Annals of internal medicine
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Infection with the human immunodeficiency virus (HIV) (formerly HTLV-III/LAV) is transmitted by sexual contact, by blood and blood products, and perinatally. There is no evidence for casual transmission. The risk to health care workers is low but appropriate infection control precautions should be taken. ⋯ Counseling and HIV antibody testing should be offered to pregnant high-risk women. Laboratories that process specimens potentially containing HIV virus should adhere to maximum containment procedures. An intensive and continuing educational program on the epidemiology of HIV infection and appropriate infection control practice is recommended.
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The spinal tap, or lumbar puncture, has indisputable value; opinions differ, however, on the amount of that value. The procedure has variable utility depending on the clinical indications and the results of tests on the cerebrospinal fluid. ⋯ Because of the potential risk of the spinal tap, decisions about when to do the procedure must be made carefully. A probability analysis is provided to elucidate the usefulness of data from cerebrospinal fluid tests.
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Obesity is commonly considered a surgical risk factor, but the degree of risk has been imprecisely quantified. There is little evidence that excessive body weight in itself should contraindicate general surgery. However, obesity is often associated with abnormal cardiorespiratory function, metabolic function, and hemostasis, which may predispose to morbidity and mortality after surgery. We review pertinent data and offer guidelines to minimize the risks of surgery in obese patients.
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Cardiopulmonary arrest is a test of the brain's tolerance to global ischemia. New insights into the pathophysiology of global ischemia have led to the potential use of early prophylactic anticonvulsants, hypothermia, barbiturate coma, glucose manipulations, calcium-blocking agents, and hemodilution. ⋯ The distinctive features of these sequelae and their pathophysiologic aspects are discussed. Special attention is given to brain death and prognostication.
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Patients are considered to have hypercoagulable states if they have laboratory abnormalities or clinical conditions that are associated with an increased risk of thrombosis (prethrombotic states) or if they have recurrent thrombosis without recognizable predisposing factors (thrombosis-prone). The number of specific primary hypercoagulable states that are recognized is growing. ⋯ Secondary hypercoagulable states are generally acquired disorders in patients with underlying systemic diseases or clinical conditions known to be associated with an increased risk of thrombosis: for example, malignancy, pregnancy, use of oral contraceptives, myeloproliferative disorders, hyperlipidemia, diabetes mellitus, and abnormalities of blood vessels and rheology. The complex pathophysiologic features of these secondary hypercoagulable states are discussed, and a framework is provided for the laboratory investigation and systematic clinical approach to the patient.