Annals of internal medicine
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Review Practice Guideline Guideline
Clinical ecology. American College of Physicians.
Clinical ecologists propose the existence of a unique illness in which multiple environmental chemicals, foods, drugs, and endogenous C. albicans have a toxic effect on the immune system, thereby adversely affecting other bodily functions. The proposal uses some concepts that superficially resemble those that apply to clinical allergy and toxicology and others that are novel. Review of the clinical ecology literature provides inadequate support for the beliefs and practices of clinical ecology. ⋯ Enumeration of lymphocyte subsets and quantitation of serum immunoglobulin and complement levels in patients with "environmental illness" have not yielded clear-cut evidence of immunologic abnormality. Clinical ecologists use a treatment program that includes avoidance of environmental chemicals, rotation of foods in the diet, and neutralization of symptoms with injected or sublingual extracts. Except for small-dose oral nystatin, which is used for treatment of patients with the candida hypersensitivity syndrome, drug therapy is intentionally avoided, although some clinical ecologists recommend mineral salts, oxygen, vitamins, minerals, and antioxidants for relief of symptoms.(ABSTRACT TRUNCATED AT 400 WORDS)
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Advances in surgical and immunosuppressive techniques as well as increased public awareness have made organ transplantation a well-accepted therapy. To meet the increased need for transplantable organs, medical staff need to recognize which dying patients may be suitable organ donors and how to optimally maintain that donor. We present an overview of the absolute and relative contraindications to organ donation as well as a review of the problems that may be encountered when managing organ donors and how they can best be solved. These guidelines will help increase the number of suitable organ donors and optimize the condition of the transplanted organs.
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To evaluate the clinical efficacy of diagnostic tests used for persons with suspected allergic disease. ⋯ Tests that are effective for identifying allergenic substances usually can be determined from a careful patient interview. Clinicians should be aware of nonspecific test results and allergy tests of unproven effectiveness.
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Immunosuppressed patients are at risk for developing cytomegalovirus retinitis. This disorder is the most common cause of vision loss in patients with the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus retinitis is probably the result of hematogenous spread of the virus to the retina after systemic reactivation of a latent cytomegalovirus infection. ⋯ Ganciclovir and foscarnet are investigational antiviral drugs that appear to be effective in treating cytomegalovirus retinitis. However, maintenance therapy with these medications is required after initial treatment because the disease often relapses. The combined expertise of the internist and the ophthalmologist is needed to diagnose and treat these patients.