Postgraduate medicine
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Postgraduate medicine · Jun 1983
Fungal infection of the lung. The big 3--histoplasmosis, blastomycosis, coccidioidomycosis.
Diseases caused by the normally pathogenic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are common but seldom serious. Treatment is usually needed only if respiratory status is compromised, if there is progressive tissue destruction, or if the infection disseminates outside the lungs. ⋯ Although this drug has no firmly established role, it has proved useful for several aspects of disease. More experience with its use will prove whether it is truly curative or merely suppressive.
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Postgraduate medicine · Jun 1983
Comparative StudyNarcotics for acute postoperative pain. Is intramuscular administration passé?
Intramuscular (IM) injection of narcotic has been the mainstay of postoperative analgesia. However, problems inherent in IM administration--pulmonary dysfunction and inadequate pain control due to variable peak levels of drug concentration and variable absorption rate--have resulted in continuing efforts to find a more desirable method of administration. Intravenous (IV) infusion on a continuous or self-administered intermittent basis controls pain more effectively than IM injection. ⋯ Some investigators are studying injection of narcotic into the epidural or subarachnoid space of the spine as a means of providing postoperative analgesia. This method provides an unusually intense, prolonged, and segmental analgesic action, as well as greater improvement in respiratory dynamics than with IV infusion. Although the advantages of the IV and spinal methods seem to outweigh the disadvantages, further research is needed before they can be recommended as alternatives to the standard IM method used to control postoperative pain.
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When a mammal's bite breaks the skin, aggressive management is indicated to prevent infection and provide for a good cosmetic and functional result. Vigorous irrigation and thorough debridement play a more important role than antibiotics in preventing infection. ⋯ Suturing may or may not be advisable, depending on cosmetic considerations and risk of infection. Prophylaxis against tetanus is a must, and hepatitis and rabies prophylaxis may also be necessary in selected cases.