Postgraduate medicine
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Postgraduate medicine · Jan 1987
ReviewCurrent issues in transfusion therapy. 2. Indications for use of blood components.
Many factors have stimulated a recent renewal of interest in indications for and use of blood components, including red blood cells, platelets, fresh-frozen plasma, cryoprecipitate, and granulocyte concentrates. Laboratory test results often provide helpful guidelines for the decision to use blood components. In this era of cost consciousness, the most important consideration still is to treat the patient in the most expedient and beneficial way. A conservative approach with an emphasis on high-quality medical practice is to choose and use blood components with consideration of both clinical information and laboratory findings.
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At the scene of an accident with possible injury to the cervical spine, management should focus on life support and prevention of further injury. On arrival of the patient in the emergency department, three standard x-ray films should be obtained in search of the abnormalities in soft tissues, alignment, and joints that indicate cervical spine injury and a thorough neurologic assessment should be performed. The potential of cord injuries to deteriorate makes careful monitoring of blood gases, urine output, and blood pressure imperative during this period. Early therapy with steroids and mannitol seems to minimize neurologic deterioration.
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Colonic diverticula result from herniation of the mucosa through weak spots in the muscular wall. Clinically manifested diverticulitis has been thought to have its pathologic basis in an abscessed diverticulum obstructed by a fecalith, but studies of resected sigmoids have failed to produce evidence to support this view. Instead, the outstanding lesion was found to be a perforation in the fundus of a diverticulum, with surrounding peridiverticular or pericolic inflammation. ⋯ Diverticula without muscle thickening are usually asymptomatic, and the condition is referred to as diverticulosis or simple massed diverticulosis. It is uncertain whether the two types have a similar pathogenesis. High intrasigmoid pressures, abnormalities of sigmoid musculature, low-fiber diet, and psychologic stress are thought to be important factors in the formation of diverticula.