Comprehensive therapy
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Comprehensive therapy · Sep 1995
ReviewThe neuropsychiatric complications of corticosteroid therapy.
A variety of neuropsychiatric complications can result from the treatment with corticosteroids. Toxic effects that are usually observed result from continued use of large dosages or withdrawal of therapy. ⋯ Awareness of the side effects of corticosteroids should help the physician in the management of patients receiving steroid therapy. Knowledge and recognition of the adverse neuropsychiatric effects of steroids should enable the physician to promptly intervene when adverse reactions develop.
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Comprehensive therapy · Jul 1995
ReviewPericardial effusion and tamponade: evaluation, imaging modalities, and management.
Pericardial effusions may be present in a variety of clinical situations, often presenting challenging clinical diagnostic and therapeutic problems. Although several imaging modalities are available, ECHO has become the diagnostic method of choice due to its portability and wide availability. CT and MRI may also be employed and may be more accurate. ⋯ However, this may need to be accompanied by catheter drainage or surgical pericardial window. A new catheter based technique--percutaneous balloon pericardiotomy-- appears useful in select patients with malignancy in order to avoid more invasive surgical procedures. Occasionally, in patients with recurrent effusions, instillation of sclerosing agents into the pericardial space or even total pericardiectomy may be necessary.
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Fulminant hepatic failure is defined as the development of hepatic encephalopathy within 8 weeks of the onset of illness. While there are many causes of FHF, viral hepatitis, particularly hepatitis B, remains the most common etiology. Several drugs and toxins can also lead to FHF, most notably acetaminophen. ⋯ Conservative management focuses on invasive monitoring and the prevention and treatment of complications like cerebral edema, infection, renal failure, and coagulopathy. Only orthotopic liver transplantation has reduced mortality from 80% to 30% to 50%. Therefore, the goals of management and treatment now include determining which patients are appropriate for liver transplant and finding a donor in a timely fashion.