Latest Articles
- The role of azithromycin and clarithromycin in clinical practice
Clinical trials show these to be excellent alternatives to conventional agents for treating infections of the respiratory tract, skin, and skin structures. Their high cost, however, may prohibit routine use.
- Coronary artery disease in women: a risk-factor analysis
Coronary artery disease (CAD) has long been considered a disease of men. However, the risk factors for CAD are similar for women and men, and these factors need to be considered when counseling women for the prevention of CAD.
- Pheochromocytoma: current diagnosis and management
In patients with paroxysmal or sustained hypertension, especially if symptoms are present, pheochromocytoma should be suspected.
- 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.
- 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.