Secondary) (Follow-up)

, pharmacologic treatment should last for 5 years; generic drugs should be used when possible. Monitoring of bone mineral density (BMD) during the 5 years of treatment in women with osteoporosis is not advised, as evidence suggests that fracture risk may be reduced regardless of BMD changes For women aged 65 and older who have osteopenia and are at high fracture risk, decisions to treat should take into account patient preference, fracture-risk profile, benefits, harms, and price of medications In men (...) and patients" can lead to increased bone mineral density (BMD) testing and greater use of osteoporosis medications. [ ] In addition, a physician reminder in conjunction with a patient risk assessment strategy apparently can result in a reduction in patient fractures and an increase in osteoporosis therapy. The authors concluded that multicomponent tools aimed at doctors and patients may support clinical decision making in the management of osteoporosis. A 2009 study indicated that the use of a case manager

2014 eMedicine.com

8802. Phimosis, Adult Circumcision, and Buried Penis (Follow-up)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDQyNjE3LXRyZWF0bWVudA== processing > Phimosis, Adult Circumcision, and Buried Penis Treatment & Management Updated: Dec 15, 2018 Author: Ryan P Terlecki, MD; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Phimosis, Adult Circumcision, and Buried Penis Treatment Medical Care Phimosis Applications of steroid creams (0.05% ) have been used to manage phimosis medically. [ ] The usual regimen is application of the steroid cream once or twice daily for 4-6 weeks. Studies have (...) intervention study in the Orange Farm township of South Africa. Medicine (Baltimore) . 2017 Jan. 96 (4):e5328. . . Kong X, Kigozi G, Ssekasanvu J, Nalugoda F, Nakigozi G, Ndyanabo A, et al. Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda. JAMA . 2016 Jul 12. 316 (2):182-90. . . Kigozi G, Lukabwe I, Kagaayi J, Wawer MJ, Nantume B, Kigozi G, et al. Sexual satisfaction of women partners of circumcised men in a randomized trial of male

2014 eMedicine.com

8803. Pedicle/Interpolation Flaps (Follow-up)

medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Faith Miller Whalen, MD Procedural Dermatology Fellow, Department of Dermatology, Geisinger Medical Center Faith Miller Whalen, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department (...) of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery John G Albertini, MD is a member of the following medical societies: , Disclosure: Serve(d) as a director, officer

2014 eMedicine.com

8804. Rehabilitation Management of Neuromuscular Disease (Follow-up)

. An effective rehabilitation program can also minimize secondary medical comorbidity, prevent or limit physical deformity, and allow the patient to integrate into society. Modalities such as range-of-motion and strengthening exercise, along with bracing and appropriate surgical intervention, may prolong ambulation. Today, adaptive devices such as wheelchairs and lifts are now often interfaced with computer technology, providing better strategies for improving the patient’s mobility. Endurance (aerobic (...) Psychologists Treatment should be goal-oriented, with clear input regarding the patient’s expectations and personal goals. Although NMDs are not curable, they are treatable and do respond to rehabilitation. Ideally, because of the significant mobility problems associated with most NMDs, all key clinic personnel should be available at each visit. Tertiary care medical centers in larger urban areas can usually provide this type of service. A number of organizations sponsor research and clinical care

2014 eMedicine.com

8805. Therapeutic Exercise (Follow-up)

Therapeutic Exercise (Follow-up) Therapeutic Exercise: Overview, Physiologic Aspects of Physical Fitness, Medical Evaluation Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzI0NTgzLW92ZXJ2aWV3 processing (...) that can return a convalescing patient to the peak of physical condition. Therapeutic exercise seeks to accomplish the following goals: Enable ambulation Release contracted muscles, tendons, and fascia Mobilize joints Improve circulation Improve respiratory capacity Improve coordination Reduce rigidity Improve balance Promote relaxation Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC) Improve exercise performance and functional capacity (endurance

2014 eMedicine.com

8806. Tattoo Lasers (Follow-up)

, and blurred with time, presumably as a consequence of ink particles moving deeper into the dermis through the action of mobile phagocytic cells. Random biopsy samples of older tattoos demonstrate pigment in the deep dermis, in contrast to the more superficial location of newer tattoos. Eventually, tattoo ink appears in the regional lymph nodes of patients with tattoos. Tattoo ink is remarkably nonreactive histologically, despite the frequent use of different pigments of unknown purity and identity (...) abraded surface. Exposed pigment is curetted or removed with fine tweezers. Other mechanical treatments include linear incisions, scratches, punctures, and a grid of crisscross abrasions followed by the application of a caustic chemical. Surgical excision of skin containing tattoo pigment is also common but often results in incomplete tattoo removal, tissue distortion, and scarring because of limitations in wound closure and healing. Small tattoos located in areas of adequate skin laxity that allow

