ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Atherosclerosis is a complex disease in which progressive cellular changes occur for decades before the acute manifestation of cardiovascular disease. Definition of atherogenic mechanisms in humans is hindered by the complexity and chronicity of the disease process, combined with the inability to sequentially characterize lesions in an individual patient because of shortcomings in noninvasive detection modalities. Therefore, there has been a reliance on animal models of the disease to define mechanistic pathways. Over the last decade, the mouse has become the predominant species used to create models of atherosclerosis. The initial interest was based on the great diversity of inbred strains with defined genetic backgrounds that provides a means of linking genes to the development of atherosclerosis. More recently, the ability to genetically modify mice to over or under express specific genes has facilitated the definition of pathways in the atherogenic process. All of the current mouse models of atherosclerosis are based on perturbations of lipoprotein metabolism through dietary and/or genetic manipulations. Although hyperlipidemia is necessary for the development of atherosclerosis, mouse models have demonstrated that many nonlipid factors can influence the severity and characteristics of lesions. This review selectively highlights some of the most commonly used mouse models of atherosclerosis and compare their lesions to those formed in the human disease.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Peripheral arterial disease (PAD) involving the lower extremities is presumably a disease of the elderly. The awareness of PAD in the general population, and in younger adults in particular, is low. Atherosclerosis is the major cause of lower limb ischemia in the young. Young adults with clinical manifestations of premature lower extremity atherosclerosis (PLEA) typically have multiple cardiovascular risk factors and the majority are smokers, with strong family history of cardiovascular disease, and typically have chronic symptoms of claudication at diagnosis. Frequently these symptoms are either not reported in a timely manner by the patients or are attributed to other, presumably more common causes of leg pain in the young. More than 70% of patients with PLEA have angiographic evidence of severe aortoiliac disease. The results of surgical revascularizations in young adults are inferior to those reported in older patients. Younger adults typically require multiple revascularizations with relatively high amputation rate. We conclude that PAD should be considered in adults with multiple risk factors regardless of their age if appropriate symptoms are present. There is a need for increased public health awareness for premature lower extremity atherosclerosis.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Clinical data and experimental studies have established the important role of abnormal lipid metabolism in the causation of atherosclerosis and enthroned the hydroxymethylglutaryl coenzyme reductase inhibitors (statins) as a mainstay in management of patients with coronary heart disease. However, emerging experimental data underline the role of vascular renin-angiotensin systems in mediating the early stages of vascular endothelial dysfunction and inflammation as prerequisites for unleashing the cascade of cellular and molecular events that lead to the deposition of foam cells and their eventual progression to the atherosclerotic plaque. We discuss here the biological effects of statins and angiotensin II in the evolution of atherogenesis, underscoring possible links between statins and angiotensin receptor blockers. From the assessment of the commonality of effects resulting from the nonlipidic actions of statins and angiotensin II on the process of atherogenesis, we develop the argument that dyslipidemia may influence the ability to control blood pressure in hypertensive subjects and hypothesize that the combined use of statins and blockers of the renin-angiotensin system may have an additive effect in the management of hypertensive subjects.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Among the modifiable risk factors for cardiovascular disease, hypertension is the most powerful and treatable. For an asymptomatic patient to remain on a lifetime of antihypertensive treatment that might cause adverse effects is difficult for most patients. Managed care plans should treat hypertensive patients in ways that the patient can remain on therapy to prevent complications and thereby reduce the long-term costs associated with untreated hypertension. The recent disappointing outcomes achieved with antihypertensive drugs suggest there is room for improvement in the management of hypertension. Since the introduction of the first orally active angiotensin II receptor blocking drug, losartan, attention has been focused on the central role of angiotensin II in hypertension and cardiovascular disease. Studies of angiotensin II antagonists (AIIAs), which block the tissue receptor for angiotensin II, show that these agents effectively control hypertension when given once daily and cause no significant adverse effects or laboratory abnormalities. Losartan is unique among the AIIAs in that it offers 1-step titration dosing and has a uricosuric effect. Losartan, candesartan, and valsartan have been shown to improve the symptoms of congestive heart failure; losartan has been similar to an angiotensin-converting enzyme inhibitor in reducing systolic dysfunction congestive heart failure mortality. At 1 year, the refill rate for losartan in a managed care setting has been more than that for any other class of antihypertensive agents. Although there is not yet a clinical trial determining the long term mortality of AIIA treatment in hypertension compared with other antihypertensive agents, the use of AIIAs in conjunction with lifestyle modification and patient education can provide more efficient hypertension control and a provide a treatment with which patients can live.