Cleveland Clinic journal of medicine
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Obstructive sleep apnea (OSA) is associated with increased risks of cardiovascular disease and stroke and with elevated rates of postoperative complications (including cardiac ischemia and respiratory failure) in surgical patients. Additionally, the prevalence of OSA is higher in surgical patients than in the general population. Screening for OSA prior to surgery is recommended to identify patients at risk for postoperative complications. The presence of moderate or severe OSA calls for modified strategies of perioperative anesthesia, pain management, and postoperative monitoring to reduce the chance of OSA-associated complications.
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Newer ventilators can be set to modes other than the pressure-control and volume-control modes of older machines. In this paper, the authors review several of these alternative modes (adaptive pressure control, adaptive support ventilation, proportional assist ventilation, airway pressure-release ventilation, biphasic positive airway pressure, and high-frequency oscillatory ventilation), explaining how they work and contrasting their theoretical benefits and the actual evidence of benefit.
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Studies of the epidemiology of osteoporosis and of drug treatments for it have challenged the concept that denser bone means stronger bone. Bone strength or resistance to fracture is not easily measured by routine densitometry, being a function of both density and quality.
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Small fiber neuropathy is increasingly being recognized as a major cause of painful burning sensations in the feet, especially in the elderly. Although strength remains preserved throughout the course of the disease, the pain and paresthesias are often disabling. ⋯ Skin biopsy (with an evaluation of the density of intraepidermal nerve fibers) and tests of autonomic nerve function are useful for the diagnosis. Management involves controlling pain and identifying and aggressively treating the underlying cause.
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Peripartum cardiomyopathy is a life-threatening condition of unknown cause that occurs in previously healthy women during the peripartum period. It is characterized by left ventricular dysfunction and symptoms of heart failure that can arise in the last trimester of pregnancy or up to 5 months after delivery. We review its possible causes and how to recognize and manage it.