American family physician
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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.
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American family physician · Oct 1993
Case ReportsBronchial carcinoid presenting as refractory asthma.
Bronchial carcinoids are low-grade malignant neoplasms that usually occur in the central airways. The central endobronchial location typically results in symptoms of bronchial obstruction. Infrequently, asthma-like symptoms may be produced by endobronchial tumors. The diagnosis of bronchial carcinoid is often made after months of unsuccessful treatment for more common respiratory conditions.
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Sertraline is a serotonin reuptake inhibitor that has been approved for use in the treatment of depression. Its side-effect profile is similar to that of fluoxetine, a drug of the same class. The side effects of these drugs most often affect the gastrointestinal tract. ⋯ However, no clinical studies comparing sertraline and fluoxetine have been published. The wholesale cost of a month's supply of sertraline is about $50, compared with about $5 for a generic tricyclic antidepressant. Despite their cost, serotonin uptake inhibitors may be the initial drugs of choice in depressed elderly patients, because these patients are at increased risk for suicide and have a low tolerance for the side effects of tricyclic antidepressants.
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American family physician · Jun 1993
ReviewStrontium-89 therapy for painful osseous metastatic prostate and breast cancer.
Strontium-89 chloride is a radiopharmaceutical that localizes to actively forming new bone, such as metastatic bone lesions from prostate and breast cancer. It provides effective systemic endo-osseous local radiation therapy to these painful lesions. Strontium-89 will soon be available to physicians in the United States for use in the palliative management of metastatic bone pain.