American family physician
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A systematic approach to identifying the cause of pain and rational use of drug therapy are keys to providing pain relief to cancer patients. Aspirin, acetaminophen and nonsteroidal anti-inflammatory drugs are effective for mild to moderate pain, and they enhance the effectiveness of weak oral narcotics, such as codeine. ⋯ A variety of adjuvant drugs can be used to enhance the effect of narcotics and to treat specific side effects of the disease or of therapy. For the terminally ill patient, a peaceful death with dignity should always be possible.
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Pain along the vertebral column is such a frequent complaint that it is easy to overlook unusual etiologies or serious complications. In addition to the common traumatic and degenerative causes of back pain, infectious, rheumatic and neoplastic conditions must also be considered. Nonmusculoskeletal disorders may sometimes be mistaken for lumbosacral strain. A systematic and sympathetic approach to the diagnosis may uncover uncommon pathologies.
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Outpatient intravenous antibiotic therapy is a cost-effective modality to shorten hospital stays and provide continued care to patients with infections. The recent availability of tamper-proof pumps that can deliver multiple antibiotics on independently timed regimens will further expand the use of home intravenous antibiotics. Problems with reimbursement remain, and new classes of oral antibiotics may provide alternatives to parenteral medications.
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A balloon that bursts during inflation may result in foreign body obstruction of the upper respiratory tract. Retrieval may require a finger-sweep maneuver to dislodge the adherent material. Because balloon fragments are propelled rather than merely inhaled, the obstruction may be located deep in the airway. The clenched-teeth technique for balloon inflation can prevent this potentially fatal complication.
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Intestinal malrotation is a developmental anomaly that occasionally causes an unusual array of symptoms in adults. The delay in diagnosis that is common in patients with malrotation frequently results in a ruptured appendix. Appendicitis should be considered when characteristic signs and symptoms are present, even if the location of abdominal pain is atypical.