The Canadian Journal of Diagnosis

2001 • 2002 • 2003 • 2004 • 2005 • 2006 • 2007 • 2008 • 2009 • 2010 • 2011 • 2012

	December 2002 Feature 1 Taking the Ouch Out, A Case Study in Osteoarthritis By Martin Cohen, MD, FRCPC OA is one of the most common causes of pain and disability in the elderly. It can be defined as a gradual loss of articular cartilage and mild chronic synovial inflammation. Feature 2 HPV Testing and Cervical Cancer Screening: Are They Linked? By William Chapman, MD, FRCPC Cervical cancer screening by the Pap smear has been one of the greatest success stories in medicine in the past 50 years. Despite its triumphs, the Pap smear is far from the perfect solution. Researchers have found that HPV testing may be another effective method. Case of the Month Coma Conundrum By Sam Campbell, MD, CCFP This new department features a case and discussion — tools for your daily practice. The Den This department offers thoughtful stories and anecdotes by Canadian general practitioners. This month: Therapeutic Delight, By Brian S. Pound, MB, BS, LRCP, MRCS, LMCC My Diagnostic Triumph This department highlights diagnostic triumphs that happen every day. This month: The Miracle Cure, By Lorena C. Vincent, MD, DPH, MHSc Update Abstracts and news from the medical literature of interest to the primary-care physician. This month: Preventing Myocardial Infarction: Warfarin, Aspirin or Both? No Sticky Situations with Duct Tape An Alternative to EMLA Celiac Disease Instigator Identifed Post-Traumatic Stress Disorder: Is One Day’s Rest Enough? Is Radical Mastectomy Necessary? Does Blood Pressure Help Identify Brain Lesions? Accurately Diagnosing Acute Stroke What’s Your Diagnosis? How do I know it’s pneumonia? By Malvinder S. Parmar, MD, FRCPC, FACP A 36-year-old woman presented to the emergency department with symptoms of fever, chills, and a cough that produced yellowish phlegm. She had recently returned from visiting her sister’s cottage where she slept in the gazebo for two nights. She also experienced sharp pain in her right chest aggravated by deep breathing. Photo Diagnosis Illustrated quiz on problems seen in everyday practice (various entries). ECG Clinic Review ECGs with specialists from the University of Western Ontario, and the London Health Sciences Centre. CME Credit Quiz This test offers the opportunity to assess your knowledge and retention of the information presented in the articles in this issue. This test is prepared with the Dalhousie University CME department. Medical Briefs An abridged look at current events in and around the health-care industry. This month: New Weapon for Warts Good News for Prostate Cancer Patients Preventing Renal Failure: The Right CCB Valtrex® Reduces Herpes Transmission Help in the Fight Against Heart Attacks Alternative for Heart Failure Patients GlaxoSmithKline Shows its Green Thumb Cholesterol-Lowering Drug Approved HOPE for Women With Cardiovascular Disease Beating Resistant Pneumonia The Best Medicine Funny medical anecdotes plus a cartoon!
	November 2002 Feature 1 Why does my stomach hurt so much? Exploring Irritable Bowel Syndrome Flavio M. Habal, MD, PhD, FRCPC Irritable bowel syndrome (IBS) is a global condition affecting up to 20% of the populations. In industrialized countries, the majority of patients seeking medical care for IBS are women. Feature 2 “Breathe easier my child.” Kids & Asthma Moyez Ladhani, MD, CCFP, FAAP. FRCPC The diagnosis of asthma in children is not an easy task. Unfortunately, spirometry in the young child is difficult, therefore the diagnosis is a clinical one. Case of the Month Celery sticks gone wrong: An unexpected reaction Peter Vadas, MD, PhD, FRCPC, FACP This new department features a case and discussion — tools for your daily practice. The Den This department offers thoughtful stories and anecdotes by Canadian general practitioners. This month: A touching gesture, by George Burden MD My Diagnostic Triumph This department highlights diagnostic triumphs that happen every day. This month: A matter of life and death, by Clément Vézina, MD Update Abstracts and news from the medical literature of interest to the primary-care physician. This month: Patient-physician communication can improve compliance Are allergies bad for your mood? Genes + breast density = cancer? Antibiotic short therapy likely effective Surgery better then splinting for severe carpal tunnel syndrome Hands cleaner with alcohol Mold sensitivity and severe asthma linked What’s Your Diagnosis? Flashing Lights – A Warning Sign Myrna Lichter, MD, FRCSC A 55-year-old man presents with a two- to three-day history of flashing lights in the periphery of his vision. He describes the flashes as quick, lasting only a few seconds. Photo Diagnosis Illustrated quiz on problems seen in everyday practice (various entries). ECG Clinic Review ECGs with specialists from the University of Western Ontario, and the London Health Sciences Centre. CME Credit Quiz This test offers the opportunity to assess your knowledge and retention of the information presented in the articles in this issue. This test is prepared with the Dalhousie University CME department. Medical Briefs An abridged look at current events in and around the health-care industry. This month: New weapon to battle pneumonia New therapy in treating hepatitis C Good news for baby boomers’ sex lives Hope for erectile dysfunction More effective treatment for bipolar disorder One quarter of the obese population is diabetic Birth control patch approved in Canada McGill receives $1, 000, 000 for osteoporosis research The Best Medicine Funny medical anecdotes plus a cartoon!
	*October 2002* Feature 1 Make the pain stop: Relieving acute migraine pain Ralph Kern, MD, FRCPC Migraines are often under-recognized and under-diagnosed. This article reviews how to assess a migraine headache and what to do about it. Feature 2 “Resistant” hypertension: Following the clues Richard Ogilvie, MD, FRCPC, FACP Physicians need to pay extra attention to patients who are resistant to hypertension medications. This article outlines a few steps to consider. Women’s Health Care Polycystic Ovary Syndrome in teens: The need for early detection What exactly is Polycystic Ovary Syndrome? These authors describe the syndrome and provide tools on how to diagnose and treat PCOS. Case of the Month Scratching the surface of skin lesions Catherine Maari, MD, FRCPC; and Zenovia Hatziris This new department features a case and discussion — tools for your daily practice. The Den This department offers thoughtful stories and anecdotes by Canadian general practitioners. This month: Out of the Blue, by Kathryn MacFarland, MD Diagnostic Triumph This department highlights diagnostic triumphs that happen every day. This month: More than a grain of salt, by Jeannie Rosenberg, MD Update Abstracts and news from the medical literature of interest to the primary-care physician. This month: Questioning Home BP Measurement? Magnesium Can Help Asthmatics Early Exposure Minimizes Pet Allergies Protection Against Restenosis Antipsychotics Risky for Diabetic Schizophrenics Surprise — No Stiches! Exercise Improves Fibromyalgia InforMed.doc Practical Hints for Busy Physicians Barrie McCombs, MD, CCFP, FCFP Medical Information Service (MIS), University of Calgary Getting a handle on Palm OS What’s Your Diagnosis? Doctor, why am I so tired? Jay Silverberg, MD, FRCPC, FACP A 28-year-old nurse comes to the office at the insistence of her husband. Her main complaints consist of fatigue, edginess and trouble sleeping. Photo Diagnosis Illustrated quiz on problems seen in everyday practice (various entries). ECG Clinic Review ECGs with specialists from the University of Western Ontario, and the London Health Sciences Centre. CME Credit Quiz This test offers the opportunity to assess your knowledge and retention of the information presented in the articles in this issue. This test is prepared with the Dalhousie University CME department. Medical Briefs An abridged look at current events in and around the health-care industry. This month: Hope for Stroke Patients Making Daily Tasks Easier for Arthritis Patients The Guide for Sexual Dysfunction Largest Heartburn Trial Shows Relief from Reflux New Therapy for Benign Prostatic Hyperplasia New Data Results on Alzheimer’s Disease Therapy Anniversary for Once-a-Day Bladder Drug! Drug Heralded to Fight Constipation in Women The Best Medicine Funny medical anecdotes plus a cartoon!

