American family physician
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Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.
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Acute epiglottitis in adults is a fulminant disease characterized by local cellulitis of supraglottic structures. Symptoms include sore throat, dysphagia, respiratory difficulty and muffled voice. ⋯ Diagnosis is facilitated by an upright, lateral neck x-ray and indirect laryngoscopy. The mainstays of treatment are airway maintenance, antibiotics, steroids, hydration, cool mist, oxygen and supportive care.
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At least 35,000 persons kill themselves each year in the United States. Many of the victims saw their family doctors during the month before death. ⋯ Suicidal behavior is associated with alcoholic intoxication and with feelings of hopelessness. Low brain serotonin is under investigation as a possible etiologic factor.