Treatment of Parkinson's Disease

(Great Britain—The Practitioner, September 1997, p. 512.) Parkinson's disease occurs in one of every 1,000 persons and is associated with normal life expectancy despite the morbidity caused by hypokinesis, rigidity, tremor and impaired postural reflexes. Patients and family members must be fully informed about the condition and should take an active role in therapeutic decisions. Non-pharmacologic options such as occupational therapy, speech and language therapy, physical therapy, psychologic support and support groups or organizations play important roles in minimizing disability and maximizing the patient's quality of life. The most effective therapy is levodopa, which is almost always used in combination with a peripheral decarboxylase inhibitor. The initial nausea associated with levodopa therapy is usually reduced by taking the medication with meals. Psychologic upsets and involuntary movements are the major side effects of levodopa and may require reduction of the dosage. Seligiline may delay the need for levodopa and is also used to potentiate its effectiveness. The older anticholinergic agents are useful to reduce tremor and may relieve rigidity. Other medications often are used to treat specific symptoms such as sleep disturbance, urinary urgency or retention, and autonomic dysfunction. Stereotactic surgery, such as pallidotomy or thalamic stimulation, remains experimental but has shown promising results in selected patients.

Use of Emergency Contraception

(Great Britain—The Practitioner, October 1997, p. 582.) Emergency contraception refers to actions taken to prevent pregnancy, usually within 72 hours of unprotected intercourse. It has been reported that 70 percent of terminations of pregnancy could be avoided by use of emergency contraception and that 90 percent of women undergoing pregnancy termination would have preferred to use emergency contraception. The most common technique, the Yuzpe method, involves the administration of 100 μg of ethinyl estradiol and 1,000 μg of norgestrel, with the dosage repeated after 12 hours. This method is believed to delay ovulation, affect the formation of a corpus luteum (if taken after ovulation) and make the endometrium unsuitable for implantation. Other methods of emergency contraception involve the administration of large doses of progesterone (the Ho and Kwan method) or the insertion of a copper-containing intrauterine contraceptive device. All patients requesting emergency contraception should be examined for sexually transmitted diseases, counseled about effective contraception and followed within three weeks of the initial visit to check on these issues and on pregnancy status.

Types of Pain Related to Occupation

(Ireland—Forum, November 1997, p. 47.) Although back pain and carpal tunnel syndrome are widely recognized as occupationally related overuse syndromes, other conditions are prevalent in specific groups of workers. Tenosynovitis crepitans may occur in assembly-line workers. This condition presents as a painful swelling 4 to 12 cm proximal to the radial styloid on the dorsum of the arm, and crepitus is present on movement of the wrist. De Quervain's syndrome, epicondylitis, rotator cuff tendinitis, bicipital tendinitis and other specific musculoskeletal conditions of the hands and upper limbs may result from occupational practices. Use of computer screens, especially by office workers, has been associated with neck and shoulder pain as well as hand, wrist and arm symptoms, especially as a result of poor posture and work practices. Computer screens have also been linked to headaches and eye strain. Early concerns that computer screen exposure is associated with miscarriage and birth defects have not been validated by research.

Management of Simple Nasal Polyps

(Great Britain—The Practitioner, October 1997, p. 620.) Patients with simple nasal polyps usually present with symptoms of nasal obstruction, rhinorrhea, sneezing, postnasal drip, sinusitis or decreased sense of smell. Polyps are bilateral edematous swellings of the nasal mucosa that usually originate in the ethmoid sinuses and the area around the middle turbinate. Since polyps are generally insensitive, probing with a blunt instrument will distinguish polyps from the very sensitive swelling of turbinates. Betamethasone drops relieve symptoms in over 80 percent of cases. These drops should be administered with the patient in a head-down position so that the medication remains in contact with the mucosa and is not immediately swallowed. Significant adrenal suppression has not been associated with prolonged topical treatment in the correct dosage. A short course of high-dose oral corticosteroids may provide an additional adjunctive treatment to topical steroid therapy.