Geriatrics
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Urinary tract infections are problems in both men and women in the geriatric age group, although causative factors in each sex differ widely. Diagnostic evaluation is directed at determining obstructive disease in men and underlying anatomic abnormalities in both men and women. Bacteriologic diagnosis is important, and localization studies are often helpful. Antibiotic therapy is guided by the usual standards, with special awareness of the greater incidence of chronic or degenerative disease in older patients.
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With clinical vigilance and laboratory tests of platelet and coagulation factor function, the clinician can promptly recognize and treat hemostatic disorders in leukemic patients. For example, laboratory values are strikingly abnormal in disseminated intravascular coagulation. Prompt neutralization of the underlying cause of the coagulopathy is essential. ⋯ Immune thrombocytopenic purpura may be easy to diagnose when the reduction in the circulating platelet count is compared with the normal number of marrow megakaryocytes. But attempts to increase platelet count by platelet transfusions may be frustrating. Treatment involves high doses of corticosteroids, followed by splenectomy if necessary.