Annual review of medicine
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Combined management of infertile couples is optimal. The most common problems in men are low sperm concentration and motility of unknown cause. ⋯ In the woman, disorders of ovulation can usually be treated successfully, but results of tubal surgery for past inflammatory damage remain poor. In vitro fertilization may be useful for idiopathic infertility and semen disorders of mild to moderate severity, as well as for tubal obstruction.
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Current evidence indicates that Type I diabetes mellitus is a slowly progressive autoimmune disease resulting in complete beta-cell destruction in genetically susceptible individuals. Histocompatibility region genes are major determinants of genetic susceptibility, and more than 90% of Type I individuals express HLA alleles DR3 or DR4. Prior to clinical diabetes, islet-cell antibodies and activated T lymphocytes are found in conjunction with a slowly progressive loss of intravenous glucose-stimulated insulin secretion. Present clinical research efforts are aimed at detection of susceptible individuals prior to the development of diabetes and selective immunotherapy to halt beta-cell destruction.
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The Adult Respiratory Distress Syndrome is a complication of many illnesses such as sepsis, pneumonia and trauma afflicting over 150,000 patients per year. While progress in intensive care medicine has increased the survival rates in many of these underlying illnesses, major obstacles remain in the successful therapy of ARDS. Animal and human investigations shed light on the pathophysiology of the illness that is allowing researchers to formulate promising new treatment strategies.
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The sleep apnea syndromes have attracted the interest of physicians and scientists in many different disciplines because the disorders involve the physiology of sleep, the control of respiration, the function of the upper airway, and the clinical sequelae upon cardiac, pulmonary, and psychological function. Over the eight years since this subject was last reviewed here (1), the pathophysiology of obstructive sleep apnea has become better understood. A variety of new treatments are now available. ⋯ This chapter reviews current understanding of these syndromes, with particular emphasis on recent advances, and highlights questions for future investigation. First, we consider normal upper airway function and the control of breathing during sleep. Then, we apply this information to a consideration of the pathophysiology, clinical features, and treatment of sleep apnea syndromes.
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Exposure of the fetus at any gestational stage to high concentrations of alcohol can adversely affect growth, morphology, and neurophysiologic development. Sustained heavy drinking can result in the fetal alcohol syndrome. Cessation of heavy drinking during pregnancy will benefit both mother and child. Primary health care providers can effectively identify and treat women at risk.