The Mount Sinai journal of medicine, New York
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The predictable relationship between surgical injury responses and the ensuring postoperative pain has led to the development of the concept of preemptive analgesia, with its potential to improve the quality of the postoperative period. ⋯ Techniques directed toward reducing and/or eliminating postoperative pain are still being developed, and their clinical utility is yet to be fully evaluated.
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Case Reports
Severe hyponatremia, neuroleptic malignant syndrome, rhabdomyolysis and acute renal failure: a case report.
Acute renal failure secondary to myoglobinuria is a rare yet possible complication of malignant neuroleptic syndrome associated with the use of dopamine antagonists. We describe the case of a 42-year-old schizophrenic man who presented with severe hyponatremia, and proceeded to acute malignant neuroleptic syndrome, rhabdomyolysis, and acute renal failure. We contend that the acute hyponatremia may have served as a precipitating factor.
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Boston Health Care for the Homeless Program (BHCHP) physicians conduct a primary care clinic twice a week at Massachusetts General Hospital (MGH). The MGH clinic is part of a city-wide network of BHCHP clinics providing primary care services to indigent patients. Despite this network, long term control of chronic illnesses such as hypertension (HTN) continues to challenge the clinic staff. ⋯ A greater proportion of patients with concomitant psychiatric diagnoses exhibited blood pressures < or = 140/90 mm Hg than patients without mental illness. The increased frequency of visits at the onset of treatment may confer a positive effect on long term control of HTN among homeless patients attending outpatient hospital-based clinics.
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Approximately 50,000 pregnant women undergo nonobstetric surgery each year in the United States. Administering anesthesia during such surgery is one of the only situations in which anesthesia impacts on more than one individual (mother and fetus) at the same time. Providing a safe anesthetic to the pregnant woman requires an understanding of the physiologic changes of pregnancy and the impact of anesthesia and surgery on the developing fetus. The following review will consider the risks of the mother and to the fetus during nonobstetric surgery.