American journal of therapeutics
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Occlusion of lower extremity vascular bypass grafts results in acute limb-threatening ischemia. The underlying cause of graft failure generally is distal anastomosis stenosis, and relief of culprit stenosis is a required to maintain long-term patency. Of the three thrombolytic agents used for prolonged infusion to accomplish fibrinolysis, streptokinase was the first to be used and is limited owing to the antigenicity that precludes repeated use. ⋯ One patient underwent amputation owing to unsuccessful thrombolysis. No major bleeding or vascular complications occurred. We conclude that intra-arterial thrombolysis using rt-PA is a safe and effective therapy for patients with thrombotic occlusion of synthetic lower extremity bypass grafts presenting with acute limb-threatening ischemia and allows a high rate of secondary patency, avoiding amputation.
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Emergency department (ED)-based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. This is a retrospective study of 5,714 patients seen in an ED observation unit from October 16, 1996 through July 12, 2000. Of the 5,714 patients seen in the observation unit, 4,191 were discharged and 1,314 were admitted. ⋯ Pediatric patients had the shortest stay, averaging only 11.2 hours, although adult and geriatric patients averaged 15.1 hours and 15.4 hours, respectfully. The ED-based observation unit can be of great value to patient care. Although not a substitute for an inpatient unit, it is meant to be a convenient location from which to observe patients who exhibit questionable admitting criteria.
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Of the 62 million common colds requiring medical attention in the United States each year, more than 80% affect school-aged children. Controlled clinical trials have demonstrated the effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) in reducing cold duration. The objective of this study was to determine the effectiveness of zinc gluconate glycine lozenges in reducing the duration and severity of colds in school-aged subjects and to identify the benefits of prophylactic administration of zinc gluconate glycine lozenges in reducing the occurrence of colds. ⋯ Prophylaxis also significantly reduced the median number of colds per year (0.0 versus 1.3; P < 0.001) and concomitant antibiotic use to manage colds (4.1% versus 36.2%; P < 0.0001). Therapy with zinc gluconate glycine lozenges significantly reduced cold duration and antibiotic use in school-aged subjects. Prophylactic administration also significantly decreased cold frequency.
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This paper provides a brief history of the evolution of the Jehovah's Witness faith with a short discussion on the biblical justification for followers' refusal of blood transfusions. It also briefly considers the ethical principles leading to potential conflicts between health care workers and Jehovah's Witnesses patients and examines several significant legal rulings in the United States and Canada that caregivers should be aware of. A discussion of what blood products are and are not currently acceptable is also presented. Finally, the impact of the Jehovah's Witness reform movement aimed at allowing blood transfusions and the nature of recent doctrinal shifts in the Jehovah's Witness faith on the matter of blood transfusions are discussed.
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A number of pharmacologic and nonpharmacologic technologies are in current use to minimize perioperative homologous blood use. Clinical trials, many of them randomized controlled trials, have been done evaluating these approaches and have demonstrated their efficacy. However, data on safety has relied mostly on case reports, uncontrolled studies, and, for the pharmacologic agents, extrapolation from the nonsurgical setting. ⋯ DDAVP is low-risk, provided it is not overused, which can induce hyponatremia. Autologous predonation probably has similar risks as homologous blood with respect to transfusion errors and bacterial infection. As with most medical interventions, we must be vigilant to prevent human error.