The Medical clinics of North America
-
Despite earlier recognition and treatment of hyperthyroidism, thyroid storm remains a life-threatening, although fortunately rare, medical emergency. Prompt recognition and aggressive treatment employing a multifaceted approach are generally effective at correcting the homeostatic decompensation that is the hallmark of thyroid storm. Research is furthering understanding of the cellular actions of thyroid hormone and may lead to additional, even more effective treatment modalities in the future.
-
This article reviews the pathogenesis of diabetic ketoacidosis (DKA) and provides a rational approach to the management of patients with DKA. The therapeutic discussion includes the use of low-dose insulin, no bicarbonate, or phosphate therapy on the majority of DKA patients, based on numerous prospective randomized studies. The article also discusses controversial subjects such as the use of hypotonic versus isotonic saline with and without colloids, hydration of subjects before insulin therapy, and admission of DKA patients to the general ward versus emergency ward versus intensive care unit. A concise, simple protocol is also presented as a suitable reference for management of patients with DKA.
-
Med. Clin. North Am. · Sep 1994
ReviewNosocomial pneumonia in the medical and surgical patient. Risk factors and primary management.
Nosocomial pneumonia is a large and growing problem in American hospitals. This article reviews the epidemiology, risk factors, microbiology, natural history, and presentation of nosocomial pneumonia. Pathogenesis is also reviewed, and practical measures for prevention are stressed.
-
von Willebrand's disease is the most common of the inherited bleeding disorders. It is caused by quantitative and/or qualitative abnormalities of von Willebrand factor, and it usually presents with bleeding from mucosal surfaces. The diagnosis is confirmed by measuring von Willebrand factor activity and antigen levels, factor VIII activity, and performing a multimer analysis of von Willebrand factor. Treatment may require plasma-derived concentrates, but can often be accomplished with DDAVP, a vasopressin analogue that causes transient release of von Willebrand factor from body storage sites.
-
The objective of this article has been to focus on the more common infectious diseases that the physician caring for athletes may encounter in the office practice of sports medicine. Clearly the physician plays a critical role in treatment and prevention through early recognition and intervention when appropriate. ⋯ It is critical that physicians caring for athletes take an active role to educate and counsel their patients on appropriate preventive measures and give clear return to participation recommendations. Advice should be based on consideration of each athlete's unique situation as well as up-to-date knowledge concerning the particular infectious disease process involved and appropriate treatment options.