Postgraduate medicine
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Postgraduate medicine · Jan 1994
Oncologic emergencies. Treating acute problems resulting from cancer and chemotherapy.
Oncologic emergencies can occur in cancer patients who have a good prognosis. In all of them, the challenge to the clinician is to diagnose and treat before irreversible complications occur. In febrile patients with neutropenia, cultures of body fluids should be obtained and therapy should be started immediately with broad-spectrum antibiotics. ⋯ For brain metastases, immediate treatment with dexamethasone (Decadron, Dexone, Hexadrol) is indicated. For hypercalcemia, a number of drugs that inhibit bone resorption, resulting in lower serum calcium levels, are now available. Malignant cardiac tamponade is relatively rare but potentially lethal; emergency pericardiocentesis often results in marked improvement.
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Rhabdomyolysis should be considered in the differential diagnosis of acute muscle weakness or pain in patients who have recently increased their level of exercise, no matter what their previous level of physical fitness. Measurement of an elevated creatine kinase level confirms the diagnosis. Management of rhabdomyolysis is aimed at avoiding acute renal failure through aggressive fluid replacement to maintain a high urine output.
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Pulmonary involvement by a connective tissue disease can result in clinically important complications. Pathogenic mechanisms vary from granulomatous reaction and interstitial inflammation to primary vasculitis and immune complex-mediated disease. Understanding the pulmonary complications of connective tissue diseases is challenging in that several distinct patterns of involvement are associated with the same disease but the same lung abnormalities are found with several different diseases. Early recognition and treatment of pulmonary involvement may offer the patient a better chance of recovery from serious conditions that often carry a grim prognosis if undetected.
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Postgraduate medicine · Jun 1993
ReviewMethanol intoxication. How to help patients who have been exposed to toxic solvents.
Methanol intoxication can be a challenge, in part because it is relatively uncommon but also because of the pharmacokinetics involved. A patient may not experience symptoms and thus may not present for treatment for several hours, or even a day or two, after exposure to the toxic substance. ⋯ Treatment focuses on prevention of methanol conversion to its toxic metabolites, correction of metabolic acidosis, and elimination of the toxic substances from the system. Ethanol and bicarbonate administration and hemodialysis have been effective.