Arch Intern Med
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Case Reports
Pulmonary function after adult respiratory distress syndrome associated with Legionnaires' disease pneumonia.
Two patients with adult respiratory distress syndrome (ARDS) caused by Legionnaires' disease were treated with erythromycin lactobionate, and they survived. Sequential pulmonary function studies and chest roentgenograms were obtained in both patients. Despite previous suggestions that severe fibrosis might complicate the recovery of patients with this disease, both patients had normal lung volumes and only minimal reduction in single-breath carbon monoxide diffusing capacity ten weeks after the onset of the disease. Thus, pulmonary function after ARDS caused by Legionnaires' disease seems to be only minimally disturbed.
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Hemodialysis or sorbent hemoperfusion has been used in the management of clinical overdose of salicylates or acetaminophen. Hemodialysis offers considerable benefit in severe salicylate poisoning and is preferred to hemoperfusion or peritoneal dialysis, since it more rapidly corrects acid-base and electrolyte abnormalities than does hemoperfusion, and since it is clearly more efficient than is peritoneal dialysis for the removal of salicylates. ⋯ Hemodialysis and hemoperfusion are of questionable benefit in clinical acetaminophen overdose. However, our clinical experience to date with charcoal hemoperfusion in "late" acetaminophen overdose has been associated with a less notable increase in liver enzyme concentrations in comparison with results of retrospective studies of series of patients treated or not treated with sulfhydryl donors.
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Aspirin and acetaminophen are the mainstays of oral analgesic combinations. One group of combinations is composed of antipyretic-analgesics combined with each other. ⋯ On the other hand, there is substantial evidence that combinations of an optimal dose of aspirin or acetaminophen with a narcotic (eg, codeine, hydrocodone, or oxycodone) produce an additive analgesic effect greater than that obtained by doubling the dose of either constituent administered alone. There is also some evidence that the adverse effects produced by such combinations are less than would be produced by an equianalgesic dose of a single constituent.
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Case Reports
Counterpulsation and dobutamine. Their use in treatment of cardiogenic shock due to right ventricular infarct.
A patient had right ventricular infarction complicated by cardiogenic shock. Volume expansion along with high doses of dopamine hydrochloride successfully alleviated hypotension in this patient. However, he had persistent mental obtundation and low cardiac output, and adverse chronotropic responses to high doses of dopamine developed. ⋯ Counterpulsation, however, failed to augment cardiac output. Simultaneous use of dobutamine hydrochloride along with counterpulsation was associated with a noticeable increase in cardiac output. To our knowledge, this is the first reported case of right ventricular infarct complicated by shock in which the simultaneous use of counterpulsation and dobutamine therapy resulted in a substantial increase in cardiac output.