2014 eMedicine.com

8807. Transurethral Resection of the Prostate (Follow-up)

. To this day, it remains the criterion standard therapy for obstructive prostatic hypertrophy and is both the surgical treatment of choice and the standard of care when other methods fail. Since the advent of medical therapy for symptomatic prostatic hypertrophy with 5-alpha reductase inhibitors and alpha-adrenergic blockers, the need for immediate surgical intervention in symptomatic prostatic obstruction has been reduced substantially. However, alpha-blockers do not modify prostate growth, and even (...) the use of prostatic growth inhibitors such as finasteride or dutasteride often fails to prevent recurrent urinary symptoms of BPH and retention. In the past, these patients would almost certainly have undergone TURP years earlier. The criteria for performing TURP surgery are now more stringent than before. In general, TURP surgery is reserved for patients with symptomatic BPH who have acute, recurrent, or chronic urinary retention; in whom medical management and less-invasive prostatic surgical

2014 eMedicine.com

8808. Transureteroureterostomy (Follow-up)

):40-4. . Media Gallery Transureteroureterostomy. of 1 Tables Contributor Information and Disclosures Author Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: , , , , , Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical; Olympus. Specialty Editor Board (...) Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Shlomo Raz, MD Professor, Department of Surgery, Division of Urology, University of California, Los Angeles, David Geffen School of Medicine Shlomo Raz, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Chief Editor Edward David Kim

2014 eMedicine.com

8809. Transposition Flaps (Follow-up)

System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery John G (...) Albertini, MD is a member of the following medical societies: , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: QualDerm Partners; Novascan
Have a 5% or greater equity interest in: QualDerm Partners - North Carolina. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine Dirk M Elston, MD is a member of the following medical societies

2014 eMedicine.com

8810. Total Joint Replacement Rehabilitation (Follow-up)

Rasul, Jr, MD, FAAPMR, FCCP NeuroSciences, SLO Abraham T Rasul, Jr, MD, FAAPMR, FCCP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Jeffrey Wright, PT, ATC Director, Department of Rehabilitation Services, Doctors Community Hospital; Director, Department of Rehabilitative Services, Providence Hospital; Director, Department of Sports Medicine, National Hospital for Orthopaedics and Rehabilitation; Certified Strength and Conditioning Specialist (...) Jeffrey Wright, PT, ATC is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans Stephen Kishner, MD, MHA is a member of the following medical societies: , Disclosure: Nothing to disclose. Acknowledgements Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department

2014 eMedicine.com

8811. The Approach to the Painful Joint (Follow-up)

. Palpation of the joints is used to assess for signs of inflammation (eg, warmth, synovial hypertrophy, joint effusion, and tenderness) and signs of joint damage (eg, bony swelling and crepitus). The examiner should palpate with enough pressure to blanch his or her thumbnail. This ensures that the assessment of joint tenderness is uniform. Application of this amount of force during palpation should not cause pain in a normal joint. Assess limitation of passive motion by comparing it with the expected (...) passively with the other. In the lower extremities, crepitus of the hip or knee can sometimes be heard as the patient arises from a chair, climbs a step, or pivots on the affected joint. Assess instability or abnormal mobility by applying forces to the relaxed joint in planes of motion normally associated with little or no motion. Instability of a lower-extremity joint (eg, a knee or ankle) should also be assessed by observing the joint during weight-bearing and walking. Instability of the joint may

2014 eMedicine.com

8812. Indoor Aeroallergens (Follow-up)

treatment options for individuals with allergic diseases, including allergic asthma: Aeroallergen avoidance Medications Allergen immunotherapy More than 90% of the average person's time in developed countries is spent indoors. This statistic underscores the importance of avoidance measures, especially in those who are allergic to indoor allergens. Modern medicine has vastly increased the effective treatment of allergic disorders and asthma. However, the first line of treatment for these diseases (...) photomicrograph of Dermatophagoides farinae. See , a Critical Images slideshow, to help identify a variety of allergens and symptoms. Avoidance Measures and Interventions The physician has the following 3 treatment options for individuals with allergic diseases, including allergic asthma: Aeroallergen avoidance Medications Allergen immunotherapy Avoidance of the offending agent is the first line of treatment for allergic disorders and asthma. It is the most cost-effective treatment modality, and it sometimes

2014 eMedicine.com

8813. Intracorporeal Lithotripsy (Follow-up)

, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: , , , , , Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical; Olympus. Additional Contributors Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen (...) (Urology), University of Santo Tomas; Head of Urology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital; Chief of Urologic Oncology, St Luke’s Medical Center Global City, Philippines, for the video contribution to this article. Medscape Reference also thanks Edgar V Lerma, MD, FACP, FASN, FAHA, Clinical Associate Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training

