Mayo Clinic proceedings
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Mayo Clinic proceedings · Nov 1989
Respiratory bronchiolitis-associated interstitial lung disease and its relationship to desquamative interstitial pneumonia.
Respiratory bronchiolitis is a mild inflammatory reaction commonly noted in asymptomatic cigarette smokers. We reviewed 18 cases of respiratory bronchiolitis-associated interstitial lung disease (RB/ILD), which had been diagnosed on the basis of clinical evaluation and open-lung biopsy. All patients were cigarette smokers. ⋯ In most patients, respiratory improvement ensued when they stopped smoking. Because of histologic similarities to desquamative interstitial pneumonia (DIP), the 18 cases of RB/ILD were compared with 36 cases of DIP. DIP tended to occur in older persons, caused more severe symptoms, displayed ground glass infiltrates on chest roentgenograms, was characterized by more severe interstitial disease on pulmonary function tests, and was often associated with progressive respiratory disease.
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Mayo Clinic proceedings · Sep 1989
ReviewPreoperative assessment of cardiac patients undergoing noncardiac surgical procedures.
A careful clinical history and physical examination are the most important components of the preoperative assessment of the cardiac patient who is to undergo a noncardiac surgical procedure. From these factors and the nature of the surgical procedure planned, a reasonable estimate of potential cardiac risk can be formulated to guide judicious preoperative testing for further definition of potentially high-risk patients. The potential risks associated with an invasive cardiac procedure or surgical intervention must always be considered along with the potential benefits of such a procedure in an attempt to reduce the cardiac risk of noncardiac operations. Aggressive and conscientious preoperative assessment and perioperative care of the high-risk patient by the concerted efforts of the medical consultant, anesthesiologist, and surgeon may substantially diminish cardiac-related morbidity and mortality during noncardiac surgical procedures.
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Neuroepidemiology has been important in providing clues about the cause and pathogenesis of multiple sclerosis. In this review, we update the incidence and prevalence rates of multiple sclerosis in Olmsted County, Minnesota, and examine the potential role of viruses, exposure to animals, toxins, trauma, and diet in the development of this disease. Diseases of probable autoimmune nature have also been linked to multiple sclerosis. These descriptive data may contribute to the formulation of testable specific hypotheses about the pathogenesis and treatment of multiple sclerosis and other demyelinating diseases.
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Despite the lack of a definitive remedy for central nervous system demyelination in multiple sclerosis, certain manifestations of the disease are treatable. Recognition and identification of specific impairments, disabilities, and handicaps faced by the patient afford the physician the best opportunity to provide effective intervention. ⋯ The goal of rehabilitation in multiple sclerosis is to maximize the patient's physical, emotional, social, and vocational independence. Through the multidisciplinary efforts of numerous health-care workers in close cooperation with the patient and the family, this goal can be attained.
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Mayo Clinic proceedings · Jun 1989
Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients.
The association between preoperative smoking cessation and postoperative pulmonary morbidity was studied prospectively in 200 consecutive patients undergoing an elective coronary artery bypass surgical procedure. Detailed respiratory, cardiovascular, and smoking histories were elicited. Preoperative arterial blood gas analyses and bedside spirometry were performed. ⋯ Patients who had stopped smoking for more than 6 months had rates similar to those who had never smoked (11.1% and 11.9%, respectively). Preoperative pulmonary dysfunction, increased pack-years of smoking, prolonged surgical time, and the use of enflurane were independently associated with postoperative pulmonary morbidity (P less than 0.05). We concluded that smoking cessation should occur at least 2 months preoperatively to maximize the reduction of postoperative respiratory complications.