Cleveland Clinic journal of medicine
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According to widely accepted theory, migraine is a self-limited neurogenic sterile inflammation characterized by initial cerebral vasoconstriction, subsequent extracranial and intracranial vasodilation, sterile inflammation, and secondary muscle contraction. It is characterized by recurrent attacks of headache, usually unilateral and accompanied by nausea, vomiting, and, often, other symptoms. Frequency, duration, and intensity of attacks are widely variable. ⋯ Precipitating factors include foods, alcohol, medications, visual stimuli, changes in routine, and stress. The first-line agent for abortive therapy is ergotamine; corticosteroids are indicated for prolonged headache. Propranolol is recommended for daily prophylactic therapy, and alternatives include calcium channel blockers, nonsteroidal anti-inflammatory agents, and tricyclic antidepressants.
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Mortality from asthma is increasing, raising questions about the goals and adequacy of treatment. It is important to understand the pathophysiology of asthma and the rationale and options for treatment. ⋯ Appropriate medical therapy includes treatment with compounds that specifically suppress airway inflammation. The best approach to treatment may be an anti-inflammatory agent--preferably by inhalation--along with an inhaled direct bronchodilator, with objective measures of airflow limitation to assess disease severity.
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Valve repair is the best operation currently available for patients with mitral valve disease. However, repair is technically more difficult than valve replacement and has a risk of early and late failure. ⋯ Preoperative echocardiography, including Doppler color flow mapping to evaluate intracardiac flow, is used to assess the feasibility of repair. Intraoperatively, epicardial and transesophageal echocardiography are used to monitor surgical results immediately after repair, ensuring successful outcome of surgery.
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Editorial Comparative Study
The Canadian health care system: is our present your future?
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Laparoscopy, with the use of carbon dioxide or nitrous oxide for insufflation is a common procedure with the potential for several major complications. For example, pneumomediastinum, pneumothorax, and subcutaneous emphysema can occur singly or in any combination with this procedure. ⋯ Possible mechanisms are presented, along with discussion of the need for prompt diagnosis and termination of the procedure with deflation of the abdomen. The life-threatening potential of this complication is emphasized.