International journal of general medicine
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Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. ⋯ In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24-48 hours of dural puncture. The optimum volume of blood has been shown to be 12-20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare.
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Little is known about the epidemiology of Mondor's disease. The aim of this study was to analyze the clinical features of Mondor's disease in an outpatient clinic where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease. ⋯ These results suggest that a high rate of smoking in middle-aged females may be a characteristic feature of Mondor's disease. These epidemiological data may be useful in detection of the disease in the primary care setting in Japan.
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Satisfactory results have been seen with epidural steroid injections (ESI) in patients with herniated disks (HD), but the role in lumbar spinal stenosis (LSS) has been less investigated. We compared long-term effects of ESI in HD and LSS patients. ⋯ Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.
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When a physician provides an insufficient explanation to a patient, such as regarding diagnosis, treatment, drug use, or prognosis, the physician is deemed to have delivered substandard care. It is likely that the standards applied to physicians' explanations have changed as a result of the increased importance of patients' rights of self-determination. However, little or no research on decisions in medical malpractice cases has been conducted with respect to this issue. ⋯ We found that there was an association between physicians' explanatory behaviors and judicial decisions concerning substandard care, and courts were increasingly likely to consider inadequate explanatory behaviors to be a breach of the duty of care.
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The natural course of heart failure with decreased and preserved systolic function is almost identical. The current concept of heart failure where decreased cardiac output plays the major role does not explain this similarity. ⋯ The small difference in morbidity and mortality in favor of heart failure with preserved systolic function reflects the contribution of low output syndrome to the natural course of the disease. Congestion can result from low output or from multiple other conditions, but severity of congestion is the major determinant of progression of heart failure.