American journal of therapeutics
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Abdominal compartment syndrome (ACS) is defined as an organ dysfunction caused by intra-abdominal hypertension (IAH). Up to 4.2% of the patients in intensive care unit may develop IAH with it being an independent predictor of mortality. However, overall, it still remains a relatively underdiagnosed condition, part in because physical examination alone is very unreliable. ⋯ We recommend that any patient with evidence of new onset oliguria in the setting of distended abdomen, unexplained respiratory failure, with or without hypotension should be suspected of having IAH/ACS. Intravesicular pressure measurement represents a safe, rapid, and cost-effective method of diagnosing IAH. We hereby review the pathophysiology, diagnosis, and management of ACS and its association with acute kidney injury.
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Review Case Reports
A case of life-threatening retinoic acid syndrome and review of literature.
All-trans-retinoic acid represents a major progress that has made acute promyelocytic leukemia the most curable subtype of acute myeloid leukemia in adults. Although all-trans-retinoic acid is usually well tolerated, some patients develop the retinoic acid syndrome, characterized by unexplained fever, weight gain, respiratory distress, interstitial pulmonary infiltrates, pleural and pericardial effusions, episodic hypotension, and acute renal failure. Further studies of growth factor expression and modulation of adhesion molecules are warranted to provide further insights into the pathogenesis of the syndrome and may lead to its prevention.
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Up to 90% of patients with metastatic or advanced stage cancer will experience significant cancer-related pain. Approximately half or more of patients diagnosed with cancer may experience bone pain. It has been estimated that tumor metastases to the skeleton affects roughly 400,000 US citizens annually. ⋯ Although the mechanisms underlying the development of bone metastases remain incompletely understood, there appears to be important bi-directional interactions between the tumor and the bone microenvironment. A greater understanding of the pathophysiology of painful osseous metastases may lead to better and more selective targeted analgesic therapy. Additionally, potential future therapeutic approaches to painful osseous metastases may revolutionize approaches to analgesia for this condition, leading to optimal outcomes with maximal pain relief and minimal adverse effects.
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Review Case Reports
Angioedema from recombinant TPA administration: case report and pathophysiology review.
Angioedema is an uncommon, yet morbid, adverse reaction to recombinant tissue plasminogen activator (rtPA) administration for ischemic stroke. Orolingual edema may preclude completion of rtPA therapy and cause potential airway compromise. Few case reports and case series have examined the incidence of angioedema and anaphylaxis related to this common stroke therapy. We report a case of orolingual edema and bleeding in a patient who received rtPA for acute ischemic stroke who was concurrently on an angiotension-converting enzyme inhibitor and discuss the pathophysiology of this reaction.
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Obstructive sleep apnea is a common, chronic disorder characterized by the cessation or reduction in airflow due to periodic mechanical obstruction of the upper airway passage during sleep. Symptoms and signs of sleep apnea include daytime sleepiness, fatigue, poor concentration, snoring, resuscitative snorts, and related occupational accidents. Sleep apnea is classified into 3 types based on its severity and management varies accordingly. ⋯ Positive airway pressure is the preferred treatment modality and can be delivered via 3 different modes. Oral appliances are of 3 types and are generally indicated in mild to moderate obstructive sleep apnea. Surgery is a final therapeutic option that focuses on the removal of excessive tissue from different sites of the pharyngeal airway.