Postgraduate medicine
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Postgraduate medicine · Jul 1991
Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens.
Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.
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Postgraduate medicine · Jul 1991
Sepsis and septic shock. Deadly complications that are on the rise.
Most patients are already hospitalized when sepsis and septic shock develop, and in spite of therapy, at least 50% die. Although newer therapeutic agents are being evaluated, current management consists of antibiotics, fluids for volume resuscitation, inotropic agents, and surgery for septic foci. Greater emphasis on preventive measures is recommended.
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Postgraduate medicine · May 1991
Case ReportsWhen migraine is more than a headache. Stroke in a young patient.
Stroke rarely occurs in a young patient with migraine. Nevertheless, vascular headache can lead to catastrophic neurologic consequences, and severe headache associated with persistent neurologic deficits poses a complex diagnostic problem.
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Postgraduate medicine · May 1991
ReviewNonprescription drugs and hypertension. Which ones affect blood pressure?
Hypertensive patients should be aware of the possible effects of nonprescription medications on blood pressure control. For absolute safety, no adrenergic agents should be used. Nasal phenylephrine hydrochloride is probably the safest of these agents, and pseudoephedrine hydrochloride may also be safe. ⋯ The effects of other adrenergic agents (eg, epinephrine) on blood pressure have not been clinically evaluated. Ibuprofen may elevate blood pressure if taken in maximum over-the-counter doses for more than a few days. The ethanol and sodium chloride content of nonprescription drugs taken in recommended doses does not appear to pose a great hazard.
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Postgraduate medicine · May 1991
ReviewDetermining the cause of anemia. General approach, with emphasis on microcytic hypochromic anemias.
In the vast majority of cases, the cause of microcytic hypochromic anemia is clearly suggested by the patient history, physical examination results, red cell indexes, and peripheral blood smear. Thus, further diagnostic testing, if necessary, can be very selective. When the underlying cause of anemia is obscure, the serum ferritin concentration should be measured first. ⋯ The serum iron level is low in anemias caused by iron deficiency and chronic disease but normal or elevated in those resulting from the thalassemias, hemoglobin E disorders, and lead toxicity. The free erythrocyte protoporphyrin level is elevated with iron deficiency, the anemia of chronic disease, and lead toxicity but normal with thalassemias and hemoglobin E disorders. Results of these two test indicate which of the more specific tests is most likely to yield the correct diagnosis.