	September 2002 Memory Loss: When is it Alzheimer's? Chris MacKnight, MD, MSc, FRCPC Kenneth Rockwood, MD, FRCPC How to assess a patient with Alzheimer's disease? What are the stages of Alzheimer's disease? Memory Loss: Information for patients about alzheimer's disease Information for Patients: 10 Warning Signs of Alzheimer's disease How to Treat Patients with ADHD? Alexander K.C. Leung, MBBS, FRCPC, FRCP(UK & Irel), FRCPCH, DCH(Lond & Irel), FRSH, FRAM, FHKCPaed, FHKAM, FAAP Jean-François Lemay, MD, FRCPC What are the signs of ADHD? How should patients be evaluated and treated? HRT and Osteoporosis: What's the controversy? What are the alternatives? Aliya Khan, MD, FRCPC, FACPE Ahmad Ghany The Women's Health Initiative raises the question: Is Hormone Replacement Treatment worth it? Selecting a Hand-held computer Barrie McCombs, MD, CCFP, FCFP Here are a few points to consider if you are planning to purchase one of these handy "personal digital assistants". Doctor, what's wrong with my tongue? Wladyslaw Wojcik, MD, FRCPC Jerzy Pawlak, MD, MSc, PhD A 75-year-old man presented with a history of generalized weakness, fluid retention and weight loss of approximately 50 lbs over the last year. He also noted a change in his voice and an significant enlargement of his tongue. "The Yellow Fever Plot" Germ warfare during the Civil War Lawrence Segel, MD Confederate desperation would lead allegedly one medical practitioner to embark on a campaign of deadly biological warfare. A Breathless Patient Keith J.C. Finnie, MB, ChB L.J. Melendez, MD A 52-year-old women presents with complaints of increasing shortness of breath, reduced energy levels and ankle swelling over the preceding few weeks.

