Articles: adult.
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This clinical policy focuses on critical issues in the evaluation and management of patients with acute myocardial infarction or unstable angina. A MEDLINE search for articles published between January 1993 and December 1998 was performed using combinations of the key words chest pain, acute myocardial infarction, unstable angina, thrombolytics, primary angioplasty, 12-lead ECG, ST-segment monitoring, cardiac serum markers, and chest pain centers. Subcommittee members and expert peer reviewers also supplied articles with direct bearing on the policy. ⋯ Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med. May 2000;35:521-544.].
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Internal disc disruption is a common cause of disabling low back pain in a substantial number of young, healthy adults. Crock described this painful entity and reported annular fissures that distort the internal architecture of the disc; Externally the disc appears relatively intact and undeformed. A clinical diagnosis of internal disc disruption, in absence of objective clinical findings, is extremely difficult. ⋯ Recent studies indicate the existence of a biochemical/ biomechanical model of discogenic pain, which explains the disabling low back pain in some subjects with no objective evidence of nerve-root compromise. However, a reluctance to acknowledge internal disc disruption as a valid clinical entity delays diagnosis and treatment. Failure to identify and treat this entity early and aggressively results in longterm disability, thereby perpetuating the enigma of chronic low back pain.
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Objective. To determine the long-term relief of spasticity and complication rates in patients who underwent placement of a programmable intrathecal baclofen pump for treatment of medically intractable spasticity of spine or brain etiology. Methods. ⋯ Intrathecal baclofen is a very effective strategy for the relief of medically intractable spasticity of spine or brain etiology. Even though 36% of patients have required revisions, no patient has experienced any long-term morbidity. Patients and their primary care givers have been pleased with the long-term effects of this therapy upon quality of life.
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To review human thermoregulation and the pathophysiology and management of induced and accidental hypothermia. ⋯ Operative hypothermia reduces ischaemic injury during cardiac and neurosurgical procedures. Hypothermia induced following tissue injury has not yet been shown to be of benefit. Management of accidental hypothermia requires passive and active warming methods, the indication of each depending on the availability of the method and severity of hypothermia.