Latest Articles
- Primary aldosteronism: new approaches to diagnosis and management
Uncertainties persist regarding optimal screening methods, the diagnostic process, diagnostic criteria, and differentiation of the growing number of etiological subgroups.
- Stereotactic and computer-assisted neurosurgery at the Cleveland Clinic: review of 501 consecutive cases
By allowing precise preoperative planning, image-guided stereotactic neurosurgery provides a safe, accurate alternative to many traditional techniques in the diagnosis and treatment of intracranial lesions.
- Coronary artery disease in young women: risk factor analysis and long-term follow-up
Risk factors include hypertension, hypercholesterolemia, diabetes mellitus, familial coronary disease, and smoking. The long-term prognosis is excellent for those without advanced diabetes mellitus and renal failure.
- Stereotactically guided thrombolysis of deep cerebral hemorrhage: preliminary results
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.
- From bathtub ring to osteoporosis: a clinical review of the bisphosphonates
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.
- Lung transplantation: the Cleveland Clinic experience
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.
- Parkinson’s disease: where do westand?
Although a cure has not been found, certain drugs can relieve symptoms and may actually slow disease progression.
- The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: insights and highlights from the chairman
Highlights include the new classification schema and recommendations on the use of labetalol.