No abstract

Hypothermia, defined as a core temperature less than 35 degrees C, is frequently not recognized, in part because of the inadequacy of standard thermometers. This entity has multiple causes and unique pathophysiologic consequences that complicate diagnosis and treatment. Understanding of the physiology of thermoregulation is important in light of recent advances in therapy using core rewarming. Pathophysiology, etiology and management of the hypothermia syndrome are reviewed.

The pressure sore is a common clinical problem, although its pathophysiology and management are poorly appreciated by many physicians. The impact of these lesions in terms of patient morbidity and rehabilitation, and health care expenditures is great. Shearing forces, friction and moisture, as well as pressure, contribute to the development of these sores. This paper reviews the clinical settings, causative factors, complications, and principles of prevention and management of the pressure sore. Early surgical consultation is important, because of the deceptive nature and multiple sequelae of these wounds.

Scurvy is a disease that can mimic other more serious disorders such as deep vein thrombosis, vasculitis, and systemic bleeding disorders. Because the clinical features of scurvy are no longer well appreciated, scorbutic patients are often extensively evaluated for other disorders. Familiarity with the risk factors for and clinical manifestation of scurvy can facilitate earlier diagnosis. We report three patients who highlight the epidemiology, clinical features, and differential diagnosis of scurvy.

In this ambulatory patient population attitudes toward living wills were influenced by knowledge and understanding of these documents. Primary care physicians and institutions should develop patient education strategies that enhance understanding of advance directives.