Latest Articles
- The shifting etiologies of lobar hemorrhage
Better treatment of hypertension is changing the type of intracranial hemorrhages physicians most often see.
- Detecting and preventing ventricular remodeling after MI
Infarct expansion after an MI carries a poor prognosis. Thrombolysis prevents early left ventricular dilatation by attenuating infarct expansion. A full-color illustration compares the effects of early reperfusion, late reperfusion, and no reperfusion.
- What primary care physicians should know about the toxicityof cancer chemotherapy
Although symptomatic side effects of chemotherapy reduce a patient’s quality of life, organ-system effects are potentially more serious.
- A 30-year-old woman with headache
On the basis of the clinical picture and laboratory data, what is the most likely diagnosis?
- Adult vaccinations: a short review
Recommended use of vaccines against pneumococcal pneumonia, influenza, hepatitis A and B, varicella, measles, mumps, rubella, tetanus, and diphtheria.
- Evaluating adrenal incidentalomas
Adrenal incidentalomas are detected on approximately 1% to 2% of all abdominal CT scans. The question is, how clinically significant are they?
- Clinical practice guidelines: renal cell carcinoma
BACKGROUND Renal cell carcinoma (RCC) is the most common renal malignancy and is increasing at an annual rate of approximately 2% worldwide. Metastatic RCC is among the more chemotherapy-refractory malignancies, with a 5-year survival rate less than 2%. A variety of therapies are currently under investigation for the treatment of metastatic RCC, particularly involving immunotherapeutic agents such as interferon alfa.
OBJECTIVES To review and compare historical and current data that define practice guidelines in the treatment of RCC.
DISCUSSION Of the various treatment modalities available for RCC, only surgery with complete removal of tumor burden can be considered as potentially curative, since the tumor is resistant to chemotherapy, hormonal therapy, and radiation therapy. However, biologic response modifiers (BRMs)—particularly immunotherapeutic agents such as interferon alfa—have been extensively studied and appear to produce objective tumor regression in selected patients with advanced disease.
CONCLUSIONS In patients with metastatic RCC, performance status is the most important predictor of outcome, and should therefore be utilized for therapeutic decision making. Immunotherapy with BRMs such as recombinant interferon alfa and recombinant interleukin-2 has been associated with meaningful antitumor responses in selected patients. Combination therapy with recombinant interferon alfa, recombinant interleukin-2, and 5-fluorouracil may offer considerable promise, and the subcutaneous administration of recombinant interferon alfa and recombinant interleukin-2 may improve the tolerability and convenience of these cancer treatments by reducing side effects and permitting outpatient administration. As treatment expectations for metastatic RCC are limited, experimental approaches are warranted.
- A 34-year-old woman with odynophagia and weight loss
On the basis of the clinical picture and laboratory data, what is the most likely diagnosis?