American family physician
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Unintended injuries have become the third most frequent cause of death in the United States, and the relative importance of homicide and suicide has also increased. In recent decades, death rates from highway crashes and fires have fallen, and experience indicates that serious injuries in the workplace can be drastically reduced. ⋯ Tasks for the future include more research on the efficacy of preventive interventions, improvement of injury surveillance and prevention programs, and education of children and adults about injury prevention. Family physicians can play an important role in injury prevention efforts.
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Thyroglossal duct cyst is a midline congenital nonodontogenic cyst seen predominantly in children. The clinical history and physical examination, along with characteristic radiographic findings, enable the physician to make a preoperative diagnosis with a high degree of certainty. Surgery is the definitive treatment.
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Wernicke's encephalopathy should be considered as a possible diagnosis in comatose and hypothermic patients. The classic triad of confusion, ophthalmoplegia (or nystagmus) and ataxia may be absent, and the history of alcohol abuse or other causes of thiamine deficiency may be unknown. Left untreated, acute Wernicke's encephalopathy has a 17 percent mortality rate. Since the morbidity from Wernicke's encephalopathy is potentially reversible with parenteral thiamine, and large doses of thiamine can be given without documented ill effects, it is recommended that all comatose or hypothermic patients, as well as those with more classic presentations of Wernicke's encephalopathy, be given parenteral thiamine before administration of glucose.
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Malignant melanoma often presents with multiple-organ involvement. Pulmonary metastases are present in more than 50 percent of patients with a diagnosis of melanoma at autopsy. Metastases to the lung may be solitary or multiple. Computed tomographic scanning is the most sensitive radiologic method for detecting these pulmonary lesions.
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The diagnosis of acute arsenic poisoning should be considered in any patient presenting with severe gastrointestinal complaints. Signs and symptoms include nausea, vomiting, colicky abdominal pain and profuse, watery diarrhea. ⋯ Quantitative measurement of 24-hour urinary arsenic excretion is the only reliable laboratory test to confirm arsenic poisoning. Treatment includes gastric emesis or lavage, chelation therapy, electrolyte and fluid replacement, and cardiorespiratory support.