The Journal of the Kentucky Medical Association
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Thirty-two patients were treated in this Department from 1981-1992. The median age was 14 years (range 4 years to 17 years). There are 6 patients (19%) below the age of 10 years, 16 patients (50%) between 11 years to 15 years, and 10 patients (31%) above 16 years. ⋯ One patient with Stage III disease developed a second cancer (PNET: primitive neuroectodermal tumor) 111 months after combination treatment and has died. One Stage IV patient has died with Hodgkin's disease 28 months after treatment with combination therapy. All other patients are followed closely along with the primary physicians and consultants.
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Last Acts released the first nationwide evaluation of palliative care services in November 2002. Each state was evaluated or "graded" on the following eight measures: advance care planning policies, location of death, hospice use, hospital end-of-life care services, care in ICUs at the end of life, pain among nursing home residents, state pain policies, and palliative care certified physicians and nurses. Kentucky scored well on state pain policies and number of nurses certified in palliative care but received low grades for hospital services and the number of patient deaths occurring in the home. This manuscript explores Kentucky's deficiencies and accomplishments related to the Last Acts evaluation and addresses opportunities for improving end-of-life care across the Commonwealth.
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Case Reports
Spontaneous negative pressure changes: an unusual cause of noncardiogenic pulmonary edema.
The principal physiologic mechanism underlying the formation of negative pressure pulmonary edema (NPPE) is thought to be the creation of excessive negative intrathoracic force from inspiration against a critical obstruction of the upper airway. The increased subatmospheric transpulmonary pressures result in transudation of fluid from the pulmonary capillaries to the interstitium and alveoli. ⋯ Aggressive diagnostic and therapeutic intervention can be avoided if the syndrome is recognized early. This report highlights the clinical features of NPPE and serves as a reminder to the clinician that although NPPE can cause significant morbidity, conservative supportive therapy typically results in a good outcome.