Latest Articles
- Parathyroid carcinoma: 50-year experience at The Cleveland Clinic Foundation
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.
- Assessing hypertension management: the role of 24-hour blood pressure monitoring
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.
- Irritable bowel syndrome: new perspectives on management
Long classified as psychosomatic, irritable bowel syndrome is now considered a motor disorder in which a number of factors are at play.
- The use of G-CSF and GM-CSF in bone marrow transplantation
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.
- The pulmonary effects of free-base cocaine: a review
Respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, pulmonary barotrauma, and other pulmonary effects of free-base cocaine are reviewed.
- Surgeon’s Skill Key to Ovarian Cancer Management
No good screening test exists for ovarian cancer, yet women are being advised to demand screening.
- Noninfectious respiratory disease in pregnancy
BACKGROUND Pregnancy increases the risk of many noninfectious respiratory conditions.
OBJECTIVE To review the clinical presentation and management of a variety of noninfectious respiratory conditions in pregnant women.
SUMMARY Asthma, aspiration pneumonia, venous air embolism, adult respiratory distress syndrome, pulmonary embolism, and deep venous thrombosis may have unique features in pregnant women.
CONCLUSIONS Evaluation and treatment of these diseases and conditions requires an understanding of the normal physiologic alterations that accompany pregnancy and an awareness of the risks of medication use during pregnancy and in the postpartum period.
- Noninvasive risk assessment after myocardial infarction
BACKGROUND Mortality from acute myocardial infarction is substantially less than it was two and even one decade ago. This improvement in both short-term and postdischarge outcome results both from early interventions to restore myocardial perfusion and mitigate expansion and remodeling, and from later assessment and management of functional status at the time of hospital discharge.
OBJECTIVE Recent studies suggest that invasive evaluation of the patient who has had a myocardial infarction (MI) should not be recommended on a routine basis. This review provides an approach to the noninvasive assessment of the patient.
DISCUSSION Stress testing to ascertain post-MI ischemia, ejection fraction determination to evaluate ventricular volumes and function, and ambulatory electrocardiographic monitoring, electrophysiologic study, and signal-averaged electrocardiography to assess presence and type of ventricular ectopy are discussed.
CONCLUSION The approach to the post-MI patient offered herein is felt to be medically sound and cost-effective. Refinement and alterations in this approach will be necessary as outcomes in specific patient groups, such as thrombolysis patients, women, and the elderly, become clearer.
- Acquired immunodeficiency syndrome: case reporting at a university hospital
BACKGROUND Planning and allocating resources for care of patients with acquired immunodeficiency syndrome (AIDS) requires accurate assessment of disease incidence.
OBJECTIVE To assess the accuracy and completeness of AIDS case reporting at our institution, we reviewed all inpatient and outpatient records of patients with AIDS seen at University Hospitals of Cleveland, Ohio, between January 1983 and July 1990.
METHODS The patients were identified through review of hospital discharge summaries, ambulatory clinic listings, and laboratory identification of opportunistic infections.
RESULTS We found that 24 of 291 AIDS cases (8%) seen at this institution had not been reported to state health departments. Of the 24 patients with unreported AIDS, 16 had received an AIDS diagnosis at other institutions, 11 had never been hospitalized at this institution, and 2 had used pseudonyms.
CONCLUSIONS Review of AIDS case reporting can ascertain the magnitude of underreporting; the profile of patients who were unreported may be used to evaluate the accuracy of reporting elsewhere and to identify systematic problems in case reporting methods.