Arch Intern Med
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Three patients with untreated sleep apnea fell asleep while driving and caused serious automobile accidents. One person died, another became permanently paraplegic, and the three patients with sleep apnea were seriously injured in these crashes. This sequela of sleep apnea is not surprising, since subjects with sleep apnea may be poor drivers with a high accident rate and a high incidence of "near-miss" vehicular incidents. ⋯ Second, physicians must consider the diagnosis of sleep apnea when examining patients who fall asleep while driving. Next, physicians must warn their patients with sleep apnea about the risks of driving with untreated sleep apnea. Finally, physicians must treat any seriously impaired driver with sleep apnea and keep these patients from driving until they can receive successful treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intermittent injection vs patient-controlled analgesia for sickle cell crisis pain. Comparison in patients in the emergency department.
--The purpose of this study is a prospective assessment of morphine sulfate administration by intermittent intravenous (IV) injections (Int-IV) vs patient-controlled analgesia (PCA) in patients in the emergency department (ED) with sickle cell crisis pain. ⋯ --At both the low- and high-dose regimens, PCA is equally safe and effective and may be used in place of Int-IV administration of morphine in the ED treatment of sickle cell crisis pain.
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Sarcoidosis is a multisystem disorder of unknown cause. The disease is characterized by the presence of noncaseating granulomas in the affected tissue system. ⋯ The disease appears in the differential diagnosis of many infectious and noninfectious neurological syndromes. We have reviewed all aspects of neurosarcoidosis from the point of view of practicing internists, including the clinical manifestations, cerebrospinal fluid and radiographic changes, differential diagnosis, and treatment.