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundUp to 2 million elderly persons are abused or neglected in the United States each year. Although elderly patients see their physicians an average of five times per year, physicians make only a small percentage of reports to Adult Protective Services (APS) agencies. The purpose of this study was to learn how practicing geriatricians define, diagnose, and address abuse and neglect to provide some guidance to the busy general internist regarding this complex issue.MethodsTen local geriatricians were interviewed with a standardized set of open-ended questions. A team analyzed the verbatim transcriptions using both quantitative and qualitative methods.ResultsThe average number of cases diagnosed per year was 8.7 (range, 2–20). The geriatricians were fairly consistent in their definitions of elder abuse and neglect and how they diagnosed it through the history and physical exam. The most common findings in the history were rapport between the patient and caregiver, medical noncompliance, activities of daily living and instrumental activities of daily living assessments, and loss of social activities. The most common findings on the physical exam were bruising/trauma, general appearance/hygiene, malnutrition, and dehydration.ConclusionsThe geriatricians emphasized keeping the diagnosis of abuse and neglect in mind for every patient. A variety of interventions were employed by physicians and ranged from automatically calling APS on each case to addressing cases through work with an interdisciplinary geriatrics team.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundIn general, there is a good correlation between the specific gravity and osmolality of a urine sample. In certain clinical conditions, such as uncontrolled diabetes mellitus, nephrotic syndrome, after the administration of intravenous radiocontrast material or saline diuresis, dependence upon specific gravity for determining the concentrating ability will result in over- or underestimation.MethodsWe studied the relationship between specific gravity and osmolality in vitro with simulated urines of varying composition. Urine samples from patients with different clinical conditions were also analyzed.ResultsThe in vitro curves for sodium chloride, urea, creatinine, glucose, contrast dye, and albumin were plotted (specific gravity versus osmolality). We found a linear correlation between the specific gravity and osmolality of the 6 substances that were studied and for their combinations. The urine samples obtained from patients with different clinical conditions documented that reliance on specific gravity could over- or underestimate the urine osmolality.ConclusionsWe concluded that in those clinical conditions, urine osmolality should always be determined and it should not be estimated based on specific gravity.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A growing number of peptide hormones and growth factors have been shown to operate in the intracellular space after either internalization or retention in their cells of synthesis. These factors, called intracrines, in many cases are expressed as multiple isoforms, traffic to nucleus or nucleolus, and regulate gene transcription. Some intracrines are angiogenic. It is here argued that intracrine action is the modern analogue of a biologically ancient mechanism for regulating message translation and ribosome synthesis. The implications of this view for research and therapeutics are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

It is recommended that physicians do not care for their family members. However, there are also many concerning issues when physicians care for the family members of their colleagues. This can be particularly challenging when the patient is an adolescent. We present the case of Dr. B who is asked to see the teenage daughter of her colleague Dr. A, and discuss the issues of caring for an adolescent family member of a physician colleague. Patient confidentiality, autonomy, and maintenance of the patient-physician relationship are core principles that must be adhered to in this situation. The roles of the treating physician and the parental physician are discussed.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Tuberculosis of the pancreas is a clinical entity rarely described in the literature. The pancreas is biologically protected from infection byMycobacterium tuberculosis, probably because of the presence of pancreatic enzymes that interfere with the seeding ofM tuberculosis. However, when pathogens are able to overcome the resistance, they can have diverse presentations, such as pancreatic masses that can mimic carcinoma, obstructive jaundice, pancreatitis, and gastrointestinal bleeding. Herein we describe 2 cases of pancreatic tuberculosis that presented as multicystic masses, and we review the literature to describe the diverse clinical manifestations of this condition.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID