Postgraduate medicine
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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.
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Postgraduate medicine · May 1976
ReviewIntermittent positive-pressure breathing. A critical appraisal.
There are relatively few valid indications for the use of intermittent positive-pressure breathing (IPPB). It is of limited or no value as prophylaxis of postoperative pulmonary problems (pneumonia, atelectasis) or as a means of delivering aerosol medications or treating stable chronic obstructive pulmonary disease. In these situations, IPPB has few if any advantages over voluntary hyperventilation or deep breathing.
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The prognosis in cardiogenic shock remains poor despite improvements in treating other complications of acute myocardial infarction. In some situations, left ventricular function can be improved by increasing the vascular volume, but the benefits of increasing the cardiac uutput must be balanced agains the risk of pulmonary edema. ⋯ An aggressive approach will not cure great numbers of extensive myocardial damage remains, but it will identify those who are hypovolemic or who have other correctable contributory factors. Most important, this approach may help to identify therapies currently in use that may actually increase rather than lessen myocardial damage.