British medical bulletin
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Management of thrombosis in coronary heart disease comprises the management of acute coronary thrombosis presenting as myocardial infarction or as unstable angina, the use of anticoagulant therapy to prevent or treat complications of myocardial infarction, and prophylaxis in patients identified as being at increased risk. Thrombolytic therapy and aspirin independently and additively reduce mortality in evolving myocardial infarction. ⋯ Aspirin has been shown to reduce the risk of further cardiovascular events or cardiac death in patients identified as at high risk. Current research is evaluating the role of antithrombins and platelet adhesion inhibitors as adjuvant therapy after thrombolysis, in unstable angina, and as heparin substitutes during coronary angioplasty, and of low dose warfarin as long-term prophylaxis in high risk patients.
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Alcohol is a special commodity because of its dependence producing properties and the extent and severity of problems associated with its use, many of which are preventable. The elements of a comprehensive preventive policy include: controls to raise the price of alcohol; controls on the availability of alcohol, particularly minimum age limits for the purchase of alcohol and limits to the hours and days of sale of alcohol and numbers of outlets; controls on the use of alcohol, particularly restricting drinking and driving; product safety standards, particularly information on the alcohol content of beverages, controls on marketing, particularly restrictions on advertising and sponsorship and; education and information programmes, including those based at a community level to promote support for prevention policies and those based in schools and primary health care.
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Significant progress has been made since the first successful human heart-lung transplantation (HLT) for pulmonary vascular disease performed in 1981. The refinement of surgical techniques, use of cyclosporin as the main immunosuppressant, technique of distant organ procurement to expand the donor organ pool, and improved diagnosis and management of pulmonary infection and rejection have all contributed to this accomplishment. ⋯ Because of the success, consideration was given to transplantation for parenchymal pulmonary diseases, initially pulmonary fibrosis and emphysema, and then suppurative lung disease such as in cystic fibrosis (CF). However, the application of HLT to patients with CF lagged behind because of concern related to the risk of sepsis, the systemic nature of the disease, malnourishment, and fear of recurrence of the epithelial CF defect in the transplanted lungs.
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Measures to increase individual participation in adequate amounts of physical exercise have a key place among the strategies to improve health and prevent disease. The scientific justification is based on a variety of evidence drawn from numerous epidemiological, clinical and physiological studies and is accepted as sound. The prevalence of physical disability is high. ⋯ Weight-bearing exercise has been shown to prevent osteoporosis at any age. The links between many of the functional adaptations which occur with exercise and improvements in health have been demonstrated. The exercise programmes which are effective have been defined.
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Pain can either be 'nociceptor-mediated', produced as a consequence of the activation of high threshold nociceptors, or 'A-fibre mediated', resulting from the activation of low threshold A beta afferent fibres. Under normal circumstances nociceptor mediated pain only occurs in response to high intensity noxious stimuli. Following peripheral tissue injury the inflammatory reaction generates a complex set of chemical signals that alter the transduction properties of nociceptors such that they can be activated by low intensity stimuli, the phenomenon of peripheral sensitization. ⋯ This is the phenomenon of central sensitization. Because afferent inputs can provoke prolonged alterations within the central nervous system, optimal treatment of acute pain states should be directed both at abolishing peripheral sensitization and to preventing the establishment of central sensitization. The latter involves the strategy of pre-emptive analgesia.