Texas medicine
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Primary care physicians, surgeons, and anesthesiologists are all involved in assessing patients before surgery. The medical literature describes techniques to identify high-risk cardiac patients before elective surgery and strategies to reduce risk once these patients have been identified. Multifactorial indices can identify high-risk patients undergoing nonvascular surgery. ⋯ We have no convincing evidence that prophylactic revascularization benefits high-risk patients. Perioperative beta-blockade reduces perioperative myocardial ischemia, mortality, and the incidence of cardiovascular complications for up to 2 years. Therefore, perioperative beta-blockers are recommended for high-risk patients undergoing elective noncardiac surgery.
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Studies have shown that patients often experience suboptimal analgesia in the postoperative period. In the past decade, a number of advances have been made to improve patient comfort after undergoing surgery. ⋯ However, new methods and routes of administration, including patient-controlled analgesia and epidural and intrathecal drug administration, are currently being used. These modalities, when used appropriately, provide better analgesia, often with fewer side effects than when opiates are given by the traditional intramuscular route.
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Over the past 30 years, adolescents represent the only age group in the United States whose health status has not improved significantly. In this population, major health problems that are becoming increasingly important in regard to preventive intervention include substance abuse, depression, teenage pregnancy, and AIDS. Research in adolescent mental health during the past decade has focused on both the etiology and the prevention of problem behaviors. We review the development and application of various preventive intervention approaches in the field of adolescent mental health and discuss implications for future directions.
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A 3-year-old child experienced edema of the face and extremities approximately 2 weeks after being stung on the legs, scrotum, and penis by "fire ants" (Solenopsis invicta). After diagnosis of idiopathic minimal-change nephrotic syndrome and treatment with steroids, the edema rapidly disappeared. Follow-up 3 years after his hospitalization showed no recurrence of nephrotic syndrome. We have correlated this case with previously published reports of the causal relationship of allergy to nephrotic syndrome, but we are unaware of any previously published correlation between ant bite and nephrotic syndrome.