This community contains collections of the Department of Family Medicine.

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Recent Submissions

  • Split peroneus brevis tendon: an unusual cause of ankle pain and instability.

    Chauhan, Bindiya; Panchal, Pina; Szabo, Edward; Wilkins, Thad; Department of Family Medicine; Department of Orthopaedic Surgery (2014-03)
    Tears of the peroneus brevis tendon may cause ankle pain, swelling, and instability. Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and tenodesis. We describe a 64-year-old woman with a split peroneus brevis tendon presenting with lateral ankle pain, swelling, and instability, and we review the literature regarding presentation, diagnostic testing, pathophysiology, predisposing factors, and treatment recommendations. Primary care physicians should consider peroneal tendon injuries in patients with chronic lateral ankle pain and instability.
  • Salmonella newport bacteremia in a 12-day-old infant.

    Singh, Abhijit; Wilkins, Thad; Schade, Robert R.; Department of Family Medicine (2011-03)
    In the United States, Salmonella infections (salmonellosis) cause multiple medical problems. Although the most common presenting symptom is diarrhea, bacteremia can also occur. An estimated 1.4 million cases of salmonellosis occur annually in the United States. We present a case of Salmonella bacteremia in a 12-day old infant. We discuss the presenting signs, symptoms, and management strategies for a patient younger than 28 days old (neonate) presenting with fever and diarrhea.
  • Diagnosis and management of Crohn's disease.

    Wilkins, Thad; Jarvis, Kathryn; Patel, Jigneshkumar; Department of Family Medicine (2011-12-15)
    Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.
  • Nasolaryngoscopy in a family medicine clinic: indications, findings, and economics.

    Wilkins, Thad; Gillies, Ralph A; Getz, April; Zimmerman, Dave; Kang, Larry; Department of Family Medicine (2010-09)
    Nasopharyngeal complaints are common among patients who present to primary care. Patients with these complaints are often referred for nasolaryngoscopy evaluation to exclude serious conditions such as laryngeal cancer.
  • Diagnosis and management of upper gastrointestinal bleeding.

    Wilkins, Thad; Khan, Naiman; Nabh, Akash; Schade, Robert R.; Department of Family Medicine; Department of Medicine (2012-03-01)
    Upper gastrointestinal bleeding causes significant morbidity and mortality in the United States, and has been associated with increasing nonsteroidal anti-inflammatory drug use and the high prevalence of Helicobacter pylori infection in patients with peptic ulcer bleeding. Rapid assessment and resuscitation should precede the diagnostic evaluation in unstable patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early upper endoscopy (within 24 hours of presentation) is recommended in most patients because it confirms the diagnosis and allows for targeted endoscopic treatment, including epinephrine injection, thermocoagulation, application of clips, and banding. Endoscopic therapy results in reduced morbidity, hospital stays, risk of recurrent bleeding, and need for surgery. Although administration of proton pump inhibitors does not decrease mortality, risk of rebleeding, or need for surgery, it reduces stigmata of recent hemorrhage and the need for endoscopic therapy. Despite successful endoscopic therapy, rebleeding can occur in 10 to 20 percent of patients; a second attempt at endoscopic therapy is recommended in these patients. Arteriography with embolization or surgery may be needed if there is persistent and severe bleeding.
  • Anomalous coronary artery found in the syncopal workup of an elderly man

    Oommen, Ronnie; Wilkins, Thad; Chen, Stephen Y; Arora, Vishal; Department of Family Medicine; Department of Medicine; Department of Cardiology (2012-07)
    Syncope, defined as a transient loss of consciousness, is seen in 1% of all visits to emergency departments and urgent care clinics in the United States. Syncope is categorized as cardiogenic, neurologic, or psychogenic. Anomalies of the coronary arteries are rare, and anomalous coronary arteries present as syncope more often in the young than in the elderly; syncope rarely occurs in patients 65 years of age and older. There are 2 major variants of coronary anomalies. In the first variant, the left main coronary artery arises from the right aortic sinus. In the second variant, the right coronary artery arises from the left aortic sinus. The risk of sudden death is higher in patients with the left coronary artery arising from the right aortic sinus. We present a case of an anomalous coronary artery discovered during the syncopal workup in a 66-year-old man because no such cases have been published in the United States. We will discuss the management of anomalous coronary arteries as well as a systematic approach to the diagnosis and management of syncope.
  • Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data

    Joura, Elmar A; Garland, Suzanne M; Paavonen, Jorma; Ferris, Daron G.; Perez, Gonzalo; Ault, Kevin A; Huh, Warner K; Sings, Heather L; James, Margaret K.; Haupt, Richard M; Department of Family Medicine; Department of Obstetrics and Gynecology (2012-03-27)
    Extra material supplied by the author: Supplementary tables 1 and 2 showing effects of using 60 day or 90 day interval between initial surgery or disease diagnosis and subsequent disease diagnoses on vaccine efficacy estimates:
  • Imiquimod 3.75% Cream Applied Daily to Treat Anogenital Warts: Combined Results from Women in Two Randomized, Placebo-Controlled Studies

    Baker, David A.; Ferris, Daron G.; Martens, Mark G.; Fife, Kenneth H.; Tyring, Stephen K.; Edwards, Libby; Nelson, Anita; Ault, Kevin A; Trofatter, Kenneth F.; Liu, Tiepu; Levy, Sharon; Wu, Jason; Department of Family Medicine; Department of Obstetrics and Gynecology (2011-08-24)
  • End-of-study safety, immunogenicity, and efficacy of quadrivalent HPV (types 6, 11, 16, 18) recombinant vaccine in adult women 24â 45 years of age

    Castellsague, X; Munoz, N; Pitisuttithum, P; Ferris, Daron G.; Monsonego, J; Ault, Kevin A; Luna, J; Myers, E; Mallary, S; Bautista, O M; Bryan, J; Vuocolo, S; Haupt, Richard M; Saah, A; Department of Family Medicine; Department of Obstetrics and Gynecology (2011-06-28)
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