WMJ : official publication of the State Medical Society of Wisconsin
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Review Case Reports
Atypical presentation of subarachnoid hemorrhage: case report and review of the literature.
Subarachnoid hemorrhage is a threatening condition often associated with significant morbidity and mortality. The risk of rebleeding and ischemic complications can be markedly reduced when the prompt diagnosis of cerebral aneurysmal rupture is made. The sudden onset of severe headache with or without neurologic deficit raises the clinical suspicion, however atypical symptoms exist making the diagnosis difficult. ⋯ A computed tomographic scan of the brain revealed a subarachnoid hemorrhage. Two intracranial cerebral aneurysms were identified by cerebral angiography and subsequently treated. The diagnosis and treatment of subarachnoid hemorrhage is reviewed.
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As a result of recent publications in the lay press, individuals have started to ask physicians and other medical personnel about the availability of screening CT for lung cancer. Many imaging centers, perhaps without full knowledge of the complex issues involved, have capitalized on this enthusiasm by instituting CT screening programs. Whether a health care provider offers screening CT or not, physicians and other medical personnel need to be informed about recent developments in CT screening for lung cancer in order to advise patients. This article reviews the significance of lung cancer as a cause of death, the causes of lung cancer and how it can be prevented, the types and frequencies of different lung cancers, the conditions of effective screening, the biases associated with screening, and past and present lung cancer screening trials.
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Heart failure is a common clinical problem, affecting at least 5 million Americans. There have been substantial advances in the understanding and treatment of heart failure in the last several years. We review current concepts for the evaluation and treatment of the various manifestations of patients with heart failure.
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Comparative Study
The effectiveness of a follow-up program at improving HIV testing in a pediatric emergency department.
HIV infection is on the rise in the adolescent population, with the most common risk for infection being sexual exposure for youth aged 15-24 years. Therefore screening for HIV infection should be performed on adolescent patients presenting to the emergency department (ED) with signs or symptoms of sexually transmitted disease (STD). Lack of opportunity for follow-up of HIV test results may prevent ED physicians from obtaining this test. ⋯ Coincident with the institution of an appropriate follow-up system, HIV testing in the ED increased and follow-up of these patients improved. However, further steps should be taken to improve the HIV testing in the pediatric ED.