The American journal of medicine
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Biography Historical Article
Mastectomy without anesthesia: the cases of Abigail Adams Smith and Fanny Burney.
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Hip fractures associated with underlying osteoporosis result in significant morbidity and mortality in elderly patients and increase the risk for future fractures. Several underlying modifiable contributors may be identified, while osteoporosis itself is amenable to a number of effective treatments. Other interventions can further reduce the risk of falls and second fractures. This paper reviews evaluation and management options after fragility (low trauma) hip fractures in the geriatric population.
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Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain. ⋯ BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.
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Randomized Controlled Trial Multicenter Study Comparative Study
Immunosuppressive therapy with oral prednisone to prevent restenosis after PCI. A multicenter randomized trial.
Prednisone at immunosuppressive doses after stenting has shown remarkable efficacy in reducing ischemic recurrences in nondiabetic patients with high post-procedural levels of C-reactive protein; the study aim was to compare the clinical outcome obtained in a control group of patients treated with bare metal stents versus 2 other study groups--bare metal stent plus oral prednisone or drug eluting stents--assuming similar optimal adjunctive medical treatment. ⋯ Compared with bare metal stents alone, prednisone treatment after bare metal stents or drug-eluting stent implantation result in a better event-free survival at 1 year.
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Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. ⋯ A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.