Mayo Clinic proceedings
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To report the success rate and complications associated with peripherally inserted central venous catheters (PICCs) and to compare costs between PICCs and centrally inserted central catheters. ⋯ PICCs can satisfy long-term vascular needs and are safe in many patient populations. The infection rate did not depend on insertion mode, lumen number, or patient's immune status. Use of total parenteral nutrition was the most important risk factor in all patient subsets. Cost and safety considerations strongly favor PICCs as alternatives to other vascular access devices.
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To describe the entity of isolated ventricular noncompaction (IVNC) and present a series of cases of this rare disorder in an adult population. ⋯ Although the diagnosis of IVNC in an adult population is often delayed because of similarities with more frequently diagnosed conditions, two-dimensional echocardiography will facilitate the diagnosis of IVNC in this subset of patients. Because of the high incidence of heart failure, ventricular arrhythmias, and embolization in adults with IVNC, early diagnosis is important.
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Optic disk edema with a macular star is a descriptive term encompassing a heterogeneous group of disorders. The clinical features include sudden visual loss, swelling of the optic disk, peripapillary and macular exudates that may occur in a star pattern, and cells in the vitreous. Herein we describe the clinical features, potential etiologic factors, differential diagnosis, work-up, and natural history of this entity. ⋯ Patients with a recurrent type of the disease may not experience pronounced improvement in optic nerve function. The macular exudate may not develop in cases of disk edema until 2 weeks after the patient's initial assessment; thus, patients who have acute papillitis with a normal macula should be reexamined within 2 weeks for development of a macular star. The presence of a macular star militates strongly against subsequent development of multiple sclerosis.
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Generalized convulsive status epilepticus (GCSE) is a medical emergency that may be associated with severe neuronal injury. The mortality attributable to GCSE ranges from 3 to 35%. The disorder occurs most frequently in the young and the old extremes of the population. ⋯ More than half the patients will respond to initial treatment. Patients with refractory status epilepticus require a physician with expertise in epilepsy. Treatment options include pentobarbital, high-dose phenobarbital, or inhalation anesthetic agents.
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Mayo Clinic proceedings · Jul 1996
Gonadotroph adenoma of the pituitary gland: a clinicopathologic analysis of 100 cases.
To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas. ⋯ Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.