Geriatrics
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To meet the needs of old patients and young physicians, all medical schools and hospitals should have geriatric courses, residency training programs, and geriatricians to lead these programs.
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Pulmonary disease may set in motion a chain of events that ultimately leads to hypertrophy--or even failure--of the heart's right ventricle. The most common cause is chronic obstructive disease, which deprives the lungs of oxygen and produces pulmonary hypertension. But other disorders that raise pulmonary artery pressure also may be responsible. ⋯ Controlled-dose supplemental oxygen therapy is particularly effective, according to recent studies. Bronchospasm or bronchial infection super-imposed on the chronic lung condition may prove too much for the already strained right ventricle. Right ventricular failure calls for hospitalization and vigorous treatment, which may include mechanical ventilation, phlebotomy, antibiotics, steroids, digitalis, diuretics, and correction of electrolyte disturbances.
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Sudden, often severe pain in the spinal region that is followed-sometimes within minutes-by paraplegia may signal spontaneous spinal epidural hematoma. This is a true surgical emergency calling for immediate laminectomy. Otherwise, the neurologic deficit becomes irreversible and the patient probably will die. ⋯ Urinary retention and sensitivity to pinprick at the level of the hematoma are additional diagnostic clues. The case reported here and 13 others from the literature point up the importance of prompt surgical treatment. Eight of the 12 patients who had laminectomy improved and five of them recovered completly, but both of the patients who were not treated surgically died.
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Prevention of infection in the newer orthopedic procedures that involve implantation of large foreign bodies requires the establishment of routines and a policy of meticulous attention to detail. A careful preoperative examination, including identification of occult infections, is crucial. ⋯ An iodophor skin preparation appears to achieve satisfactory skin asepsis. Although the use of unidirectional airflow or ultraviolet light reduces the level of airborne bacteria, these procedures have not been proved to be more effective than meticulous, carefully performed surgery in lowering rates of postoperative wound infection.