Cleveland Clinic journal of medicine
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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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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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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.
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Advances in chemotherapy and surgery have significantly improved the outcome of infective endocarditis, but the disease remains a therapeutic challenge with an overall mortality of 20%. More cases of infective endocarditis seen today are associated with prosthetic heart valves, intravenous drug abuse, or complications of medical and surgical technology. Prosthetic valve endocarditis occurs in 1% to 4% of patients with prosthetic valves. ⋯ The principal indication for urgent surgical intervention is acute valvular dysfunction. Other considerations for surgery include evidence of myocardial invasion, infection by antibiotic-resistant organisms, and large vegetations. For patients at risk of infective endocarditis, antibiotic prophylaxis during invasive procedures is an accepted practice.