2014 eMedicine.com

8814. Lower Limb Prosthetics (Follow-up)

Information and Disclosures Author Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine Janos P Ertl, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) William J Brackett, MD Research Assistant, Department of Orthopedic Surgery, Indiana University School of Medicine (...) Disclosure: Nothing to disclose. William Ertl, MD Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma College of Medicine Disclosure: Nothing to disclose. James W Pritchett, MD Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center James W Pritchett, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University

2014 eMedicine.com

8815. Lower Limb Orthotics (Follow-up)

Information and Disclosures Author Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine Janos P Ertl, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) William J Brackett, MD Research Assistant, Department of Orthopedic Surgery, Indiana University School of Medicine (...) Disclosure: Nothing to disclose. William Ertl, MD Clinical Assistant Professor, Department of Orthopedics, University of Oklahoma College of Medicine Disclosure: Nothing to disclose. James W Pritchett, MD Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center James W Pritchett, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University

2014 eMedicine.com

8816. Low Energy Availability in the Female Athlete (Follow-up)

clinical guidelines with regard to screening for the triad, along with its diagnosis and treatment. Return-to-play recommendations were offered as well. In terms of nonpharmacologic therapy, for example, the statement advises that “successful treatment of athletes and exercising women is contingent on a multidisciplinary approach for recovery from the Triad, including a primary care and/or sports medicine physician, a sports dietitian and mental health practitioner.” The statement also reports (...) , performance, and medication history. Nutritional history It is important to gather information about nutritional intake and eating patterns. The components of each athlete's diet are important in terms of the quantity of protein, carbohydrate, vitamins, and minerals consumed. Also important are the effects of training on an athlete's diet and the modification of the athlete's diet in times of increased training. Assessing whether a female athlete has an inadequate carbohydrate intake and tends to consume

2014 eMedicine.com

8817. Laparoscopic and Robotic Radical Prostatectomy (Follow-up)

, placement of stitch in dorsal vein complex, dissection of prostate off bladder, dissection around prostate; development of plane between prostate and rectum, preservation of neurovascular bundles and division of dorsal vein complex and urethra. Procedure performed by Samuel Sterrett, DO, Bon Secours Medical Group, Greenville, SC. Courtesy of BroadcastMed (http://uro.broadcastmed.com/4120/videos/robotic-prostatectomy). See , a Critical Images slideshow, to help determine the best diagnostic approach (...) of 402 mL. The authors also reported a decreased mean hospital stay, due predominantly to earlier removal of the Foley catheter. Even in the hands of these skilled laparoscopists, nerve-sparing dissection and construction of the urethrovesical anastomosis were demanding. With advances in medical technology, improved optics, and the widespread use of new laparoscopic instrumentation such as ultrasonic cutting and coagulating devices (eg, Harmonic scalpel), laparoscopic radical prostatectomy began

2014 eMedicine.com

8818. Laparoscopic Pelvic Lymph Node Dissection (Follow-up)

predictive probability (95% confidence interval) of the patient having a given final pathologic stage based on a multinomial log-liner regression of all 3 variables. [ ] Contributor Information and Disclosures Author Robert G Moore, MD Clinical Associate Professor of Urology, Wake Forest University School of Medicine; Staff Urologist, Department of Surgery, Veterans Affairs Medical Center Robert G Moore, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s (...) Professor of Surgery, University of Utah College of Medicine Jay T Bishoff, MD is a member of the following medical societies: , , Disclosure: Received honoraria from Pfizer for speaking and teaching; Received none from PerSys for consulting. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief

2014 eMedicine.com

8819. Keloid and Hypertrophic Scar (Follow-up)

. Imiquimod induces TNF-alpha, IFN-alpha and IFN-gamma, IL-1, IL-4, IL-5, IL-6, IL-8, and IL-12 and alters the expression of markers for apoptosis. In one study, 13 keloids were treated with excision in combination with nightly applications of imiquimod 5% cream for 8 weeks. Ten patients with 11 keloids completed the 6-month study, and no keloids recurred after 6 months. Mild irritation was experienced with the application of imiquimod, and some patients needed a vacation period from the medication (...) Keloid and Hypertrophic Scar (Follow-up) Keloid and Hypertrophic Scar Treatment & Management: Medical Care, Prevention, Standard Treatments Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA1NzU5OS10cmVhdG1lbnQ

2014 eMedicine.com

8820. Cystectomy, Partial (Follow-up)

, University of Wisconsin School of Medicine and Public Health Tracy Downs, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Matthew D Grimes, MD Resident Physician in Urologic Surgery, Department of Urology, University of Wisconsin Hospital and Clinics Matthew D Grimes, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jason R Van Roo University of Wisconsin School of Medicine and Public Health Disclosure: Nothing to disclose (...) . Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine Bradley Fields Schwartz, DO, FACS is a member

2014 eMedicine.com

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