The Medical clinics of North America
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Med. Clin. North Am. · Sep 2001
Review Case ReportsAbnormal coagulation in the postoperative period contributing to excessive bleeding.
This article deals primarily with acquired disorders that disrupt normal hemostasis and cause excessive bleeding in the postoperative period because of the coagulopathy itself or because of drugs needed to treat the hemostatic disorder.
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Alcohol withdrawal syndrome is a significant cause of perioperative morbidity and mortality. Physicians should be able to: (1) identify high-risk patients preoperatively by using the various screening tests, (2) recognize patterns with AWS, and (3) use the appropriate supportive, behavioral, nutritional and pharmacological treatment.
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Cardiac arrhythmias are common in the perioperative period. Most arrhythmias are clinically benign. ⋯ The current availability of a wide array of techniques for controlling serious arrhythmias--pharmacologic, electrical, and interventional--enable the physician to manage most arrhythmias and conduction disturbances successfully. The added risks posed by arrhythmias and conduction disturbances in the perioperative period now can be minimized.
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Some general recommendations can be made, collected from these subjective descriptions of personality types. Because determining an accurate psychiatric diagnosis is not the internist's aim, it is better for him or her to have a stance that generalizes to all patients, which can be refined as personality characteristics emerge. Tolerate the patient's affect (such as anger or anxiety), being firm and kind, rather than punitive or overinvested. ⋯ The physician should edit the composites based on experience with real patients. This article has described human characteristics and rough guidelines for helpful human responses and possible pharmacologic interventions. So equipped, the primary care physician may find it less troubling and more interesting to face the wide variation in human character.
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The cholinesterase inhibitors provide the first clearly effective treatments for the cognitive deficits of AD and appear to have a beneficial effect on activities of daily living function and noncognitive behavior. There is increasing support for starting donepezil, rivastigmine, or galantamine early in the disease course and maintaining treatment at least during the early and middle stages of AD. ⋯ The atypical antipsychotics are the first choice for managing psychosis and disruptive agitation in AD and particularly in the Lewy body variant of AD. Studies suggest that low-dose treatment with risperidone, 1 mg/d, or olanzapine, 5 mg/d, offers the optimal ratio of therapeutic to adverse effects.