	August 2002 What's that Smell: Olfactory Dysfunction Steven Sobol, MD, MSc Saul Frenkiel, MD, FRCSC Debbie Mouadeb Apart from lowering a patient's quality of life, smell disorders may signal an underlying disease. Patient information, about Olfactory Dysfunction Saul Frenkiel, MD, FRCSC Information for your patients on Olfactory Dysfunction Infliximab in Sarcoidosis Monique Camerlain, MD, FRCPC Will infliximab reactivate pulmonary disease if a patient is being treated for sarcoidosis? Is infliximab therapy successful in the treatment of refractory sarcoidosis? "What's my line?" Linear Lesions in Travellers or Recent Immigrants Edith Lederman, MD J.S. Keystone, MD, FRCPC Four case studies highlight unfamiliar lesions and their origins. Drugs in Cyberspace: Part 2 Barrie McCombs, MD, CCFP, FCFP A review of Canadian and American medical search engines. Attacks of Unknown Origin Stephen Workman, MD, FRCPC A patient was suffering from narrow complex tachycardia with a rate of 180 beats per minute. Quiz An illustrated quiz on problems seen in everyday practice. "Confessions of an English Opium Eater" Thomas de Quincey's Addiction Lawrence Segel, MD The effects of opium on de Quincey and its effects today. A Narrow Complex Tachycardia L.J. Melendez, MD Keith J.C. Finnie, MB, ChB A 79-year-old man underwent coronary bypass surgery.

	July 2002 Genetic Counseling for BRCA 1 and 2 Dawna Gilchrist, MD, FRCPC, FCCMG Since the BRCA 1 and 2 genes were discovered, physicians have been able to test individuals and families at high risk for breast cancer. Assessment of Foot Deformities in the Infant Maureen Baxter, MDCM, FRCS The first step in examining a child with a foot deformity is to conduct a general neuromuscular assessment. Women and Reproductive Mental Health Shaila Misri, MD, FRCPC Xanthoula Kostaras, BSc It is imperative that GPs have the necessary background for diagnosing and treating mental disorders associated with women and reproductive cycles. Drugs in Cyberspace: Part 1 Barrie McCombs, MD, CCFP, FCFP Searches for drug-related information are one of the most common information-seeking tasks for physicians and other health professionals. Vestigial Remnant, but Not Innocent Mira Parai, MD, FRCP Joseph F. Wasielewski, MD, FRCP Allan Kirk, MD, FRCP A 60-year-old man presented with a large swelling of the anterior abdomen. Quiz An illustrated quiz on problems seen in everyday practice. The Stigmata Lawrence Segel, MD These strange wounds, which seem to occur without any obvious apparent injury, have been collectively known as the Stigmata - the marks of Christ's suffering. "To Lyse or Not to Lyse, That is the Question" Keith J.C. Finnie, MB, ChB L.J. Melendez, MD A 66-year-old woman presents with a history of severe chest pain which began approximately four hours earlier.

