Mayo Clinic proceedings
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Mayo Clinic proceedings · Aug 1993
ReviewManagement of postoperative pain: influence of anesthetic and analgesic choice.
Improved control of postoperative pain is being increasingly scrutinized yet concomitantly demanded by patients, physicians, and even the federal government. Our ever-increasing subspecialization in medicine has compartmentalized much of perioperative care and has created substantial difficulty for physicians in understanding the overall influence of other physicians' perioperative decisions, including control of pain. ⋯ Additionally, outcome studies show that provision of improved analgesia and minimization of the perioperative stress response enhance clinical outcome in both low- and high-risk patients. This article highlights new information on how anesthetic and analgesic management influences perioperative pain and decreases the incidence of complications in surgical patients.
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The "duty to warn" has become fixed in US law since the 1976 case of Tarasoff v Regents of the University of California. In that case, the California Supreme Court decided that psychotherapists whose patients make a specific, serious threat of violence against a specific, clearly identifiable potential victim have a duty to warn the intended victim, directly or indirectly, of the threat. Tarasoff inspired several successful and unsuccessful lawsuits. ⋯ The duty to warn is explicitly based on considerations of social utility and, as such, is attractive for courts to expand because an apparently minimal effort by therapists will often prevent substantial harm to victims. Some states have codified the duty to warn in a statute, but other states have refused to adopt the Tarasoff reasoning. In the absence of clear legal decisions to the contrary, psychotherapists may well anticipate that the duty to warn operates in their states.
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Mayo Clinic proceedings · Jun 1993
Comparative StudyProspective study of anti-neutrophil cytoplasmic autoantibody tests in the diagnosis of idiopathic necrotizing-crescentic glomerulonephritis and renal vasculitis.
We prospectively assessed the value of anti-neurtrophil cytoplasmic autoantibodies (ANCA) and nuclear or perinuclear anti-neutrophil autoantibodies measured by indirect immunofluorescence microscopy and antimyeloperoxidase autoantibodies measured by a solid-phase assay in the diagnosis of idiopathic (pauci-immune) necrotizing-crescentic glomerulonephritis (NCGN) and renal vasculitis at our institution. A diagnosis was established on the basis of clinical and renal biopsy findings, and follow-up continued for at least 6 months. ANCA were measured at the conclusion of the study. ⋯ The antimyeloperoxidase autoantibody values would have suggested the diagnosis in the other two patients. Of these 28 patients, 5 had negative ANCA results. High antimyeloperoxidase autoantibody values were detected in patients with NCGN and renal vasculitis, whereas lower values were less specific and were detected mainly in patients with anti-glomerular basement membrane antibody disease and lupus glomerulonephritis.
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Mayo Clinic proceedings · Dec 1992
ReviewColonic cancer during pregnancy: case report and review of the literature.
Colonic cancer during pregnancy is rare. Herein we describe a case of adenocarcinoma of the transverse colon in a 29-year-old pregnant patient. ⋯ Management of colonic cancer during pregnancy depends on gestational age and operability of the tumor. Medical and surgical management considerations are discussed.