Physician as listener

Your face is full of attention, full of listening. How I remember that face!…. How you trusted your power of listening, your state of attention…. I know now that this is why you devoted yourself to medicine…. —Jacob Needleman … well, interesting that you should ask, but, yes, there have been several such incidents that…

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Andropause. Testosterone replacement therapy for aging men

The idea of andropause (“male menopause”) has received widespread attention in the popular and medical press in the last few years. As men age, total testosterone levels decline gradually and concentrations of free and bioavailable testosterone decline sharply with each decade beyond the 30s. Aging men often begin to experience symptoms such as sexual dysfunction…

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Use of CPAP and BiPAP in acute respiratory failure

Level I evidence shows that continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) are effective for preventing intubation and saving the lives of carefully selected patients with acute respiratory failure. This article attempts to review this evidence. We began by searching the literature, using OVID, looking for all randomized studies of congestive…

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Vitamin B12 injections versus oral supplements

In 1991, Frank A. Lederle identified highdose oral vitamin B12 (cobalamin) treatment for pernicious anemia as “medicine’s best kept secret.” Lederle noted that only mg of cobalamin is required for daily metabolic functions. Because 2.0% of oral vitamin B12 is absorbed by small bowel mucosa independent of intrinsic factor or the terminal ileum, a daily…

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Pharmacologic management of refractory depression

Major depression is a common and debilitating disorder that affects 10% to 15% of the population each year. Advances in understanding the psychopharmacology of depression has lead to the introduction of several new classes of antidepressant medication in the past decade. Despite these advances, however, patients’ overall response to any given pharmacologic approach continues to…

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Deep vein thrombosis

Deep vein thrombosis is feared for its potentially fatal complication, pulmonary thromboembolism (PE), the leading cause of preventable mortality among patients in hospital. Deep vein thrombosis affects both healthy people and many patients in hospital. Incidence of DVT is unknown because it is hard to diagnose and because most DVT is silent. Pathophysiology Venous thrombosis…

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Cancer chemotherapy during pregnancy

Diagnosis of cancer during pregnancy is one of the most extreme scenarios in medicine: the creation of a new life might coincide with the mother’s death. This situation can put immense stress on pregnant patients, their families, and medical staff. Cancer occurs only rarely during pregnancy; incidence is 0.07% to 0.1%. The current trend to…

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