The Journal of the American Osteopathic Association
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Many patients admitted to the intensive care unit have respiratory failure and thus require mechanical ventilation. Weaning patients from mechanical ventilation after their primary disease process has been treated can be difficult in approximately 30% of patients. ⋯ Assessing whether a patient can be weaned from mechanical ventilation involves two major factors: (1) examining the patient for evidence of an increase in the work of breathing, and (2) measuring spontaneous breathing variables. Although different modalities have been used in weaning patients from mechanical ventilation, none has been shown to be more successful than repeated trials of spontaneous breathing.
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Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is an important clinical diagnosis that every family practitioner should be able to recognize. Although penile Mondor's disease is rare, proper diagnosis and consequent reassurance can help to dissipate the anxiety typically experienced by patients with the disease. This article describes the symptomatology, diagnosis, and treatment of superficial thrombophlebitis of the dorsal vein of the penis.
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Low back pain, a leading cause of disability in the United States, has a significant economic impact not only on lost productivity but also on healthcare expenditures. Approximately a fifth of patients will see multiple physicians in their quest for relief of low back pain. ⋯ This article reviews the diagnosis and assessment of pain levels and a triad system of therapy involving cortical, spinal, and peripheral levels. Options include antidepressants, neuroleptics, neurostimulants, and osteopathic manipulative treatment (OMT) (cortical level); opiates, tramadol hydrochloride, and transcutaneous electrical nerve stimulators (spinal level); and nonsteroidal anti-inflammatory drugs, epidural injections, spinal blocks, antispasmodics, physical therapy, muscle relaxants, exercise, and OMT (peripheral level), By choosing a modality directed at each level, the clinician may provide the patient with a pain management program that will maximize the chosen mode of therapy and restore function and mobility.
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J Am Osteopath Assoc · Feb 2001
Comparative StudyPredicting factors of successful recovery from lumbar spine surgery among workers' compensation patients.
It is commonly believed that patients who are compensated for a work-related injury have less incentive to return to work. This study evaluated how various factors affected the outcomes of lumbar spine surgery in terms of pain relief, functional status, return to work, and general health. Eighty-seven workers' compensation patients had spinal fusion or microdiskectomy. ⋯ Overall, 55% of patients did return to work in some capacity, but the rate was 72% for microdiskectomy patients versus 43% for fusion patients. While outcomes significantly improved, postoperative scores remained severe. This did not correlate with return-to-work rates, suggesting that outcomes measures may not be effective.
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J Am Osteopath Assoc · Dec 2000
Case ReportsRe-expansion pulmonary edema following puncture of a giant bulla.
Ipsilateral pulmonary edema may occur in a lung that has been rapidly reinflated after a period of collapse. The syndrome of re-expansion pulmonary edema is associated with variable degrees of hypotension and hypoxemia. ⋯ The initial cause of uninflated pulmonary parenchyma described with re-expansion pulmonary edema has typically been either a large undrained pleural effusion or a pneumothorax. The authors describe a patient in whom re-expansion pulmonary edema developed when inadvertent puncture of large emphysematous bullae released previously atelectatic lung.