Maryland medical journal (Baltimore, Md. : 1985)
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Review
Noise-induced hearing loss and symphony orchestra musicians: risk factors, effects, and management.
Although industrial and recreational noise have been recognized as potential causes of noise-induced hearing loss for quite some time, it is only recently that the sound levels within a symphony orchestra have been implicated as possible sources of harmful noise levels. Many studies have concluded that not only are dangerous levels of noise present within the symphony orchestra, but there is evidence of noise-induced hearing loss among symphony orchestra musicians. Although hearing protection designed for industrial use may not be appropriate for the special listening needs of professional musicians, recent advances in hearing protection design have made hearing protection practical for this population. Suggestions are made for monitoring and protecting the professional ear.
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Ankle sprains are a common, costly, and potentially disabling problem. The proper history and physical examination will determine the need for radiological evaluation and treatment. Complications of ankle trauma like osteochondral fractures, peroneal tendon injuries, fracture of the os trigonum, synovial impingement, tarsal tunnel syndrome, Achilles tendon inflammation or rupture, and nerve injury are reviewed. ⋯ Treatment begins with rest, ice, compression, and elevation. Casting and orthotics may be needed to facilitate healing. Primary rehabilitation, functional rehabilitation, and performance testing and the assessment of efficacy for each of these modalities are critical parts of proper treatment for ankle sprains.
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Review Case Reports
Small cell carcinoma of the prostate: a case report and review of the literature.
Primary small cell carcinoma of the prostate is rare. A case of primary small cell prostate cancer treated with radiation and chemotherapy is presented, and 33 previously published case reports are reviewed. Most of the patients (61%) had mixed tumors (small cell and adenocarcinoma) at diagnosis or had a history of adenocarcinoma of the prostate. ⋯ Visceral metastases were common. Only one of seven patients responded to hormonal therapy, and two of eight patients responded to chemotherapy. Overall prognosis was poor.
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Many clinicians do not realize the costs associated with delirium. Francis and Kapoor found that patients who had had delirium had higher two-year mortality rates and greater loss of independence than control patients. ⋯ Levkoff and coworkers found that delirium was associated with no change in mortality, but that it was associated with prolonged hospital stays and an increased risk of institutional placement among community dwelling elderly. Poor outcomes might be avoided, in part, with early diagnosis and appropriate management of delirium.