Cleveland Clinic journal of medicine
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Comparative Study
Use of the sleep laboratory in suspected sleep apnea syndrome: is one night enough?
Sleep-disordered breathing appears to vary widely from night to night in the general population. ⋯ One night of testing should generally suffice. A second recording might be expected to be positive in half of the small group of patients clinically suspected of having sleep apnea who have a negative first study.
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Lactic acidosis, generally defined as a plasma lactate concentration in excess of 5 mmol/L with a concomitant blood pH less than 7.25, is reported to have a direct association with mortality. ⋯ When lactate accumulates in the perioperative period, the responsible condition is most often self-limiting. Reversible, subacute, marked lactic acidosis should not be assumed to predict mortality as it does in patients whose plasma lactate concentrations remain chronically elevated during severe systemic diseases such as sepsis.
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As the incidence of cancer rises and as physicians treat it more aggressively, more patients will experience complications of cancer or of its therapy. ⋯ Although treating the complications associated with cancer cannot always prolong the patient's life, it frequently can improve the quality of life remaining. Therefore, physicians who care for patients with cancer should anticipate these complications and treat them promptly when they occur.
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The first fully automatic portable invasive blood pressure recorder was developed 30 years ago. Today, portable noninvasive ambulatory blood pressure devices are capable of measuring blood pressure intermittently for periods of 24 to 48 hours. ⋯ The various methods of analyzing ambulatory blood pressure data should be used in a complementary fashion to evaluate antihypertensive drug therapy. We believe that this technique will soon become much more commonly used for hypertension management.
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Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught. ⋯ Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.