Three young women with jugular vein phlebitis, anaerobic sepsis and pulmonary septic emboli were mentioned at the chest conference. Lemierre described the syndrome in 1936. It is unfamiliar to most, but profound when seen.
References for this morning's chest conference...
1. Spontaneous pneumothorax review article. (Poor prognosis in setting of pneumocystis pneumonia).
2. Opportunistic infection review (pneumocystis incidence fell 60% in past ten years).
3. Judith Feinberg's review in American Family Physician.
REACH* Investigators in the current N Engl J Med conclude that "End-of-life care for patients with dementia was extremely demanding of family caregivers. Intervention and support services were needed most before the patient's death. When death was preceded by a protracted and stressful period of caregiving, caregivers reported considerable relief at the death itself."
*(Resources for Enhancing Alzheimer's Caregiver Health)
Seventy-two percent of caregivers reported that the death was a relief to them, and more than 90 percent reported belief that it was a relief to the patient. Depression and grief set in for caregivers before the death, with rapid resolution of depressive symptoms within three months after the death of the loved-one.
In the current N Engl J Med JC Ballantyen and J Mao raise unfamiliar points about opioids as immunosuppressants. They also challenge the idea that there is no ceiling to opiate dosing. Tolerance to escalating doses is discussed (not sure I follow associative and non-associative distinction). Methadone is considered an inexpensive alternative, but with a risk of accumulating serum levels.