Latest Articles
- 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.
- 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.
- 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.
- A Strategy for the Syncope Workup
Without a carefully planned workup, time and money will be wasted before the patient receives appropriate therapy.
- The changing profile of anesthetic practice: an update for internists
BACKGROUND Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught.
OBJECTIVE To update internists on recent changes in anesthetic management and how they affect the preoperative evaluation.
SUMMARY Recent advances in anesthetic management include new monitoring standards, balanced anesthetic technique, new agents, equipment changes, better understanding of human factors, and expanded pain management techniques.
CONCLUSIONS Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.