	June 2002 Inherited Disorders Causing Dementia Grace Yoon, MD Richard Camicioli, MD, FRCPC Dawna Gilchrist, MD, FRCPC, FCCMG Dementia affects 8% of people over 85 years old and 58% of people over 95 years. Many conditions, both genetic and acquired, can lead to dementia. Information for patients about Inherited Disorders Causing Dementia Dawna Gilchrist, MD, FRCPC, FCCMG Information for your patients on Inherited Disorders Causing Dementia West Nile Encephalitis Gary Victor, MB, FRCPC West Nile Virus has been known in Africa, the Middle East and in parts of Europe, Russia, India and Indonesia. The introduction of this virus into areas without immunity (like North America) can cause epidemics. Fostering Culturally Sensitive Practice Elizabeth J. Latimer, MD, CCFP, FCFP Culture, ethnicity and religion weave a fabric of each person's particular response to treatment and healing. Take One Tablet and Call Me in the Morning Barrie McCombs, MD, CCFP, FCFP A tablet computer, about the size of a letter-size paper, has a large display screen. Instead of using a keyboard, you would enter information using a hand-writing recognition software! Not All Chest Pain is Created Equal Bruno Benzaquen, MD, ABIM A 47-year-old man with essential hypertension and diet-controlled diabetes mellitus presents with chest pain of two days duration. Quiz An illustrated quiz on problems seen in everyday practice. "Turn On, Tune In, Drop Out!" The Life of Acid Guru, Timothy Leary Lawrence Segel, MD Anyone who lived through the 60s and 70s will have no trouble identifying Timothy Leary. But who was he? Tachycardia L.J. Melendez, MD Keith J.C. Finnie, MB, ChB The electrocardiogram was taken on a 62-year-old man two days after an orthopedic procedure for a fractured leg.

	May 2002 Recurrent Abdominal Pain in Children Alexander K.C. Leung, MBBS, FRCPC, FRCP(UK & Irel), FRCPCH, DCH(Lond & Irel), FRSH, FRAM, FHKCPaed, FHKAM, FAAP Jean-François Lemay, MD, FRCPC Collin Barker, MD, FRCPC, MSc(Epid) Recurrent abdominal pain is one of the most common and challenging diagnostic and therapeutic problems encountered in general pediatrics. Recurrent Abdominal Pain in Children Alexander K.C. Leung, MBBS, FRCPC, FRCP(UK & Irel), FRCPCH, DCH(Lond & Irel), FRSH, FRAM, FHKCPaed, FHKAM, FAAP Jean-François Lemay, MD, FRCPC Collin Barker, MD, FRCPC, MSc(Epid) Information for your patients on Recurrent Abdominal Pain in Children Myths about the Obese Patient Maurice Larocque, MD Given their concern for people and close contact with their patients, physicians are the health-care professionals best suited to treat obesity. Andropause: A Man's Menopause Shafiq Qaadri, MD A 34-year old male patient had a puzzling constellation of symptoms, which became a lesson is not attributing things to somatization. Ethical Care: Managing an End-Stage Symptom Control Crisis Elizabeth J. Latimer, MD, CCFP, FCFP Symptom control crisis is morally compelling for the patient, family and health-care team. Links and Personal Toolbar Barrie McCombs, MD, CCFP, FCFP The "links" feature in Explorer and the "personal toolbar" in Netscape help you get to your favorite sites fast! Getting to the Bottom of Pain Daniel S. Mishkin, MDCM Barry V. Mishkin, MD A 36-year-old female patient presents with intermittent rectal pain and a sensation of incomplete evacuation over the past eight months. Quiz An illustrated quiz on problems seen in everyday practice. "Banned, Jailed, Burned, but Never Silenced" Wilhelm Reich, MD Lawrence Segel, MD Doctor Wilhelm Reich accepted holistic health theory, along with many more provocative ideas. The "Culprit" Vessel Keith J.C. Finnie, MB, ChB L.J. Melendez, MD A 67-year-old man presents with a one-day history of intermittent anterior chest heaviness and mild shortness of breath.

	April 2002 Diagnosis of Community-Acquired Pneumonia By Jason Agulnik, MD, CM, FRCPC; and Dick Menzies, MD, FRCPC, MSc In North America, pneumonia is the sixth leading cause of death and the major cause of death due to infectious diseases. The mortality of CAP is 1% to 5% in the outpatient setting but increases to 12% in hospitalized patients. Information for patients about the Sports Medicine Specialist’s Approach to the Lumbar Spine and Sacroiliac By Aly S. Abdulla, BSc, MD, LMCC, CCFP(C), DipSportMed (CASM); and Faiza Abdulla, CDA This is the fifth in a series of sports medicine articles. The intent of this series is to review musculoskeletal conditions commonly brought to the primary-care physician’s attention, that can be diagnosed and managed easily. What’s Your Diagnosis? The Pregnant Patient with Sickle-Cell Disease By Jason Agulnik, MD, CM, FRCPC Palliative Care... In the Acute Care Hospital By Elizabeth J. Latimer, MD, CCFP, FCFP The Medicine of History “Bring Out Your Dead!” A look back in time at the bubonic plague. By Lawrence Segel, MD ECG Clinic Choosing the correct rhythm strip By Keith J.C. Finnie, MB, ChB; and L.J. Melendez, MD

