The Medical clinics of North America
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Multiple sclerosis is a demyelinating disorder of the central nervous system characterized by exacerbations and remissions of symptoms. This article deals with symptomatic therapy involving treatment of spasticity, fatigue, neurobehavioral disorders, paroxysmal disorders, pain, bladder dysfunction, and cerebellar dysfunction. This article also reviews immunosuppressive therapies including treatment of acute exacerbations or overall progression of the disorder with resultant accumulation of disability.
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The number of lung and heart-lung transplantations is growing rapidly, and hundreds of combined heart-lung, single-lung, and double-lung transplantations have been performed to date, resulting in increased survival and improved quality of life for patients with end-stage pulmonary disorders. Improved surgical technique, immunosuppression, and optimal patient selection are largely responsible for this success. Although the indications for transplantation continue to expand, the number of potential recipients far exceeds the number of available donors, making the evaluation and selection process vital to the success of any transplantation program. A multidisciplinary approach is presented that can be expected to eliminate a large number of prospective candidates and thus enhance matching limited donor organs with transplantation candidates.
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Pancreas transplantation is the only currently available potential cure for type I diabetes. Because of the complications of the procedure and the toxicity of immunosuppression, patients must be carefully selected. The procedure can be justified in patients who already require immunosuppression for a renal allograft. ⋯ Improvement in these rates may occur with the development of more effective and less toxic immunosuppressive agents. Continued improvement in surgical technique should also contribute to overall pancreas transplantation success. Until then, however, pancreas transplantation should be viewed as a therapy for only selected patients in whom the benefits clearly outweigh the risks.
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Med. Clin. North Am. · Sep 1992
ReviewCurrent issues in hypertension. Old questions with new answers and new questions.
Hypertension is a systemic vascular disease that makes its mark upon the "target organs"--heart, brain, and kidneys--through the hemodynamic hallmark of the disease, a progressively increasing vascular resistance to the forward flow of blood. The effect of pressure overload upon the heart is one of concentric hypertrophy of the left ventricle that is, in turn, associated with an independent risk of morbidity and mortality. ⋯ The issue as to why, in the face of increasing numbers of patients receiving the benefits of therapy, there is an alarming increase in patients with end-stage renal disease defies more imagination and study. Thus, many of the old questions seem to be achieving some meaningful answers; but associated with these new answers we are confronted with new questions.
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Although allergic drug reactions are just one type of adverse reaction to medications, they are clinically very important because of the morbidity and mortality they cause. An ever-expanding pharmacopeia increases the potential for allergic drug reactions. An understanding of the types of allergic drug reactions, their immunopathologic mechanisms, and the most likely medications involved; an approach to determine the drug responsible for the reaction; and ways to prevent future allergic drug reactions are important features in minimizing patient morbidity.