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Biomedical subjects

J H Leversee

Publications and source records attributed to J H Leversee.

10 recordsLinked to original sources
PubMed1993

Amiodarone-clonazepam interaction.

OBJECTIVE: To describe a potential drug interaction between amiodarone and clonazepam. CASE SUMMARY: A 78-year-old man with a history of congestive heart failure and coronary artery disease began taking amiodarone to suppress sustained ventricular tachycardia. Following the development of restless leg syndrome, therapy with clonazepam 0.5 mg qhs was initiated. Subsequently, the patient demonstrated signs and symptoms of benzodiazepine toxicity, which cleared following the discontinuation of clonazepam. DISCUSSION: Amiodarone is a Class III antiarrhythmic with an adverse-effect profile involving many different organ systems. It also has been shown to inhibit the metabolism of drugs cleared by oxidative microsomal enzymes. Clonazepam undergoes extensive hepatic metabolism, primarily by reduction and acetylation, and is therefore susceptible to altered disposition during concomitant administration of agents that inhibit hepatic microsomal enzymes. Hypothyroidism, occurring in up to 11 percent of patients treated with amiodarone, can also alter drug metabolism and sensitize the central nervous system, thus increasing the potential for toxicity. It is likely that a combination of these factors was responsible for the symptoms described in this patient. CONCLUSIONS: The complex pharmacologic profile of amiodarone and its effects on multiple organ systems necessitates close patient monitoring during concurrent administration of medications such as clonazepam, which are cleared by oxidative metabolism.

Aged↗
PubMed1990

Oral contraceptives.

Management of oral contraception requires an understanding of the relationships between the method's effectiveness, noncontraceptive benefits, and hormonal adverse effects. The new multiphasic combinations or OCs containing 35 micrograms of ethinyl estradiol and 0.5-1.0 mg of norethindrone or equivalent result in a maximum combination of efficacy and safety for the patient with minimal annoying problems for the patient and the prescriber. Patient education regarding early warning symptoms of adverse effects, breakthrough bleeding, and lack of withdrawal bleeding adds an additional margin of safety and reduces patient questions and uncertainties.

Contraceptives, Oral, Hormonal↗
PubMed1986

Aspiration of joints and soft tissue injections.

Musculoskeletal and connective tissue disorders are commonly encountered in primary care practice. These disorders include varieties of bursitis, tendinitis, myositis, arthritis, and related conditions. A certain group of these disorders lend themselves to diagnosis by needle aspiration or to treatment by injections. The conditions discussed in this article include subacromial bursitis, supraspinous and bicipital tendinitis, tennis elbow, de Quervain's syndrome, trigger finger, inflammation of the knee, ganglion, and muscle trigger points.

Biopsy, Needle↗
PubMed1982

Outpatient termination of pregnancy: experience in a family practice residency.

At the University of Washington Family Medicine Clinic, termination of pregnancy procedures were performed on 260 patients. Their records were reviewed, and an analysis was completed on demographic data, technical procedure parameters, and complication rates during and following the procedure. The majority of patients were not primigravida. Fifteen percent were between six and eight weeks of gestation. Following the procedure, 3.8 percent had excessive bleeding, and 2.7 percent developed endometritis at rates comparable to those found in the obstetrics and gynecology literature. No known perforations occurred. Outpatient termination of pregnancy performed on selected patients in a family practice setting can be a procedure of low morbidity.

Abortion, Induced↗
PubMed1981

Wrist and digital nerve blocks.

Wrist and digital nerve blocks are useful for the management of many common problems of the hands and fingers, including fractures, lacerations, and infections requiring drainage. The principal nerves in the wrist (radial, median, and ulnar), and the digital nerves in the hand or fingers are anatomically superficial. They can be easily located and are accessible for percutaneous injection of anesthetic agents such as lidocaine (Xylocaine), bupivacaine (Marcaine), and mepivacaine (Carbocaine). Careful selection of the anesthetic agent and type of nerve block can provides safe and effective anesthesia for many surgical procedures of the hands and fingers.

Anesthetics, Local↗
PubMed1978

Family physician pathway and medical student career choice. Ten years after curriculum change at the University of Washington.

In 1968 the University of Washington School of Medicine initiated a new curriculum that included a family physician pathway. Six of these classes have now graduated. Two thirds of the planned strategies for the pathway were actually implemented. Approximately half of the students in each second-year class now choose this pathway. Ninety percent of those graduating have done so in the traditional four years. Seventy-three percent of those in the pathway actually pursued family practice training on graduation. Approximately one third of all University of Washington graduates now enter training for family practice, one third enter internal medicine, 10% enter surgical fields, and 8% enter pediatrics. These rates represent significant increases in the proportion of students entering directly into family practice, internal medicine, and pediatrics training.

Career Choice↗
PubMed1977

Early ambulatory experience in the undergraduate education of family physicians.

A number of benefits have been claimed for early ambulatory experience in the training of family physicians, although few practical examples have been reported. This paper describes an approach to the education of first and second year medical students interested in family medicine which places heavy emphasis on community-based ambulatory care. During the first year, an elective introductory preceptorship permits students to participate in the office practice of a family physician in a limited role. Seminars are offered concurrently to provide integrating principles and perspective. In the second year, a nine-month-long continuity clerkship is offered in which students gain intimate contact with a small panel of families and practice the skills of primary care in the offices of family physicians. Clinical experience is accompanied by weekly seminars and integrated with elements of the required curriculum. Selected evaluation data are presented, which attest to the achievement of course objectives and provide support for the claim that this approach is beneficial to students seeking careers in primary care.

Ambulatory Care↗
PubMedDate not supplied

Initiating a vasectomy training clinic in a family practice residency.

The development of and initial experience with a vasectomy training clinic in a family practice residency program are presented. A literature review and faculty consensus resulted in the acceptance of a standardized technique in which the ends of the vas are cauterized and not tied. An appropriate time block per patient to allow for counseling and for teaching of the technique was 90 minutes. Patients were recruited by instituting reduced charges and advertising through the local Planned Parenthood office and county health service. A partial prepayment was required to reduce broken appointments. Review of the first 50 cases indicates a good resident experience, an appropriately low complication rate, and no failures.

Family Practice↗