	March 2002 Nutrition in the Elderly By Nahid Azad, MD, FRCPC Screening and assessment for malnutrition are critical in order to institute timely and appropriate nutrition intervention in the elderly. There are a number of tools available today to conduct such screening. The Sports Medicine Specialist’s Approach to the Hip, Pelvis and Groin By Aly S. Abdulla, BSc, MD, LMCC, CCFP(C), DipSportMed (CASM); and Faiza Abdulla, CDA This is the fourth article in a sports medicine series intended to review musculoskeletal conditions that commonly appear to the primary physician’s attention. Dr. Abdulla’s personal approach to history and physical examination is presented to assist in the development of the reader’s own techniques. What’s Your Diagnosis? Chest Pain in the ER By. Eric Horlick, MD, FRCPC Palliative Care Mouth Care…Treating the Often Overlooked Symptoms By Elizabeth J. Latimer, MD, CFP, FCFP The Medicine of History Unit 731 By Lawrence Segel, MD ECG Clinic Pseudoapoplectic Attacks By Keith J.C. Finnie, MB, ChB, and L.J. Melendez, MD

	February 2002 The Sports Medicine Specialist’s Approach To the Knee and Thigh By Aly S. Abdulla, BSc, MD, LMCC, CCFP(C), DipSportMed (CASM); and Faiza Abdulla, CDA When a patient presents with a sports related injury to the knee or thigh, what should you do? This article, the third in a series on sports medicine, can help. Concussions: A Head-On Approach By Chris Adam MD, CCFP; and Neil Craton BSc., MHK, MD, DipSportMed, CIME Collision sports like football, hockey and soccer provide ample risk of concussion and demand accurate diagnosis and adequate treatment plans from physicians. Outside of the world of sports, most primary-care physicians will see many concussions in their practice. They must be able to react accordingly. How to Help Your Patients Get Older By W.B. Dalziel, MD, FRCPC Getting old is rarely easy, but with help from their physicians, patients can take steps towards healthy aging, thus improving quality of life and reducing health-care costs. Case Study Pyrexia Of Uncommon Origin When a patient presented with slight nasal congestion and a fever, the initial diagnosis was viral infection. Later presentations and further investigations, however, revealed a startling cause of the symptoms. What’s Your Diagnosis? Chronic Cough By Jason Agulnik, MD, CM, FRCPC Palliative Care “How Best to Treat the Patient…” By Elizabeth J. Latimer, MD, CCFP, FCFP The Medicine of History Horrors of the Healers By Lawrence Segel, MD ECG Clinic Bradycardia By L.J. Melendez, MD; and Keith J.C. Finnie, MB, ChB

	January 2002 Breathe Easy How to Approach Unresponsive Asthma By Alessandra Sandrini, MD; and Kenneth R. Chapman, MD, MSc, FRCPC When challenged by asthma that won’t adequately respond to treatment, what can a physician do? There are a few simple questions one can ask that should help to find a treatment that works. Common Mouth Diseases: Part 2 The Tongue, Palate and Pharynx By Jerzy K. Pawlak, MD MSc, PhD; Margaret Ochonska, MD; and Mike Sochocki, BSc Typically, mouth diseases have been a neglected component of medical training. A proper mouth inspection is, however, a very important part of a medical examination. An Eye On Anthrax By Andre Dascal, FRCPC Following the recent anthrax attacks in the U.S. many people have had questions about this disease. This article, presented in a question and answer format should help you to answer any concerns your patients may have. Index A Guide to Articles From the Year 2001 Trying to find an article we published this year? Looking for more information to help with a challenging diagnosis? Maybe we can help. Why not take a look back at the articles we have published in the last year to find the answers you are looking for? Palliative Care “What Shall I Say…?” Answering the Big Questions In Palliative Care By Elizabeth J. Latimer, MD, CCFP, FCFP The Medicine of History Hormones, Daughters and Death: The DES Disaster By Lawrence Segel, MD