Annals of internal medicine
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We have studied 35 patients to find the occurrence of hyperchloremic acidosis during the recovery phase of diabetic ketoacidosis. At admission the patients had typical normochloremic acidosis, with increased anion gap exactly balancing decreased serum bicarbonate. ⋯ After the patients with ketoacidosis were treated, the acidosis became predominantly hyperchloremic with normal anion gap. Failure to normalize serum bicarbonate is attributed to excretion of ketone anions in the urine.
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We undertook a literature review to document whether certain therapeutic measures could be considered safe during pregnancy in the allergic patient. With the possible exception of brompheniramine, the commonly used antihistamine drugs appear to be safe during pregnancy. The bronchodilators ephedrine and theophylline also appear to be safe, as does cromolyn. ⋯ Because side effects are reduced when steroids are administered as aerosols in the nose or lung, these preparations seem well suited for use in pregnancy. The safety of allergic immunotherapy has been confirmed. For asthma, annual influenza vaccination is indicated.
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Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V-14) T-wave inversion suggesting ischemia in normally conducted beats. ⋯ During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p less than 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.
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Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. ⋯ Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.
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Of 133 persons with spontaneous cardiac arrest attended by paramedics within 10 minutes, 100 (75%) had ventricular fibrillation as the initial rhythm and 33 (25%) had extreme bradycardia or asystole. The latter group of arrhythmias was characterized by sinus arrest or severe sinus bradycardia (90%) and complete A-V block (10%). Junctional escape rhythm was also absent or markedly retarded. ⋯ Ventricular fibrillation developed in 11 cases (33%). One patient lived 12 days, but all others were dead on arrival or died in the emergency room. Among the 13 coronary causes of death proved at autopsy, 10 (77%) were due to a fresh thrombus and seven (54%) to an occluded proximal right coronary artery, suggesting a causal relation to this type of arrest.