Treatment of Hepatitis C Virus Infection in Liver Transplant Recipients.

Chronic hepatitis C virus (HCV) infection is the leading cause of liver transplantation in adults. Although the recurrence of HCV infection after liver transplantation is nearly universal, the recent advances in direct-acting antiviral (DAA) agents have revolutionized the management of HCV infection in the posttransplant setting. A number of these agents have been evaluated in recent clinical trials and have shown high sustained virologic response rates, shorter durations of treatment, and decreased adverse events when compared with the previous treatment of pegylated interferon and ribavirin.

Case Report: Pulmonary Papillomatosis in a Patient Presenting with Cough and Hemoptysis.

A previously healthy patient was seen in the Emergency Department for evaluation of a one-month history of cough and one-day history of hemoptysis. A computed tomography scan of the thorax found a mass on the right lower pulmonary lobe and a mass on the left upper lobe. A biopsy specimen of the right lobe lung mass, obtained during bronchoscopy, demonstrated papilloma.

Antiviral Therapy in Elderly Patients With Hepatitis C Virus Infection.

The emergence of direct-acting antiviral (DAA) agents has revolutionized the treatment schema for hepatitis C virus (HCV) infection. From cure rates to tolerability, DAA agents have shown outstanding profiles compared with the prior therapy of pegylated interferon with ribavirin. However, the efficacy and safety profiles of DAA therapy in older patients, particularly the elderly, have been unclear, and patients in the 1945 to 1965 birth cohort constitute the largest proportion of the HCV population in the United States.

Therapeutic Drug Monitoring in Children and Young Adults With Inflammatory Bowel Disease: A Practical Approach.

Therapeutic drug monitoring (TDM) is the clinical practice of measuring drug concentrations or metabolites to attain a targeted concentration in a patient's bloodstream, thereby optimizing individual dosage regimens. With the well-established knowledge of the relationship of the genetic variability of thio-purine metabolism driven by the thiopurine S-methyltransferase pathway, and the recent data supporting pharmacokinetic variability and immunogenicity with anti-tumor necrosis factor (anti-TNF) therapies, TDM has emerged as a necessary mechanism to enhance drug efficacy. This article reviews data describing the relationship between drug concentrations and outcomes, including the achievement of a sustained and durable remission.

Anesthesia for the elderly outpatient.

Purpose Of Review: As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly patients will assume increased importance.

Recent Findings: Increasing evidence supports the expanded use of ambulatory surgery for managing elderly patients undergoing elective surgery procedures.

Summary: This review article describes the demographics of ambulatory surgery in the elderly population.

Evaluation of peripapillary lymphocytosis and lymphocytic esophagitis in adult inflammatory bowel disease.

Lymphocytic esophagitis (LE) is a newly described entity characterized histopathologically by peripapillary lymphocytosis (PL) without significant granulocytes (neutrophils and eosinophils). In an initial study, a significant portion of patients with LE had Crohn's disease (CD). A subsequent study revealed LE in one quarter of children with CD.

A Randomized, Controlled Pilot Study of the Effects of Acupuncture on Circulating Endothelial Progenitor Cells in Coronary Heart Disease.

Context: Coronary heart disease (CHD) remains the number one killer of men and women in the United States, and despite traditional secondary prevention, individuals with the disease remain at risk. Endothelial progenitor cells (EPCs) may have beneficial effects on atherosclerosis, angiogenesis, and vascular repair and may contribute systemically to ongoing endogenous repair processes. Traditional acupuncture (TA), a modality used in the practice of Chinese medicine, appears to have beneficial effects in many areas associated with CHD.

Quality improvement in inflammatory bowel disease.

Chronic illnesses such as inflammatory bowel disease (IBD) present a unique opportunity to define and improve the quality of care. Processes of care can be complex, and outcomes of care may vary across different healthcare delivery settings. Patients with IBD are managed over long periods of time and often by the same physician within a single care delivery system.

Vaccination issues in patients with inflammatory bowel disease receiving immunosuppression.

Treatment regimens for Crohn's disease and ulcerative colitis increase susceptibility to infections, many of which can be prevented by vaccinations. Increased awareness concerning vaccine-preventable diseases has led to several studies investigating the immunologic responses to vaccines in immunosuppressed patients with inflammatory bowel disease. This review provides an overview of the evidence-based rationale for currently accepted recommendations regarding the use of both inactivated and live vaccines in this unique population.

Antibiotics for the treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with an estimated worldwide prevalence of 10-20%. IBS can be associated with severe gastrointestinal symptoms, including abdominal pain, bloating, and altered bowel function. Although the causes of IBS remain undefined, recent research has increasingly suggested roles for gut flora in IBS.

Responsibility after the apparent end: 'following-up' in clinical ethics consultation.

Clinical ethics literature typically presents ethics consultations as having clear beginnings and clear ends. Experience in actual clinical ethics practice, however, reflects a different characterization, particularly when the moral experiences of ethics consultants are included in the discussion. In response, this article emphasizes listening and learning about moral experience as core activities associated with clinical ethics consultation.

Low-dose nocturnal tegaserod or erythromycin delays symptom recurrence after treatment of irritable bowel syndrome based on presumed bacterial overgrowth.

Unlabelled: Our group previously demonstrated a deficiency of migrating motor complexes in irritable bowel syndrome (IBS) patients with small intestinal bacterial overgrowth (SIBO). Based on disturbed fasting motility, we tested whether low-dose nocturnal erythromycin or tegaserod can prevent the recurrence of IBS symptoms after successful antibiotic treatment.

Methods: 203 patient charts were reviewed to find IBS patients with SIBO, and treatment cycles were assessed to identify subjects with clinical and breath test resolution.