Southern medical journal
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Southern medical journal · Apr 1982
Case ReportsBleeding in patients with activated partial thromboplastin time inhibitors.
We present a case in which an activated partial thromboplastin time (aPTT) inhibitor may have significantly contributed to prolonged bleeding in a patient and review five similar cases. The possibility of an aPTT inhibitor should be considered in the evaluation of patients with unexplained prolongation of PTT and PT. Such patients may develop significant bleeding even in the absence of other hematologic abnormalities.
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Southern medical journal · Feb 1982
ReviewPharmacologic agents in the management of pheochromocytoma.
Medical management of pheochromocytoma involves the use of many therapeutic agents. Phenoxybenzamine HCl (Dibenzyline), an alpha-adrenergic blocking agent, at 40 to 80 mg per day can control the disease in most patients. Use of this drug up to the time of operation is controversial. ⋯ Alpha-methylparatyrosine (Metyrosine), which decreases catecholamine synthesis, is a new drug recently released for the treatment of pheochromocytoma when surgery is contraindicated or in cases of malignant pheochromocytoma. The use of a combination of anesthetic agents, such as nitrous oxide, thiopental, narcotics, and enflurane, ensures smooth induction of anesthesia in most cases. Careful and prompt control of hypertensive crises with sodium nitroprusside and of arrhythmias with propranolol and lidocaine are critical to the success of surgery.
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Management of the airway in acute epiglottitis is still controversial. One argument against intubation as opposed to tracheostomy is the increased complications from prolonged intubation. ⋯ Included in this series are 16 consecutive patients who were treated by nasotracheal intubation and simultaneous medical therapy. Fifteen of the 16 patients extubated safely in less than 48 hours, significantly decreasing the possibility for complications.
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Southern medical journal · Nov 1981
Case ReportsNasotracheal intubation by fiberoptic laryngoscope.
We have presented a case in which the fiberoptic laryngoscope was used for nasotracheal intubation, an alternative for the difficult laryngoscopy. We believe regional blocks combined with extensive topical anesthesia aid in the successful use of the fiberoptic laryngoscope for cases of difficult intubation in the practice of oral surgery. We were unable to obtain a complete sensory block with benzocaine or lidocaine spray since the mouth opening was less tha 1 mm. The bilateral superior laryngeal nerve block is a valuable adjunct to the procedure.
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A case of Shoshin beriberi found in a patient with severe metabolic acidosis and shock was presented. We believe the metabolic acidosis in this case is ascribable to overproduction of pyruvate and lactate resulting from lack of thiamine due to preferential intake of sake, precooked food, and rice, and also to shock. The hemodynamic studies done after recovery from shock revealed that the cardiac output, which was initially high, decreased to a slightly low level and then increased to a normal level, concomitant with an increase in the peripheral vascular resistance after introductory administration of thiamine. After treatment with thiamine, all abnormalities disappeared.