American family physician
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Family physicians should be aware of the potential effects and complications of vasectomy so they can appropriately counsel patients seeking sterilization. Vasectomy produces anatomic, hormonal and immunologic changes and, although not substantiated by clinical studies, has been reputed to be associated with atherosclerosis, prostate cancer, testicular cancer and urolithiasis. Complications of vasectomy include overt failure, occasional sperm in the ejaculate, hematoma, bleeding, infection, sperm granuloma, congestive epididymitis, antisperm antibody formation and psychogenic impotence. Compared with tubal ligation, vasectomy has fewer serious complications and a comparable failure rate.
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The nausea and vomiting that often accompany early pregnancy may be ameliorated if the patient eats small portions of food at frequent intervals, increases the amount of carbohydrates and decreases the amount of fat, and avoids bothersome food odors. When these strategies fail, antiemetic drugs such as pyridoxine and phosphorated carbohydrate solution may help, as well as doxylamine, promethazine or trimethobenzamide. When drugs are considered for use in pregnant patients, the safety of the patient and the fetus must always come first.
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Carbon monoxide poisoning usually results from inhalation of exhaust fumes from motor vehicles, smoke from fires or fumes from faulty heating systems. Carbon monoxide has a high affinity for hemoglobin, with which it forms carboxyhemoglobin. The resulting decrease in both oxygen-carrying capacity and oxygen release can lead to end-organ hypoxia. ⋯ When carbon monoxide intoxication is suspected, empiric treatment with 100 percent oxygen should be initiated immediately. The diagnosis is confirmed by documenting an elevated carboxyhemoglobin level. Hyperbaric oxygen therapy is recommended in patients with neurologic dysfunction, cardiac dysfunction or a history of unconsciousness.