Cleveland Clinic journal of medicine
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Laparoscopy, with the use of carbon dioxide or nitrous oxide for insufflation is a common procedure with the potential for several major complications. For example, pneumomediastinum, pneumothorax, and subcutaneous emphysema can occur singly or in any combination with this procedure. ⋯ Possible mechanisms are presented, along with discussion of the need for prompt diagnosis and termination of the procedure with deflation of the abdomen. The life-threatening potential of this complication is emphasized.
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Advances in chemotherapy and surgery have significantly improved the outcome of infective endocarditis, but the disease remains a therapeutic challenge with an overall mortality of 20%. More cases of infective endocarditis seen today are associated with prosthetic heart valves, intravenous drug abuse, or complications of medical and surgical technology. Prosthetic valve endocarditis occurs in 1% to 4% of patients with prosthetic valves. ⋯ The principal indication for urgent surgical intervention is acute valvular dysfunction. Other considerations for surgery include evidence of myocardial invasion, infection by antibiotic-resistant organisms, and large vegetations. For patients at risk of infective endocarditis, antibiotic prophylaxis during invasive procedures is an accepted practice.
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Wheezing is a nonspecific manifestation of airway obstruction. Even though bronchial asthma is the most common cause of wheezing, a variety of pulmonary and nonpulmonary conditions can present with this symptom. In recent years methacholine provocation challenge has simplified detection of bronchial asthma; however, establishing accurate diagnosis of other causes of wheezing is important because each condition requires specific treatment. This article describes a methodical approach to the diagnosis of wheezing in patients who are not asthmatic.
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Quality assessment and assurance in the intensive care unit require systematic monitoring and evaluation of patient care and its outcome. For analysis of these activities, data must be organized to reflect changes in such factors as patient types, ages, and lengths of stay. A model was developed to group data from the Cleveland Clinic Hospital medical intensive care unit into structural, process, and outcome categories. Development and application of the model are described.
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The authors describe a rapid technique to identify the course of the external jugular vein based on the location of the cephalic vein or the deltopectoral groove.