The American journal of medicine
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Fractures, a common complication of cardiac and liver transplantation, have not been reported in association with lung transplantation. However, many patients with end-stage pulmonary disease have multiple risk factors for osteoporosis, and several studies have suggested that osteoporosis before transplantation may increase the risk of fracture after transplantation. Therefore, we evaluated a group of patients with end-stage pulmonary disease who were awaiting lung transplantation to determine the prevalence of osteoporosis. ⋯ Osteoporosis and vitamin D deficiency are extremely common in patients with end-stage pulmonary disease. Only 34% of patients had normal lumbar spine BMD and only 22% had normal BMD at the hip. Patients with cystic fibrosis and glucocorticoid-treated patients with COPD were most severely affected. Therapies to prevent bone loss and treat established osteoporosis are uncommonly utilized in glucocorticoid-treated patients with end-stage pulmonary disease. Candidates for lung transplantation should be evaluated for osteoporosis and vitamin D deficiency at the time of acceptance to the transplant waiting list.
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The purpose of this study was to determine whether patients and their families found ethics consultations to be helpful and whether they were satisfied with the treatment decisions that were made in those cases where ethics consultation was requested. ⋯ Patients and families found ethics consultation provided by clinical ethicists at Loma Linda University Medical Center to be helpful in a majority of instances, and rarely found them detrimental. Based on an analysis of their comments, we believe ethics consultations were perceived as helpful in 7 ways: increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.
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Chronic pain differs from acute pain in that it serves no useful function, causes suffering, limits activities of daily living, and increases costs of healthcare payments, disability, and litigation fees. Pain perception begins with activation of peripheral nociceptors and conduction through myelinated A delta and unmyelinated C fibers to the dorsal root ganglion. From here, signals travel via the spinothalamic tract to the thalamus and the somatosensory cortex. ⋯ Descending pathways from the hypothalamus, which has opioid-sensitive receptors and is stimulated by arousal and emotional stress, can transmit signals to the dorsal horn that modulate ascending nociceptive transmissions. Modulation to alter the perception of pain also can occur at higher centers (e.g., frontal cortex, midbrain, medulla) by opioids, anti-inflammatory agents, as well as antagonists and agonists of neurotransmitters. This article will review our current knowledge of the mechanisms involved in (1) the transduction of tissue injury or disease signals (nociception and nociceptive receptors); (2) the transmission of signals rostrally to the thalamus and higher nervous system centers (involving perception of the quality, location, and intensity of noxious signals); and (3) the modulation of ascending sensory messages at all levels (periphery, spinal cord, and higher centers).
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral antibiotic treatment of right-sided staphylococcal endocarditis in injection drug users: prospective randomized comparison with parenteral therapy.
To compare the efficacy and safety of inpatient oral antibiotic treatment (oral) versus standard parenteral antibiotic treatment (intravenous) for right-sided staphylococcal endocarditis in injection drug users. ⋯ For selected patients with right-sided staphylococcal endocarditis, oral ciprofloxacin plus rifampin is effective and is associated with less drug toxicity than is intravenous therapy.