Launching complex medical workups from an urgent care platform.

The basic parameters for medical workups have scarcely changed in the past 30 years. That is, what the internal medicine community has deemed acceptable for outpatient, inpatient, emergency department, and urgent care evaluation has remained pretty much stable or stagnant during all that time. We are failing to take advantage of the phenomenal speed and accuracy of new laboratory and imaging technologies.

Silymarin inhibits in vitro T-cell proliferation and cytokine production in hepatitis C virus infection.

Background & Aims: Silymarin, an extract from the seeds of the milk thistle plant Silybum marianum, has been used for centuries for the treatment of chronic liver diseases. Despite common use by patients with hepatitis C in the United States, its clinical efficacy remains uncertain. The goal of this study was to determine whether silymarin has in vitro effects on immune function that might have implications for its potential effect on hepatitis C virus (HCV)-induced liver disease.

Reoperative mitral valve surgery by the port access minithoracotomy approach is safe and effective.

Background: Reoperative mitral valve (MV) surgery through sternotomy can be technically challenging. Limited exposure and injury to the right ventricle or patent grafts (previous coronary artery bypass graft surgery [CABG]) are potential complications upon sternal reentry. The purpose of this study was to examine the results of port access MV surgery through right minithoracotomy in patients with previous cardiac surgery performed through median sternotomy.

Preservation of intrahepatic hepatitis C virus (HCV)-specific CD4+ T cell responses despite global loss of CD4+ T cells in HCV/HIV coinfection.

Background: Human immunodeficiency virus (HIV) coinfection and low peripheral blood CD4(+) T cell counts are associated with increased hepatitis C liver disease.

Methods: Hepatitis C virus (HCV)-specific CD4(+) T cell responses were assessed using interferon (IFN)- gamma enzyme-linked immunospot assays on peripheral blood mononuclear cells and expanded liver lymphocytes from HCV-monoinfected and HCV/HIV-coinfected subjects. Cell frequencies were determined using flow cytometry.

Decreased NK cell frequency in chronic hepatitis C does not affect ex vivo cytolytic killing.

Prior studies have suggested that natural killer (NK) cell function might be impaired in chronic hepatitis C virus (HCV) infection. Circulating NK cell frequency and cytolytic activity were examined freshly ex vivo in HCV-infected and uninfected subjects. Surprisingly, the intrinsic cytolytic activity of peripheral blood NK-enriched cells was similar between HCV-infected and uninfected groups (P = .