Postgraduate medicine
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Postgraduate medicine · Mar 1999
Review Comparative StudyLower extremity compartment syndrome. When to suspect acute or chronic pressure buildup.
Acute compartment syndrome is a surgical emergency. A high index of suspicion is needed in cases of severe contusion, especially if patient complaints seem to outweigh physical findings. Acute surgical fasciotomy is an effective treatment and should be carried out expeditiously if compartment pressures are elevated over 70 mm Hg in order to avoid complications such as chronic disability due to contractures or rhabdomyolysis with acute renal failure. ⋯ Thallium stress testing is noninvasive and may be a more physiologic measurement. Fasciotomy may be indicated if conservative treatment lacks efficacy. For unknown reasons, the deep posterior compartment does not respond as quickly, or as well, to fasciotomy as the anterior compartment.
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Postgraduate medicine · Mar 1999
ReviewHow to help patients with restless legs syndrome. Discerning the indescribable and relaxing the restless.
Restless legs syndrome is a common, potentially disabling condition that affects about 10% to 15% of the general population and yet is often unrecognized and misdiagnosed. It is mainly diagnosed clinically and only rarely requires polysomnography. ⋯ The most effective drugs are dopaminergic agents, clonazepam, opioids, gabapentin, and clonidine. Additional agents are available that may be beneficial as add-on or alternative therapy.
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Pulmonary injury due to smoke inhalation is a significant cause of death in fire victims. Singed nasal hair and carbonaceous sputum are easily recognized warning signs, but other subtle clues should prompt thorough evaluation and aggressive treatment. Dr Lee-Chiong describes the basic mechanisms of injury and discusses how to assess and manage complications caused by smoke inhalation.