Existing drugs and agents under investigation for pulmonary arterial hypertension.

Pulmonary arterial hypertension is a progressive and debilitating disorder with an associated high morbidity and mortality rate. Significant advances in our understanding of the epidemiology, pathogenesis, and pathophysiology of pulmonary hypertension have occurred over the past several decades. This has allowed the development of new therapeutic options in this disease.

Vaccine myths and misconceptions.

Communicable diseases are on the rise worldwide. Some of the increase in prevalence of these nearly eradicated diseases is due to a decrease in vaccination rates. This decrease is primarily due to parental concerns over vaccine safety and the increasing rates of autism spectrum disorders.

Posthospital follow-up visits and 30-day readmission rates in chronic obstructive pulmonary disease.

Purpose: To examine the effect of a follow-up visit with a primary care physician and/or pulmonologist within the first 30 days of hospital discharge on readmissions, emergency department (ED) visits, and mortality.

Patients And Methods: This was a retrospective cohort study of 7,102 unique patients discharged from a Mayo Clinic hospital in Rochester, MN, and residing in Olmsted County, MN, with any mention of chronic obstructive pulmonary disease (COPD) from January 1, 2004 through November 30, 2011. The study included 839 patients who met study-entry criteria.

Amylin in vasodilation, energy expenditure and inflammation.

Metabolic syndrome significantly increases the incidence of atherosclerosis-related diseases including coronary artery disease, stroke, and type 2 diabetes. Recent progress has demonstrated that amylin, or islet amyloid polypeptide, is circulating multifunctional hormone and neuropeptide, which is co-secreted with insulin into the bloodstream by pancreatic beta cells and plays a very important role in regulating feeding, energy homeostasis and inflammation. Recent FDA approval of amylin analog pramlintide as a new drug for treating type 1 and 2 diabetes positions amylin in the spotlight.

Assessment of mutational load in biopsy tissue provides additional information about genomic instability to histological classifications of Barrett's esophagus.

Purpose: Progression of Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) is associated with accumulated genomic instability. Current risk stratification of BE for EAC relies on histological classification and grade of dysplasia. However, histology alone cannot assess the risk of patients with inconsistent or non-dysplastic BE histology.

Treatment of single peripheral pulmonary emboli: patient outcomes and factors associated with decision to treat.

Background: Increasing use of computed tomography pulmonary angiography together with higher-resolution scanners has increased the detection of peripheral filling defects. Physicians face the dilemma of whether to treat patients with these findings, especially single defects. The aims of this study were to compare the outcomes of treated and untreated patients with single peripheral filling defects (SPFD) and identify factors associated with treatment.

Complementary and alternative medicine and mind-body therapies for treatment of irritable bowel syndrome in women.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, characterized by chronic or recurrent abdominal pain with constipation, diarrhea and/or an alternation of the two, and often bloating. Complementary and alternative medicine (CAM) consists of a group of medical treatments that are not commonly considered to be a part of traditional medicine. CAM is commonly used for difficult-to-treat chronic medical conditions.

Estimating patient dose from x-ray tube output metrics: automated measurement of patient size from CT images enables large-scale size-specific dose estimates.

Purpose: To test the hypothesis that patient size can be accurately calculated from axial computed tomographic (CT) images, including correction for the effects of anatomy truncation that occur in routine clinical CT image reconstruction.

Materials And Methods: Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. Water-equivalent diameter (D(W)) was computed from the attenuation-area product of each image within 50 adult CT scans of the thorax and of the abdomen and pelvis and was also measured for maximal field of view (FOV) reconstructions.

True versus Pseudo-Intestinal Malrotation: Case Series and Review.

Intestinal malrotation is an anomaly of fetal intestinal rotation that can present with symptoms after birth or in early childhood, but is rarely diagnosed in adults. Patients who have symptomatic presentations require surgery. Other entities may mimic intestinal malrotation and respond to non-surgical management.

Inter-rater concordance of wound classifications in patients undergoing appendectomy.

Background: Despite the widespread utilization of a four-stage wound classification system to risk-adjust operations for surgical site infection (SSI) rates, we are not aware of any study evaluating the definitions of the wound classes for clarity. We limited our study of wound classifications to appendectomies and posed the question whether different reviewers classify individual cases differently.

Methods: We evaluated the wound classifications of 105 consecutive appendectomies in our community hospital.

