JAMA : the journal of the American Medical Association
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Twelve type I diabetic patients with established diabetic nephropathy were treated for 12 months with the insulin pump to determine whether glucoregulation would influence the clinical course of proteinuria. All of the subjects were known to have arterial hypertension and were receiving antihypertension medication. ⋯ These results suggest that arterial hypertension is an important risk factor in the progression of diabetes nephropathy. Further studies should be designed to recognize early proteinuria and hypertension to determine whether mean normal glucose values and BP over a prolonged period will prevent renal failure.
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Comparative Study
Arterial blood gases and pulmonary function testing in acute bronchial asthma. Predicting patient outcomes.
Pretreatment and posttreatment arterial blood gas and pulmonary function testing measurements were prospectively compared as to their ability to assess asthma severity accurately and, thus, predict the outcome in 102 episodes of acute bronchial asthma initially seen in the emergency department. The Pao2, Paco2, or pH was unable to separate these patients requiring admission from those that could be confidently discharged, while the 1-s forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) did so both before and after treatment. Furthermore, virtually all patients with hypercarbia (Paco2 greater than 42 mm Hg) and/or severe hypoxemia (Pao2 less than 60 mm Hg) had a PEFR below 200 L/min, or an FEV1 below 1.0 L. Thus, selective use of arterial blood gas analysis should substantially decrease both diagnostic cost and patient discomfort without jeopardizing health care.
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The role of emergency room thoracotomy in the management of trauma remains poorly defined despite an increase in its use. Most authors agree that the procedure is effective in the treatment of penetrating thoracic injuries, while its benefit in penetrating injuries below the diaphragm and in blunt trauma has not been established. ⋯ Penetrating abdominal wounds that are severe enough to require thoracotomy in the emergency room fare less well; those patients who suffer from blunt thoracoabdominal injuries are least fortunate. The anatomic location and mode of injury greatly influence the outcome of these patients and are useful in determining when to perform this procedure.