Mayo Clinic proceedings
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Coccidioidomycosis is a common infectious disease in the southwestern United States. Although Coccidioides species are not endemic in other areas of the country, the rapid population growth in the southwestern United States in recent decades and the increase in tourism mean that many people travel to the Southwest and return home before developing the clinical syndrome of coccidioidomycosis. In this respect, coccidioidomycosis is a disease of national importance. ⋯ The diagnosis is often made on the basis of serologic findings. Treatment is usually with an azole or amphotericin B, depending on the clinical manifestations and the immune status of the host. We discuss the most common clinical manifestations, the best way to make the diagnosis, and the treatment of common infections.
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Mayo Clinic proceedings · Mar 2008
Comparative StudyInappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital.
To determine if hospitalized medical and surgical patients were placed inappropriately on symptom-triggered therapy (STT) for alcohol withdrawal syndrome (AWS) and if certain conditions were more likely to be associated with inappropriate STT use or adverse events. ⋯ Fewer than half of the randomly selected patients met both of the inclusion criteria for the CIWA-Ar instrument, leading us to conclude that more stringent evaluation is needed. Particularly postoperatively, alternative explanations for putative AWS should be sought. Health care professionals should more aggressively seek information on recent alcohol use from medical records, family members, and patients themselves.
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Mayo Clinic proceedings · Feb 2008
ReviewRecent advances in the diagnosis and management of malignant pleural effusions.
Malignant pleural effusions (MPEs) are an important complication for patients with intrathoracic and extrathoracic malignancies. Median survival after diagnosis of an MPE is 4 months. Patients can present with an MPE as a complication of far-advanced cancer or as the initial manifestation of an underlying malignancy. ⋯ Management of an MPE remains palliative; it is critical that the appropriate management approach is chosen on the basis of available expertise and the patient's clinical status. This review summarizes the pathogenesis, diagnosis, and management of MPE. Studies in the English language were identified by searching the MEDLINE database (1980-2007) using the search terms pleura, pleural, malignant, pleurodesis, and thoracoscopy.