Texas medicine
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Review Case Reports
The often overlooked posterior dislocation of the shoulder.
Unlike most shoulder dislocations, the posterior dislocation is truly a diagnostic challenge to the treating physician because it may be missed more often than it is recognized. In fact, more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years. A history of seizures, electroshock, or a fall onto a flexed, adducted arm should alert the physician to the possibility of posterior dislocation. ⋯ A radiographic trauma series made in the scapular plane must always be obtained in cases of shoulder trauma to rule out posterior dislocation. A computed tomographic scan may also be necessary. The correct diagnosis of this injury will facilitate proper orthopedic evaluation and treatment and will reduce the incidence of missed posterior shoulder dislocation and its associated morbidity.
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Managing the symptoms of advanced disease at the end of life is one of the most challenging aspects of medicine for most clinicians. Traditional textbooks provide limited resources for treating patients at this stoichiometric point in their disease. This article provides an overview in the treatment of common symptoms at the end of life, such as anxiety, anorexia and cachexia, constipation, delirium, dyspnea, fatigue and asthenia, nausea and vomiting, malignant intestinal obstruction, and terminal restlessness. By addressing these symptoms, the physician can play a key role in the patient's achievement of a peaceful, symptom-free, and dignified death in the setting of their choice.
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Cancer patients, with their multiple symptoms and layers of suffering, are presenting many challenges to the treating physician and are turning to complementary mind-body therapies in increasing numbers. The utilization of mind-body medicine and other complementary therapies is growing at rates faster than Western medicine, and physicians are more commonly being questioned about potential benefits and risks of these therapies. This article discusses hypnosis and mind-body approaches in the care of the cancer patient, and offers suggestions regarding the evaluation of complementary medicine therapies.