Mayo Clinic proceedings
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To review the evaluation and management of delirium in elderly patients for primary-care providers. ⋯ Elderly patients frequently experience delirium. Delirious symptoms can produce devastating consequences if they are not recognized and appropriately treated.
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Mayo Clinic proceedings · Oct 1995
Role of transesophageal echocardiography in hemodynamically unstable patients.
To evaluate the clinical impact of transesophageal echocardiography on subsequent management and outcome in hemodynamically unstable patients with suspected cardiovascular pathologic conditions. ⋯ Transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
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Mayo Clinic proceedings · Aug 1995
Review Case ReportsTreatment of alcohol withdrawal in hospitalized patients.
Alcoholism can be encountered in many aspects of medicine. Frequently, primary-care physicians are asked to treat patients who are experiencing various stages of alcohol withdrawal while hospitalized for intercurrent illness. A thorough assessment of the patient is important because the symptoms and signs of alcohol withdrawal are nonspecific. ⋯ Their application by means of a symptom-triggered approach based on frequent, objective assessment of the patient is recommended. Adjunctive therapy for specific complications of alcohol withdrawal is discussed. After the acute withdrawal symptoms have been controlled, psychiatric or chemical dependence assessment (or both) is strongly encouraged.
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Mayo Clinic proceedings · Aug 1995
Case ReportsLong-term suppressive therapy for Candida parapsilosis-induced prosthetic valve endocarditis.
Prompt valve replacement is advocated in patients in whom candidal prosthetic valve endocarditis develops. Unfortunately, some patients with this condition are considered nonsurgical candidates, and they are unable to tolerate long-term administration of amphotericin B with or without flucytosine. Herein we describe a patient with Candida parapsilosis-induced prosthetic valve endocarditis in whom oral administration of fluconazole during an 11-month period successfully suppressed the fungal infection. Three previously published cases indicate that long-term noncurative suppressive therapy for C. parapsilosis-induced prosthetic valve endocarditis may allow prolonged symptom-free survival for such patients.
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Mayo Clinic proceedings · Jun 1995
Clinical TrialEarly and late survival after surgical treatment of culture-positive active endocarditis.
To describe a 30-year experience with surgically treated culture-positive active endocarditis. ⋯ Although surgical treatment of culture-positive active endocarditis is still associated with substantial mortality, the long-term outcome of hospital survivors is excellent. Subsequent reoperations for periprosthetic leak are common, but recurrent infection is uncommon.