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 · 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 · 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 · 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.
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In December 1994, the Michigan Supreme Court decided a group of cases comprising constitutional challenges to a Michigan statute against assisted suicide and prosecutions of Dr. Jack Kevorkian for his role in two incidents of suicide. ⋯ The Michigan court also decided that Kevorkian could not be charged with murder for supplying only the means by which suicide occurred, but he could be charged with a common law crime of assisting in suicide although the statute outlawing such actions became effective only after the suicides occurred. Because suicide was a crime under the prerevolutionary English Common Law, which forms the foundation of Michigan law, assisting in suicide is also a residual crime under the "savings clause" of the Michigan statutes, which incorporates common law crimes into the law of that state when no superseding statute exists.