International journal of general medicine
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Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. ⋯ In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24-48 hours of dural puncture. The optimum volume of blood has been shown to be 12-20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare.
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Little is known about the epidemiology of Mondor's disease. The aim of this study was to analyze the clinical features of Mondor's disease in an outpatient clinic where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease. ⋯ These results suggest that a high rate of smoking in middle-aged females may be a characteristic feature of Mondor's disease. These epidemiological data may be useful in detection of the disease in the primary care setting in Japan.
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Satisfactory results have been seen with epidural steroid injections (ESI) in patients with herniated disks (HD), but the role in lumbar spinal stenosis (LSS) has been less investigated. We compared long-term effects of ESI in HD and LSS patients. ⋯ Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.
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The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. ⋯ The small difference in morbidity and mortality in favor of heart failure with preserved systolic function reflects the contribution of low output syndrome to the natural course of the disease. Congestion can result from low output or from multiple other conditions, but severity of congestion is the major determinant of progression of heart failure.
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With the growing public health concern over rising rates of opioid abuse, physicians have a responsibility to incorporate safeguards into their practice to minimize the potential for opioid misuse, abuse, and diversion. Patient-specific treatment regimens should include steps to monitor treatment success with regard to optimal pain management as well as inappropriate use of opioids and other substances. Opioid formulations designed to be less attractive for abuse are also being developed. While future studies are needed to determine the impact of such formulations in addressing the issue of opioid misuse in the community as a whole, the experience of practitioners who have utilized these formulations can highlight the practical steps to incorporate such formulations into the everyday patient-care setting. ⋯ The cases presented demonstrate that the communication accompanying complete pretreatment assessment, goal-setting and expectations, and attention to individual patient needs can enable optimization of pain-related outcomes, resulting in improved quality of life for patients and fostering patient acceptance of formulations designed to help address opioid abuse/misuse issues in the community at large.