The Mount Sinai journal of medicine, New York
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Clinical Trial
Treatment with an anabolic agent is associated with improvement in respiratory function in persons with tetraplegia: a pilot study.
Pulmonary complications are a major cause of morbidity and mortality among individuals with cervical spinal cord lesions. Strengthening of the respiratory musculature may reduce these complications. Anabolic steroids have been used to increase muscle mass and improve muscle performance. Oxandrolone, an anabolic steroid, may have beneficial effects on breathing in persons with tetraplegia. ⋯ In healthy subjects with tetraplegia, the use of oxandrolone was associated with significant improvements in weight and pulmonary function, and a subjective reduction in breathlessness. Therefore, oxandrolone may be indicated to strengthen respiratory musculature in individuals who have tetraplegia and ventilatory insufficiency aggravated by superimposition of pneumonia or other such conditions. However, long-term use of oxandrolone may not be indicated, due to the adverse complications associated with this class of agents.
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Full oral rehabilitation with a high degree of success is now possible with osseointegrated implants. Osseointegration is a direct connection between living bone and the titanium implant at the level of the light microscope. Osseointegrated implants are currently used to replace single teeth, support fixed bridges and stabilize full dentures. ⋯ Bone grafts are sometimes placed on the floor of the nose or the floor of the maxillary sinus. Guided tissue regeneration is a technique used to generate bone within bony defects adjacent to implants. With long-term rates of success (5 years) of 99% for implants placed in the mandible and 95% for those placed in the maxilla, reconstruction of the jaws and cranial facial skeleton with osseointegrated implants has become the treatment of choice.
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Language barriers between patient and physician impact upon effective health care. This phenomenon is not well studied in the literature. ⋯ Lack of explanation of side effects to medication appeared to correlate negatively with compliance with medication. The language barrier correlated negatively with patient satisfaction. Cases reported more preventive testing; test ordering may replace dialogue.
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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.