Postgraduate medicine
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Postgraduate medicine · Apr 1993
ReviewHematologic emergencies. Management of transfusion reactions and crises in sickle cell disease.
Two hematologic emergencies are reviewed in this article: transfusion reactions and crises in patients who have sickle cell disease. Transfusion reactions may be due to incompatibility, IgA deficiency, allergy or, rarely, bacterial contamination of the blood product. A major hemolytic reaction due to incompatibility may progress to hypotension and shock. ⋯ The acute chest syndrome can be complicated by pneumonia; rapid respiratory failure may occur if multiple lobes are involved. Splenic or hepatic sequestration requires aggressive rehydration and transfusion. In patients who have had stroke or subarachnoid hemorrhage, a long-term exchange transfusion program is needed to keep hemoglobin S levels below 30%.
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Postgraduate medicine · Apr 1993
ReviewAcute interstitial nephritis. Why do the kidneys suddenly fail?
Acute interstitial nephritis is a clinical and pathologic entity with diverse causes. The most common cause at present is reaction to drug use, but infection, a concomitant uveitis syndrome, and other rare causes have been reported. Acute interstitial nephritis should always be considered in a patient with acute renal failure, because it is a treatable cause that may result in interstitial fibrosis and irreversible disease if not arrested.
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Postgraduate medicine · Mar 1993
ReviewCervical spine radiography after blunt trauma. Is it always needed?
In trauma cases, the mere presence of a cervical immobilization device is not an indication for radiography of the cervical spine. High-yield radiographic criteria have been prospectively determined for cases of blunt trauma, and these identify individuals at low risk for cervical spine injuries. ⋯ Cervical spine radiography alone does not ensure detection of all injuries. Adequate history taking and careful examination are always essential and may dictate additional studies.
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Although the group A beta-hemolytic streptococcus is the most important treatable cause of pharyngitis, other organisms, including viruses and groups C and G streptococci, should always be considered in the diagnosis of pharyngeal symptoms. Clinical findings and a rapid strep test aid in making the diagnosis of group A streptococcal pharyngitis. In nonallergic patients with the latter, penicillin V potassium is the antibiotic of choice; for those allergic to penicillin, erythromycin is my preferred alternative.
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Postgraduate medicine · Feb 1993
ReviewPostoperative pain. Analgesics make a difference in many ways.
Because pain has so many potent physiologic and psychological effects, successful management of postoperative pain can significantly influence the speed and degree of recovery. Drug therapy combined with nonpharmacologic pain-relief methods and an understanding of each patient's needs are required. Drs Ziser and Murray discuss the types of post-surgical pain experienced by patients and the pharmacologic treatment of this pain.