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Cleveland Clinic Journal of Medicine

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Table of Contents

July 01, 1993; Volume 60,Issue 4

Internal Medicine Board Review

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    The elevated peripheral white blood count
    Brian J. Bolwell, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 267-268;

Highlights from Medical Grand Rounds

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    Parkinson’s disease: where do westand?
    Patrick J. Sweeney, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 269-270;

    Although a cure has not been found, certain drugs can relieve symptoms and may actually slow disease progression.

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    Irritable bowel syndrome: new perspectives on management
    Marvin M. Schuster, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 270-272;

    Long classified as psychosomatic, irritable bowel syndrome is now considered a motor disorder in which a number of factors are at play.

Current Drug Therapy

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    The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: insights and highlights from the chairman
    Alan Bakst, PharmD and Ray W. Gifford, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 273-277;

    Highlights include the new classification schema and recommendations on the use of labetalol.

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    Assessing hypertension management: the role of 24-hour blood pressure monitoring
    Beatriz Esayag-Tendler, MD and William B. White, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 278-283;

    BACKGROUND The first fully automatic portable invasive blood pressure recorder was developed 30 years ago. Today, portable noninvasive ambulatory blood pressure devices are capable of measuring blood pressure intermittently for periods of 24 to 48 hours.

    OBJECTIVE To discuss the utility of automatic ambulatory blood pressure recording in assessing antihypertensive therapy.

    SUMMARY Ambulatory blood pressure monitoring is helpful in assessing the pharmacodynamics and the clinical efficacy of an-tihypertensive drugs. It is superior to office blood pressure measurement in predicting hypertensive end-organ disease. In clinical trials, ambulatory blood pressure monitoring permits a more varied population to enter a study, the number of subjects required is often reduced, and a placebo control group may be unnecessary.

    CONCLUSIONS The various methods of analyzing ambulatory blood pressure data should be used in a complementary fashion to evaluate antihypertensive drug therapy. We believe that this technique will soon become much more commonly used for hypertension management.

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    From bathtub ring to osteoporosis: a clinical review of the bisphosphonates
    Angelo A. Licata, MD, PhD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 284-290;

    BACKGROUND Etidronate and pamidronate are bisphosphonates, a class of chemical compounds originally used to soften hard water and prevent soap scum. Etidronate was serendipitously found to abate calcification in a child with myositis ossificans progressiva.

    OBJECTIVE Review the basic pharmacology of these compounds, as well as clinical uses of the approved and nonapproved forms.

    DISCUSSION Etidronate is approved for the treatment of hypercalcemia, Paget’s disease of bone, and ectopic calcification, and has been used to treat hyperparathyroidism and nephrolithiasis with limited success. Recently it has been used to treat osteoporosis. Pamidronate is approved to treat hypercalcemia. These two drugs are the only bisphosphonates available in the United States.

    CONCLUSIONS Clinical trials with etidronate have aroused widespread interest in the application of bisphosphonates to treat osteoporosis. Many trials are underway to evaluate these new drugs. More information will be available within the next 5 years.

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    The use of G-CSF and GM-CSF in bone marrow transplantation
    Brian J. Bolwell, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 291-302;

    Using hematopoietic growth factors appears to have made bone marrow transplantation safer. Treatment-related morbidity and mortality have decreased, and patients are discharged from the hospital sooner.

Original Study

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    Lung transplantation: the Cleveland Clinic experience
    Sunit R. Patel, MD, Thomas J. Kirby, MD, Patrick M. McCarthy, MD, David P. Meeker, MD, Paul Stillwell, MD, Thomas W. Rice, MD, Mani S. Kavuru, MD and Atul C. Mehta, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 303-319;

    BACKGROUND Lung transplantation has been steadily developing as a therapeutic option for end-stage lung disease.

    METHODS Retrospective analysis of all 26 patients who underwent lung transplantation at the Cleveland Clinic Foundation between February 1990 and February 1992.

    RESULTS Nineteen single-lung transplantations and seven bilateral lung transplantations were performed. The 1-year actuarial survival for all recipients was 65%. A trend was noted towards better survival in recipients with emphysema (100%) and poorer survival in those with pulmonary hypertension (37.5%). Fungal sepsis and reimplantation lung injury were the most common causes of death, and most deaths (8 of 9) occurred within the first 4 weeks. Of 119 pulmonary complications, 82% occurred in the first 3 months, with infection (39%) and acute rejection (29%) being the most common. Bacterial and fungal infections occurred mainly in the first month, and cytomegalovirus infections occurred mainly in the second and third months. The majority of survivors have shown improvement in functional status.

