The Journal of the Kentucky Medical Association
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Comparative Study Clinical Trial Controlled Clinical Trial
Epidural morphine pruritus reduction with hydroxyzine in parturients.
A majority of patients experience pruritus, nausea and/or emesis following epidural morphine administration post-cesarean section. Naloxone or diphenhydramine are commonly used to treat these side effects. Prevention or reduction in the incidence of side effects of epidural morphine is a clinical goal. ⋯ Group I (n = 20) received saline, while Group II (n = 20) received 50 mg of hydroxyzine ten minutes after the administration of 5 mg epidural morphine. Both solutions were administered by deep intramuscular injection in the thigh area. The results of this investigation demonstrated that hydroxyzine was efficacious in attenuating the incidence of severe pruritus.
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Although relatively uncommon, Guillain-Barré syndrome remains the most frequent cause of sudden weakness in persons under the age of 40 years. While most patients enjoy spontaneous resolution of their neurologic deficits, death still occurs in some individuals who suffer secondary complications from profound respiratory muscle weakness. This review of patients with ascending paralysis who required intubation and mechanical ventilation underscores that the major factors which contribute to death and morbidity can be anticipated and largely avoided using a vigilant multidisciplinary approach.
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Mycotic aneurysm secondary to Mycobacterium tuberculosis is extremely unusual. We describe a 28-year-old female patient with tuberculosis who developed synchronous mycotic aneurysms of the abdominal aorta and the innominate artery. The pathogenesis, diagnosis, and treatment of tuberculous mycotic aneurysm is reviewed.
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The routine use of hyperbaric oxygen as therapy for carbon monoxide intoxication is being critically reexamined nationally. There are no controlled prospective clinical studies that show this modality to clearly be superior to the more traditional use of high concentrations of supplemental oxygen. ⋯ We then audited the medical records of all patients treated during a four-year period with the diagnosis of carbon monoxide poisoning or smoke inhalation to determine the actual utilization of this therapeutic modality. The results of our study indicate that hyperbaric referral is not the standard treatment for significant carbon monoxide intoxication in this academic setting.
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In a retrospective study of 100 patients 40 years of age or older, routine CT of the thorax demonstrated calcification of the aortic valve in five and mitral valve in five. The prevalence of valvular calcification increased with increasing age; calcification was present in 36% of patients over 70 years of age and 75% over 80. None had a history of rheumatic fever; in nine of 10 cases valvular calcification appeared to be degenerative in etiology. ⋯ Aortic valvular calcification on CT is specific for aortic stenosis; CT also demonstrates the calcification earlier than either plain radiographs or echocardiography. In the elderly, mitral valve calcification on CT seems to occur as a manifestation of degenerative changes in the mitral valve and anulus and may be associated with mitral insufficiency, mitral valve prolapse, or conduction abnormalities. Two-dimensional echocardiography and doppler interrogation of the valves should be done in any patient in whom CT demonstrates aortic or mitral valvular calcification.