Postgraduate medicine
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Cerebral vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. With improvement in surgical techniques and perioperative care, the results in neurologically intact patients are generally satisfactory. However, cerebral vasospasm remains a major problem in the successful management of neurologically deteriorating patients. Until the pathophysiology of cerebral vasospasm is clarified, a reliable treatment regimen will remain elusive and the overall outlook for patients with aneurysmal subarachnoid hemorrhage will remain limited.
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Numerous studies have indicated that home oxygen therapy is safe and practical. In advanced chronic obstructive pulmonary disease (COPD), continuous oxygen therapy results in a higher survival rate than does administration of oxygen 12 hr/day. Practical oxygen systems are available. ⋯ Further studies are needed to evaluate the effectiveness of oxygen therapy to combat the possible effects of transient hypoxemia in patients with COPD during sleep or exercise. COPD necessitates a preventive approach, including behavioral change if possible. Early identification by simple office spirometry and aggressive treatment designed to prevent or forestall complications of advanced disease are the next logical steps in developing a systematic, comprehensive approach aimed at the ultimate conquest of COPD in the next decade.