Internal medicine journal
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Internal medicine journal · Aug 2002
ReviewControl of nausea and vomiting after chemotherapy: what is the evidence?
The control of nausea and vomiting is an important problem for patients undergoing chemotherapy. With the introduction of newer agents, including 5-HT3 antagonists, nausea and vomiting control after chemotherapy has much improved but is not always optimal. ⋯ In some circumstances newer anti-emetics may be unnecessary and better nausea and vomiting control may be established by use of older agents. This paper summarizes current evidence regarding the optimal approach to management of nausea and vomiting in patients undergoing chemotherapy.
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Internal medicine journal · Aug 2002
ReviewManagement of complicated parapneumonic effusions and thoracic empyema.
The optimal management of loculated parapneumonic effusions and empyema includes breakdown of adhesions to effect drainage of infected pleural fluid. The use of fibrinolytics intrapleurally appears to enhance intercostal tube drainage, reducing the requirement for subsequent surgical mechanical debridement. This article discusses the evidence for intrapleural fibrinolytics, their good safety profile and the practicalities of dose and administration. It also reviews early surgical intervention, which may be indicated for medical treatment failure and, some would argue, as a suitable alternative to other medical interventions.
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Internal medicine journal · Aug 2002
Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies.
Diabetic emergencies associated with ketoacidosis (DKA) and a hyperosmolar, hyperglycaemic state (HHS) are both acute life-threatening metabolic disturbances. Traditionally, DKA and HHS have been classified as distinct entities but there is evidence to suggest that patients can present with elements of both conditions. ⋯ The mixed state of ketoacidosis and hyperosmolarity was observed in 30% of presentations for diabetic hyperglycaemic emergencies. Although age and degree of hyperosmolarity both influenced mortality rates, only age was found to be an independent predictor of mortality. The mortality rate for diabetic emergencies associated with ketoacidosis remained low, in keeping with other studies. By contrast, the mortality rate for diabetic emergencies associated with a hyperosmolar state remained considerably higher. This higher mortality will most likely persist because deaths associated with a hyperosmolar state were in elderly patients with significant comorbidity.