    CONCLUSIONS The early perioperative and 1-month post-transplantation period appears critical to long-term survival. Even though the complications are numerous, they are usually manageable and, in general, do not result in long-term morbidity.

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    Stereotactically guided thrombolysis of deep cerebral hemorrhage: preliminary results
    David W. Miller, MD, Gene H. Barnett, MD, Donald W. Kormos, PhD and Charles P. Steiner, BS
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 321-324;

    BACKGROUND The neurologic outcome from conventional medical or surgical therapy of intracerebral hemorrhage (ICH) is poor; however, stereotactically guided instillation of thrombolytic agents to dissolve parenchymal clots due to hypertensive hemorrhage has recently produced results equal to or better than those obtained with conventional therapies.

    OBJECTIVE To determine whether stereotactic thrombolysis of deep ICH is safe and effective.

    METHODS We administered urokinase to clots in four patients with hypertensive ICH. After the hemorrhage was localized using angiography and computed tomography-assisted stereotactic technique, a ventricular catheter was used to administer urokinase to the clot.

    RESULTS Preliminary results showed dramatic reduction in clot volume within 48 hours of initiating treatment and modest clinical improvement in all four patients. No further hemorrhages were seen after treatment. Three patients ultimately died of non-neurologic causes.

    CONCLUSIONS With careful patient selection, stereotaxy-assisted thrombolytic therapy may be an advance in the treatment of certain cases of ICH.

Review

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    The pulmonary effects of free-base cocaine: a review
    Ira S. Meisels, MD and Jacob Loke, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 325-329;

    Respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, pulmonary barotrauma, and other pulmonary effects of free-base cocaine are reviewed.

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    Parathyroid carcinoma: 50-year experience at The Cleveland Clinic Foundation
    Albert G. Hakaim, MD, MSc and Caldwell B. Esselstyn, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 331-335;

    BACKGROUND Parathyroid carcinoma is rare, with a reported prevalence of 0.6% to 4.0% in patients presumed to have primary hyperparathyroidism. This study examines the long-term results of surgical therapy and combination chemotherapy.

    PATIENTS From 1938 to 1988, 1260 operations for primary hyperparathyroidism were performed; only six patients (0.47%) were subsequently found to have parathyroid carcinoma. A seventh patient was referred to our institution after the diagnosis of parathyroid carcinoma had been made.

    RESULTS All patients had excessive hypercalcemia (serum calcium concentration > 12.0 mg/dL) with a range of 12.3 to 18.3 mg/dL. Locally recurrent tumors causing recurrent hypercalcemia were managed by repeated neck exploration and tumor resection. Six of the seven patients (85%) survived 5 years, while four patients (57%) survived 10 years.

    CONCLUSIONS Diagnosis of parathyroid carcinoma rests upon postoperative surveillance of patients who have undergone previous neck exploration and resection of apparently benign adenomas. Long-term survival is possible with repeated resection of locally recurrent tumors.

Case Report

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    Hemopericardium and cardiac tamponade associated with warfarin therapy
    Kamthorn S. Lee, MD and Thomas Marwick, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 336-338;
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Cleveland Clinic Journal of Medicine: 60 (4)
Cleveland Clinic Journal of Medicine
Vol. 60, Issue 4
1 Jul 1993
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The beat goes on: Highlights from the new American and European A-fib guidelines
What diagnostic tests should be done after discovering clubbing in a patient without cardiopulmonary symptoms?
Tinea incognito
Prolonged venous filling time and dependent rubor in a patient with peripheral artery disease
Nociplastic pain: A practical guide to chronic pain management in the primary care setting
Sarcoidosis with diffuse purplish erythematous plaques on the hands
Cardiovascular disease in people living with HIV: Risk assessment and management
Heart to heart: Progress in cardiovascular disease prevention for people living with HIV
Don’t judge a book by its cover: Unusual presentations of pericardial disease
Hypoglycemia after bariatric surgery: Management updates
Risk-factor modification to prevent recurrent atrial fibrillation after catheter ablation
Common electrolyte imbalance, uncommon cause

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