Abstract:
:Primary prophylaxis is advisable for all patients with moderate-sized or large esophageal varices. After the first episode of bleeding, secondary prophylaxis should be initiated to prevent rebleeding. Multiple treatment modalities are available for each circumstance. Optimal regimens have not yet been established but are under investigation. At present, nonselective beta-blockers are the drugs of choice for primary prophylaxis. In patients with actively bleeding varices, octreotide or, in rare cases, a combination of vasopressin and nitroglycerin is used in conjunction with endoscopic band ligation of the varices. Either a beta-blocker, band ligation, or a combination of the two is appropriate for secondary prophylaxis. The combination is often the better choice for patients for whom primary prophylaxis with beta-blockers has failed. As in any treatment situation, the specific approach must be tailored to clinical circumstances. The patient's preferences and willingness or ability to comply with the therapy must be taken into account as well as the physician's expertise. Interventions for hepatic encephalopathy predominantly focus on reducing the amount of ammonia absorbed or endogenously generated in the body. They include correction of precipitating factors, bowel cleansing, and lactulose therapy. In difficult cases, a combination of lactulose and neomycin, metronidazole, or rifaximin is recommended. Because the prognosis for patients with hepatic encephalopathy is generally poor, orthotopic liver transplantation should be considered.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Shah VH,Kamath Pdoi
10.1080/00325481.2006.11446045subject
Has Abstractpub_date
2006-09-01 00:00:00pages
14-8issue
3eissn
0032-5481issn
1941-9260journal_volume
119pub_type
杂志文章,评审abstract::Hyponatremia (serum sodium <135 mEq/L) is a common electrolyte disorder in community or hospitalized patients. Serum sodium levels should be corrected at a proper rate in patients with hyponatremia, since overcorrection of serum sodium levels is related to devastating neurologic consequences, such as the osmotic demye...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1186488
更新日期:2016-06-01 00:00:00
abstract::Present evidence suggests that the most important nutritional factor bearing on the risk of development of diabetes mellitus is an excessive caloric intake. Other evidence suggests that both dietary prevention of diabetes and mitigation of hyperglycemia by dietary means can prevent morbidity and mortality from the mic...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11712096
更新日期:1976-09-01 00:00:00
abstract::Acute exacerbations of chronic obstructive pulmonary disease occur often. Severity should be established by signs and symptoms and by reference to baseline pulmonary function test results when necessary. If the exacerbation is mild to moderate, treatment should include antibiotics, theophylline, beta agonists, and muc...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701168
更新日期:1992-01-01 00:00:00
abstract::Preview No physician would treat hypertension without monitoring blood pressure, but some treat bronchial asthma without objectively measuring pulmonary function. This empirical approach is inappropriate, according to the authors, who discuss key measurements that should be taken to assess disease status, guide therap...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11946003
更新日期:1995-06-01 00:00:00
abstract::Breast pain is a common, often distressing problem among women. After significant disease is ruled out, most patients respond to simple reassurance. Others, however, require treatment because symptoms interfere with their lifestyle. The authors offer practical suggestions for tailoring treatment for these patients acc...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.11.369
更新日期:1997-11-01 00:00:00
abstract::External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11712183
更新日期:1977-05-01 00:00:00
abstract:STUDY OBJECTIVES:To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). DESIGN:Randomized, open label, multicenter prospective clinical trial. SETTING:Thirteen U...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3810/pgm.2014.07.2790
更新日期:2014-07-01 00:00:00
abstract::A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiograp...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716219
更新日期:1982-10-01 00:00:00
abstract::Seven bried case reports representing variations of atrial flutter point up important considerations bearing on diagnosis: situations predisposing individuals to atrial flutter with 1:1 atrioventricular conduction, the need for special care in placing ECG leads for continuous monitoring, the use of carotid sinus massa...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714577
更新日期:1977-08-01 00:00:00
abstract::The first step in evaluation of a presumed seizure is to determine whether the event was indeed a seizure and which diagnostic studies are needed. The second step is to correctly diagnose the seizure on the basis of the medical history and findings from the physical, neurologic, and laboratory evaluation. The third st...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2002.01.1074
更新日期:2002-01-01 00:00:00
abstract::Even modest alcohol ingestion can increase the risk of steatosis, and long-term, excessive consumption can lead to alcoholic hepatitis and eventually cirrhosis. Most patients with clinically significant alcoholic liver disease have histologic findings typical of all three conditions. The only clearly beneficial treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.04.462
更新日期:1998-04-01 00:00:00
abstract::Common dislocations that can usually be managed in the office include anterior dislocations of the shoulder, posterior dislocations of the elbow and joints of the fingers and toes, and lateral dislocations of the patella. A systematic approach based on an understanding of the mechanism of injury, roentgenographic docu...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714687
更新日期:1977-11-01 00:00:00