A persistent, symptomatic urinary tract infection with multiple "negative" urine cultures.

While urinary tract infections (UTIs) are often suspected on the basis of clinical symptoms and the finding of pyuria on urinalysis, the documentation of a bacterial UTI is based on the significant growth ofa uropathogen on an agar medium incubated at 35-37 degrees C. The recommended length of time for incubation has ranged from 24 to 48 hours. We present a case of a UTI associated with the slow-growing, gram-negative organism, Oligella ureolytica which was finally documented after incubation of an agar medium for more than 48 hours.

Intraluminal duodenal diverticula: collective review with report of a laparoscopic excision.

A comprehensive review of intraluminal duodenal diverticulum (IDD) is presented, along with a report of a completely laparoscopic excision of this duodenal abnormality as well as a report of magnetic resonance cholangiopancreatography demonstrating the classic fluoroscopic "wind sock sign" pathognomonic appearance of IDD. IDD may easily be missed unless one specifically considers this entity in patients presenting with symptoms of foregut disease. Patients with IDD typically present in the fourth decade of life with duration of symptoms less than 5 years that typically include pain, nausea and vomiting, pancreatitis, and gastrointestinal bleeding.

Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458.

The purpose of this article was to retrospectively evaluate the benefits of screening breast ultrasound in women with dense breast tissue following enactment of Connecticut Bill 458 in October 2009. This bill mandated that women be informed of their breast density and the possible benefit of ultrasound as an additional screening modality. Institutional approval was obtained from the institutional review board for this retrospective study.

The connecticut experiment: the role of ultrasound in the screening of women with dense breasts.

The aim of this study was to determine the potential of screening breast ultrasound to improve breast cancer detection in women with mammographically normal, but dense breasts. Six Connecticut radiology practices with 12 total sites participated in a retrospective chart review. The total number of screening mammograms, screening ultrasounds broken down by BIRADS (Breast Imaging Reporting and Data System) codes, and the number of positive and negative biopsies were collected from November 2009 through November 2010.

Relationship between sleep disorders and the risk for developing type 2 diabetes mellitus.

Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development of abnormalities in blood glucose metabolism. Evidence suggests that effectively treating sleep apnea, specifically with continuous positive airway pressure, improves glycemic and nonglycemic outcomes.

Aortopulmonary fistula in acute dissection: findings at unenhanced and enhanced computed tomographic imaging.

Acquired aortopulmonary fistulas are a rare complication of acute aortic dissections. We present a case of an aortopulmonary fistula after a Stanford type A dissection, focusing on the imaging findings and etiology of this entity. Early recognition can lead to proper surgical planning and increase the chance of survival.

Conscious or unconscious: the impact of sedation choice on colon adenoma detection.

Aim: To determine if anesthesiologist-monitored use of propofol results in improved detection of adenomas when compared with routine conscious sedation.

Methods: This retrospective study was conducted at two separate hospital-based endoscopy units where approximately 12,000 endoscopic procedures are performed annually, with one endoscopy unit exclusively using anesthesiologist-monitored propofol. Three thousand two hundred and fifty-two patients underwent initial screening or surveillance colonoscopies.

Are complications of transrectal ultrasound-guided biopsies of the prostate gland increasing?

Although transrectal ultrasound-guided biopsies (TRUSB) of the prostate gland are generally considered to be low-risk procedures, a study from Canada reported that there had been a significant increase in the percentage of hospital admissions following TRUSBs between 1996 and 2005 (1.0% to 4.1%).

Detection of postoperative sleep-disordered breathing using a portable monitoring device.

Purpose: Adverse surgical outcomes may occur more frequently in patients with sleep-disordered breathing (SDB). Despite this concern, there have been no prospective studies using objective measures of postoperative SDB to determine the scope of the problem. We designed a prospective study to determine the feasibility of identifying SDB in elective postoperative patients by the use of a type IV portable monitor (PM).

Measurement of granulocyte maturation may improve the early diagnosis of the septic state.

Background: Sepsis is a costly diagnosis in hospitalized patients. Failure to diagnose sepsis in a timely manner creates a potential financial and safety hazard. The use of transthyretin, C-reactive protein and procalcitonin measurement as early markers of systemic inflammatory response syndrome (SIRS) and sepsis in association with admission of emergency department patients to the intensive care unit (ICU) has been studied.