ABSTRACT
The understanding of early controlled range of motion adapted to the stability of the fracture is crucial in postfracture shoulder therapy. The diagnosis and management of proximal humeral fractures have been reviewed. In addition, the aspects of therapy and the pertinent rehabilitation protocols are outlined. Although this article outlines standard treatment approaches, the specific therapy should be individualized to the patient's goals and abilities, and continuous communication between all persons involved in the patient's care is essential for achieving the best possible outcome.
Subject(s)
Shoulder Fractures/rehabilitation , Exercise Therapy/methods , Female , Fracture Fixation/methods , Humans , Incidence , Male , Postoperative Complications , Range of Motion, Articular , Shoulder Fractures/classification , Shoulder Fractures/diagnosis , Shoulder Fractures/epidemiology , Shoulder Fractures/etiology , Shoulder Fractures/surgeryABSTRACT
Although cryptococcal pneumonia is a well recognized complication of the acquired immunodeficiency syndrome, optimal diagnostic approaches remain to be defined. During a 32-month period (October 1984 to June 1987), 11 patients were diagnosed with CP at our institution. The diagnosis was established in all 11 patients from specimens obtained via fiberoptic bronchoscopy (ten) and/or double-lumen catheter lavage (one). Direct stains of sedimented bronchoalveolar lavage were positive for organisms characteristic of Cryptococcus neoformans in nine of 11 patients. Transbronchial biopsies were positive (special histologic stains) in six of eight patients; bronchial washings were positive (direct smear) in seven of ten patients, the bronchial brushings were positive on stain in six of nine patients, and in one patient, a Wang transbronchial needle aspirate was positive on stain. Fungal cultures were positive on the BAL in seven of 11 patients, and on the bronchial washings in four of ten patients; the TBBx culture samples were all negative (zero of three). The serum cryptococcal antigen titer was elevated (median = 1:1024) in all eight patients in which it was assayed. Our data suggest that BAL and bronchial washings have a combined sensitivity on smear equal to that of TBBx and superior to that of TBBx fungal culture. The TBBx does not appear to be necessary in this setting. In addition, an elevated serum cryptococcal antigen titer appears to be an important adjunct in the evaluation of pulmonary infiltrates in AIDS.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Bronchoscopy , Cryptococcosis/diagnosis , Pneumonia/diagnosis , Adult , Antigens, Fungal/analysis , Biopsy, Needle , Bronchi/microbiology , Bronchi/pathology , Bronchoalveolar Lavage Fluid/microbiology , Cryptococcosis/complications , Cryptococcus neoformans/immunology , Cryptococcus neoformans/isolation & purification , Female , Humans , Male , Middle Aged , Opportunistic Infections/complications , Opportunistic Infections/diagnosis , Pneumonia/complications , Specimen Handling/methodsABSTRACT
Status asthmaticus (SA) is a life-threatening exacerbation of asthma that is refractory to usual therapeutic interventions. The etiologic factors leading to SA and pathophysiologic alterations in airway caliber, respiratory muscle function, and respiratory gas exchange are reviewed. Important parameters in the assessment of patients presenting with SA are highlighted, including the necessity to document the severity of airflow obstruction with measurement of peak expiratory flow rate or one-second vital capacity. The indications for measurement of arterial blood gases, characteristic alterations in oxygen and carbon dioxide tension, and the appropriate therapeutic measures are emphasized. In addition, the roles of beta-adrenergic agonist and anticholinergic bronchodilators, methylxanthines, and glucocorticoids are discussed in the context of the rational management of patients with SA. Airway management and assisted mechanical ventilation are reviewed, with helpful guidelines for respirator adjustment based on patient responses to the physiologic alterations that develop during assisted ventilation.
