Biomedical subjects
E N Ringdahl
Publications and source records attributed to E N Ringdahl.
Treatment of recurrent vulvovaginal candidiasis.
Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.
Vagally mediated atrial fibrillation in a young man.
Atrial fibrillation may be provoked by either vagal or sympathetic stimulation. Sympathetic effects are common in middle-aged and elderly patients with underlying heart disease. However, in the young, non-diseased heart, vagal influences are more likely to predominate. Recognition of vagally mediated atrial fibrillation in young adults as a unique clinical entity has diagnostic and therapeutic implications.
The role of the family physician in preventing teenage pregnancy.
An estimated 1 million teenage pregnancies occur each year in the United States, with more than 30,000 girls under the age of 15 years becoming pregnant. Family physicians can help reverse this trend through patient education and identification of teenagers at high risk for early sexual activity. Contraceptive counseling for teenagers who are already sexually active is essential and should emphasize proper contraceptive use.