The Journal of the Oklahoma State Medical Association
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J Okla State Med Assoc · Feb 1999
Case ReportsLate onset angiotensin-converting enzyme induced angioedema: case report and review of the literature.
Angiotensin-converting enzyme inhibitors (ACEI) such as enalapril, captopril, and lisinopril are well established as effective treatments of arterial hypertension and congestive heart failure. They are widely used and generally well tolerated. Angioedema is a rare but serious adverse effect of ACEI therapy. ⋯ Although angioedema typically occurs within the first weeks of ACEI therapy, some cases with latencies of several months to years have been reported. This paper reports a case of late onset and recurrent angioedema in a patient treated with lisinopril for hypertension. A discussion of ACEI angioedema follows.
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J Okla State Med Assoc · Dec 1998
Physician-older patient communication during the transition from independence to dependence.
This article reviews recent research regarding the communication between physicians and their older patients who are passing from independence to dependence. Major findings from these studies are summarized with a discussion of how the context of the medical encounter, the physical, cognitive and language changes related to age, the amount of time permitted for a medical encounter, the managed care environment, and the presence of a companion can affect competent communication between a physician and an older adult. The article concludes with a comment about the need to educate current and future physicians on the complexity of communicating effectively with older patients.
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Blast wave injury from bombs cause a unique but poorly understood spectrum of injuries. Previous blast wave models involved high energy explosives detonated in an open field without the sophisticated monitoring of laboratory equipment. We characterized a rodent model that produces a global blast injury in a safe laboratory environment. ⋯ Mean arterial pressure was bimodal with severe hypotension occurring immediately after the blast and, again, two to three hours later. The characteristic injuries from a blast wave, such as pulmonary hemorrhage with increased lung weight, intestinal serosal hemorrhage, and hemoperitoneum, were found in the rats subjected to the blast pressure wave. In conclusion, our rodent model accurately reproduces the clinical spectrum of injuries seen in blast victims and will provide a powerful tool for studying the pathophysiology and potential treatments of bomb blast victims.
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J Okla State Med Assoc · Sep 1997
Case ReportsGanciclovir treatment of systemic cytomegalovirus in an immunocompetent host.
Cytomegalovirus (CMV) infects a significant number of otherwise healthy individuals. Although most cases are subclinical and therefore not diagnosed, some patients present with a mononucleosis-type illness. Ganciclovir, an agent effective against CMV, has primarily been studied for use in immunocompromised patients. ⋯ Her symptoms included high fever, malaise, myalgias, cough, and abdominal pain. Work-up revealed an acute CMV infection. Intravenous ganciclovir was given with dramatic clinical and laboratory improvement.
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Acute myocardial infarction is the leading cause of death in the United States and a common cause for admission of Oklahoma Medicare beneficiaries. Based on guidelines for the management of acute myocardial infarction published by a joint committee of the American College of Cardiology and the American Heart Association, the Cooperative Cardiovascular Project was developed by the Health Care Financing Administration to measure performance on quality indicators that describe care provided to Medicare beneficiaries. The objective of the project is to use those performance measures to assist hospitals in the development of quality improvement efforts for acute myocardial infarction care. ⋯ Potentially life-saving treatments for Medicare patients hospitalized with an acute myocardial infarction are often underutilized. Improving quality of care for Medicare beneficiaries with acute myocardial infarction has been identified as a national priority.