abstract::Proximal gastric vagotomy without drainage is widely accepted in Great Britain and Europe but in the United States has been done mainly in university centers. The operation denervates the acid-secreting parietal cell mass of the stomach, preserving vagal innervation to the gastric antrum and extragastric abdominal vis...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714810
更新日期:1978-04-01 00:00:00
abstract::Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-rele...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.01.2241
更新日期:2011-01-01 00:00:00
abstract::There are three key goals in current management of the diabetic pregnancy. Normal diabetes control before conception and during the first trimester in an attempt to reduce the incidence of congenital abnormalities. This implies that all diabetic women of childbearing age should have counseling before pregnancy. Routin...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698879
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVES:The clinical significance of hyperplastic polyp-like histologic changes in random biopsy samples ('serrated epithelial change' or SEC) from patients with inflammatory bowel disease (IBD) remains uncertain, with some studies suggesting an increased risk of dysplasia and even carcinoma. Controlled studies are ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1802138
更新日期:2021-01-01 00:00:00
abstract::Why do some people spend most of the night tossing and turning while others drop off as quickly as a cat in the sun? There are many possible explanations for problems with falling and staying asleep and, sometimes, patients actually get a lot more sleep than they think they do. Each type of insomnia has its own set of...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.03.935
更新日期:2000-03-01 00:00:00
abstract::In addition to prolonged glucocorticoid therapy (not discussed here), at least five other conditions cause Cushing's syndrome. They are excessive corticotropin secretion by the pituitary gland (which results in Cushing's disease), ectopic production of corticotropin by malignant nonpituitary tumors, benign adrenal ade...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11704497
更新日期:1989-12-01 00:00:00
abstract::The cultural drive to be thin can lead to eating disorders in many women and girls. In adolescent females with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. It is clear that nonspecified and subthreshold eating...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.04.910
更新日期:2001-04-01 00:00:00
abstract::Preview Although the early symptoms of Parkinson's disease can be ameliorated, the illness is relentlessly progressive. Studies have therefore been conducted in hopes of finding therapy to delay its disabling course. In this article, Dr Ahlskog examines recent proposals and their application in cases of early and adva...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945830
更新日期:1994-05-01 00:00:00
abstract::The fact that the national death rate from carcinoma of the colon and rectum has remained static over the past two decades is strong incentive for future investigation of measures to allow detection in its early and more favorable stage. Although no significant improvements in surgical techniques have afforded improve...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715249
更新日期:1979-09-01 00:00:00
abstract::Preview A patient limps into your office with ankle pain and a story about a popping sound he heard during a mad dash to the net on a tennis court. After evaluation, you diagnose complete rupture of the Achilles tendon. Do you apply a cast or refer him to an orthopedic surgeon? When are the higher risks and costs asso...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11946048
更新日期:1995-09-01 00:00:00
abstract::Acute compartment syndrome is a surgical emergency. A high index of suspicion is needed in cases of severe contusion, especially if patient complaints seem to outweigh physical findings. Acute surgical fasciotomy is an effective treatment and should be carried out expeditiously if compartment pressures are elevated ov...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.03.599
更新日期:1999-03-01 00:00:00
abstract::Chronic otitis media was the cause of septicemia in two hospitalized men. The organisms involved, K pneumoniae and B fragilis, are not usually associated with primary infections of the middle ear and would not have been traced to this site had proper cultures not been performed. In adults, the true incidence of bacter...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1979-09-01 00:00:00
abstract::The prognosis for patients with obsessive-compulsive disorder has improved dramatically in recent years. Primary care physicians, who may be the first healthcare professionals to consult with these patients, can often provide appropriate treatment or therapeutic guidance. Psychiatric consultations and the implementati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.12.807
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. METHODS:A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.01.2100
更新日期:2010-01-01 00:00:00
abstract::Effective management of blood-loss anemia depends on an understanding of the physiologic response to volume loss, the pattern of marrow response to acute depletion of red cell mass, and the controlling influence of iron supply. Each of these elements must be evaluated and incorporated into the plan of management. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714948
更新日期:1978-10-01 00:00:00
abstract::Tests to measure the volume of gastric contents are necessary to determine the nature of a gastric emptying disorder. The conditions that can affect gastric emptying are as varied as peptic ulcer disease, achlorhydria, viral and bacterial infections of the stomach, diabetes, scleroderma, anorexia nervosa, and CNS lesi...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699726
更新日期:1987-02-15 00:00:00
abstract::Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addit...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章
doi:10.1080/00325481.1976.11708409
更新日期:1976-12-01 00:00:00
abstract:INTRODUCTION:The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several st...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.03.2126
更新日期:2010-03-01 00:00:00