The American journal of the medical sciences
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Practical complications of chronic systemic corticosteroid (SC) use in patients with sarcoidosis are poorly characterized. The objective of this study was to determine the impact of SC use in patients with sarcoidosis on unscheduled sarcoidosis-attributed and nonsarcoidosis-attributed healthcare utilization (SHCU and NSHCU, respectively). ⋯ Greater SC use is associated with small but significant increase in HCU related to infection and increased unscheduled emergency department visits for complaints not directly attributable to sarcoidosis.
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A traditional method for internal jugular vein catheterization has been through the transjugular approach. These days, ultrasound-guided cannulation is the preferred mode because of the higher success and lower complication rates. ⋯ This complication occurred in one of the patients in whom ultrasound-guided left internal jugular vein catheterization was used. The anatomical basis of this injury is discussed here.
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The most common complications of umbilical hernias in patients with cirrhosis and ascites include leakage, ulceration, rupture and incarceration. If such a complication is present, there is a high mortality rate after surgical repair. Elective repair is the most effective choice, as it prevents complications with a lower mortality. ⋯ Patients with cirrhosis and umbilical hernias should be referred for consideration of an elective surgical repair with mesh, preferably after optimal management of ascites. There should be a low threshold for placement of a TIPS to facilitate surgery and reduce the chance of severe recurrence of ascites. If surgery is contraindicated, a TIPS must be considered for control of ascites.
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National cholesterol treatment guidelines include a low level of high-density lipoprotein (HDL) cholesterol (<40 mg/dL) as a major risk factor for coronary heart disease (CHD) that should be considered when making decisions on treatment of low-density lipoprotein (LDL) cholesterol. ⋯ These data suggest a graded association exists between lower levels of HDL-cholesterol and CHD across the full range of LDL-cholesterol levels. As interventions targeting HDL levels are developed, the combinatorial effects of lower HDL levels with various levels of LDL-cholesterol should be examined.