Table of Contents
Highlights from Medical Grand Rounds
- Tales of a Gypsy Doc: perspectives on social and medical aspects of care of the American Gypsy Population
Understanding a patient’s culture and outlook is critical to any doctor-patient interaction, but perhaps especially so when dealing with the Gypsy population.
- Endocrine causes of impotence
Since 5% to 10% of impotence cases may have an endocrine component, the workup for impotence should consider endocrine disorders, which can be diagnosed readily with laboratory tests and, in the majority of patients, can be cured.
Review
- Management of variceal bleeding in the 1990s
Therapeutic options now include pharmacologic reduction of portal hypertension, endoscopic obliteration of varices, placement of decompressive shunts, and liver transplantation.
- Recurrence, remission, and relapse of seizures
Drug treatment after a first seizure reduces the risk of recurrence by about half, but many patients find the adverse effects intolerable.
Cardiology Perspective
- Breaking the thrombolytic gridlock: insights from the GUSTO trial
The GUSTO chairman reflects on the study’s contributions to the current understanding of how to treat acute myocardial infarction.
Original Study
- Mortality of patients transferred to a tertiary care hospital
A look at the effect of transfers on patient outcome and on hospital mortality statistics, and how superficial review of these statistics could lead to mistaken conclusions about the quality of hospitals to which patients are transferred.
- Early-onset prosthetic valve endocarditis
Despite advances in surgical expertise and antibiotic prophylaxis, this complication occurs in about 1% of patients with implanted heart valves, with a mortality of 30% to 50%.
- Systemic diseases associated with intermediate uveitis
Multiple sclerosis, inflammatory bowel disease, thyroid abnormalities, and possible Epstein-Barr virus infection were among the findings in 26 of 83 intermediate uveitis patients.
Current Drug Therapy
- Hepatic toxicity of antirheumatic drugs
Drug treatment of rheumatic diseases is associated with a small but well-documented risk of hepatotoxicity. Recognizing the clinical syndromes associated with liver injury by these agents facilitates the minimization of morbidity from this complication.
