The American journal of medicine
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The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the gastric mucosa are well documented. The complex mechanisms of gastric damage, however, are not fully understood. This review examines current knowledge about the normal function of the gastric mucosal barrier; the role of prostaglandins in cytoprotection and repair; the mechanisms by which aspirin and other weak organic acids are absorbed by the stomach; and the subsequent cascade of events--including ion trapping and back diffusion of hydrogen ions--that leads to gastric erosion and bleeding. A hypothesis describing NSAIDs' dual insult on the stomach is advanced.
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Heart disease has not been well characterized in patients with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome. During a prospective study of cerebrovascular disease in autoimmune disease and SLE, 11 lupus patients were identified with an antiphospholipid syndrome characterized by significant cardiac valvular disease in addition to cerebral infarction, deep vein thromboses, and thrombocytopenia. Patients were reviewed for criteria for systemic lupus and underwent echocardiographic studies and measurements of anticardiolipin antibodies, VDRL, and the lupus anticoagulant. ⋯ This report expands previous descriptions of antiphospholipid syndromes by describing a subset of lupus patients with significant aortic and mitral valvulitis in addition to circulating antiphospholipid antibodies, thrombocytopenia, and recurrent thromboses.
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To identify diagnostic errors caused by faulty clinical cognition, we analyzed 40 consecutive transcripts of problem-solving exercises published in a pedagogic series of clinical reasoning. The analysis disclosed multiple errors in cognition and produced a provisional classification of these errors based on a framework derived from cognitive science. ⋯ We instantiated each type of error by providing detailed specific examples, and identified the consequences of each error. We conclude that cognitive errors can be identified and classified, that they can produce serious morbidity, and that a classification of cognitive errors is a step toward a deeper understanding of the epidemiology, causes, and prevention of diagnostic errors.
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In this report, we have presented our experience with a patient with a rare cutaneous granulocytic sarcoma. In addition to hematoxylin and eosin, myeloperoxidase stain and specific stains for lysozyme and esterase were helpful in confirming the histologic diagnosis of granulocytic sarcoma. ⋯ Treatment with corticosteroids at the time of surgery may have prevented a local recurrence of granulocytic sarcoma despite positive tissue margins. Our experience underscores the importance of directing treatment toward the granulocytic sarcoma whereas the myelodysplasia concurrently present may not require therapy for several years.