Male Wellness Exam

Male Wellness Exam

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring The Male Wellness Exam.

Depicted are a montage of images illustrating common considerations during history and physical examination during male wellness exams, including weight and obesity screening, colonoscopy screening for colorectal cancer and immunization schedules.

According to the featured article, “The adult well male examination should incorporate evidence-based guidance toward the promotion of optimal health and well-being, including screening tests shown to improve health outcomes.  Nearly one-third of men report not having a primary care physician, and 12% rate their overall health as poor.  Medical history should include tobacco, alcohol and illicit substance use; risks for sexually transmitted infections ; diet and exercise habits; and symptoms of depression.  Physical examination should include blood pressure screening and height and weight measurements.  Men with sustained blood pressures greater than 135>80 should be screened for diabetes.  Lipid screening is warranted in all men 35 years and older and in men ages 20 to 35 with cardiovascular risk factors.  Ultrasound screening for abdominal aortic aneurysm should occur once between ages 65 and 75 in men who have ever smoked.  There is insufficient evidence to recommend screening men for osteoporosis or skin cancer.  The U.S. Preventive Services Task Force has provisionally recommended against PSA-based screening for prostate cancer because the harms of testing outweigh potential benefits; other organizations advise shared decision making about PSA testing in men age 50 years and older.  Screening for colorectal cancer should begin at age 50 for average-risk men and continue until at least age 75 via annual high-sensitivity fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years combined with FOBT, or colonoscopy every 10 years.  The USPSTF recommends against screening for testicular cancer and chronic obstructive pulmonary disease.  Immunizations should be recommended according to guidelines from the Advisory Committee on Immunization Practices.”

Labor Analgesia

Labor Analgesia

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring Labor Analgesia.

Depicted are a montage of images illustrating Epidural analgesia, a commonly employed technique which provides pain relief during labor. Epidural analgesia is a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord.

The epidural space is the space inside the bony spinal canal but outside the membrane called the dura mater (sometimes called the “dura”). In contact with the inner surface of the dura is another membrane called the arachnoid mater (“arachnoid”). The arachnoid encompasses the cerebrospinal fluid that surrounds the spinal cord.

 

Failed Total Shoulder Arthroplasty

Failed Total Shoulder Arthroplasty

This illustration was commissioned for Arthroscopically Assisted Conversion of Total Shoulder Arthroplasty to Hemiarthroplasty With Glenoid Bone Grafting by Surena Namdari, MD, MSc; and David Glaser, MD for publication in ORTHOPEDICS October 2011 issue (ORTHOPEDICS November 2011;34(11):862).

Aseptic loosening of the glenoid component after total shoulder arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss.  Glenoid component explantation and bone grafting of defects has become a common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary.  While this has been traditionally accomplished via open techniques, we describe an arthroscopic-assisted method of glenoid explantation and bone grafting for cases of aseptic glenoid loosening with contained bone defects.

Headache, Heading off Pain

Headache, Heading off Pain

Editorial illustration for Lahey Clinic Magazine Spring 2001 Issue. This illustration summarizes a glossary of headache types which are described in the feature article. Depicted are the sites of common headaches: migraine (blue arrow) cluster (red arrows) and tension type (yellow arrow).

Evaluation of Syncope

Evaluation of Syncope

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring The Evaluation of Syncope.

Syncope is a brief and transient loss of consciousness with complete return to pre-existing neurologic function.  It is classified as neurally-mediated, orthostatic, cardiac and neurogenic.  The elderly are likely to have orthostatic, carotid sinus hypersensitivity or cardiac syncope, whereas, younger patients are more likely to have neurally-mediated syncope.  Common non-syncope syndromes with similar presentations include seizures, metabolic syndromes, acute intoxication,psychiatric disorders and cerebrovascular events.

The majority of patients presenting with unexplained syncope will require admission.  Several risk stratification tools have been investigated to assess the risk of short-term death and need for immediate hospitalization.  All patients presenting with syncope except vasovagal are at increased risk of death from any cause. The AHA/ACCF syncope guidelines present an algorithmic approach for the evaluation of syncope.

The most important diagnostic tool remains the history and physical examination.  All patients presenting with syncope require an electrocardiogram, orthostatic vital signs and interval monitoring.  Patients diagnosed with neurally-mediated or orthostatic syncope usually require no additional testing.  In cases of unexplained syncope, further testing such as electrocardiographic monitoring, echocardiogram, ischemic evaluation and electrophysiological studies may be required.  Although a small subset of patients will remain undiagnosed, those undergoing comprehensive evaluation are unlikely to have a recurrent syncope event.

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