Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs.

Objective: An estimated 40-50% of patients with psoriasis (PsO) have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (PsD; e.g.

Imaging Techniques: Options for the Diagnosis and Monitoring of Treatment of Enthesitis in Psoriatic Arthritis.

Psoriatic arthritis (PsA) affects up to 30% of patients with psoriasis and may include musculoskeletal manifestations such as enthesitis. Enthesitis is associated with joint damage, and early detection and treatment are essential to management of the disease. Traditionally assessed by clinical examination and conventional radiography, entheseal inflammation can now be more accurately assessed earlier in the disease using techniques such as ultrasound, magnetic resonance imaging, computed tomography, and molecular imaging.

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality.

Importance: Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known.

Objective: To examine whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages.

Computerized clinical decision support improves warfarin management and decreases recurrent venous thromboembolism.

Background: An explicit approach to warfarin dose adjustment using computerized clinical decision support (CDS) improves warfarin management. We report metrics of quality for warfarin management before and after implementation of CDS in a large health care system.

Methods: A total of 2591 chronically anticoagulated patients were eligible for inclusion.

Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women: a multicenter randomized controlled trial comparing three methods.

Objective: To evaluate the effect of mode and amount of fluid hydration during labor.

Study Design: The authors conducted a randomized controlled trial of uncomplicated nulliparous women in spontaneous labor at 36 weeks or more gestational age. Women were randomized to receive lactated Ringer solution with 5% dextrose at (1) 125 mL/h intravenously with limited oral intake, (2) 250 mL/h intravenously with limited oral intake, or (3) 25 mL/h intravenously with ad libitum oral intake of clear liquids.

Double cement-application cavity containment kyphoplasty: technique description and efficacy.

Kyphoplasty is an effective surgical treatment for the pain and deformity that can accompany vertebral compression fractures. In certain cases, however, defects or clefts in the vertebral body result either from the original fracture or from expansion of inflatable bone tamps (IBTs). Through such a defect, cement may extrude into the epidural space, paraspinal soft tissues, or disc space.

Potential cardiovascular effects of COX-2 selective nonsteroidal antiinflammatory drugs.

The newly developed nonsteroidal antiinflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2), are effective against pain and inflammation and appear to have less gastrointestinal toxicity than conventional NSAIDs. Their COX-2 selectivity, however, has raised concerns regarding their cardiovascular safety, since they do not inhibit COX-1, the isoform of the enzyme that is active in thrombosis and vasoconstriction. At this point there is no conclusive evidence that COX-2 inhibitors cause ischemic vascular events, because retrospective post hoc analyses conflict one another, and no specific randomized trials have yet been done.

Celiac disease: how common is jejunoileal fold pattern reversal found at small-bowel follow-through?

Objective: Celiac disease, or nontropical sprue, is a cause of mucosal malabsorption. A decreased number of jejunal folds and an increased number of ileal folds (jejunoileal fold pattern reversal) found at small-bowel follow-through have been reported for patients with celiac disease. We asked three questions regarding jejunoileal fold pattern reversal found at small-bowel follow-through in patients with celiac disease.

Myocardial infarction in the 1990s. Complications, prognosis, and changing patterns of management.

Arrhythmias are the most common complications of acute myocardial infarction. However, other complications, such as ventricular free-wall rupture, thrombosis in locations other than the primary site of infarction, and thromboembolic strokes, also may occur. In addition, thrombolytic therapy given after infarction may cause intracranial hemorrhage, allergic reactions, and hypotension.

Myocardial infarction in the 1990s. The importance of early thrombolytic therapy.

Substantial advances in the diagnosis and treatment of ischemic heart disease, especially myocardial infarction, have reduced mortality rates during the past several years. This progress is tempered, however, by the continuing large overall incidence of myocardial infarction and cardiac death in persons in their prime years. Preventive measures are important and are usually best applied by primary care physicians.

Office management of common sleep-wake disorders.

The prevalence of sleep disorders manifest as insomnia and fatigue of excessive daytime sleepiness in the general population; office practice is high. Poor quality sleep may pose a significant health risk for not only the patient but society in general. Sensitivity for potentially serious sleep disorders should be coupled with an organized approach to diagnosis and therapy.

Surgery for solitary thyroid nodules: assessment of methods to select patients at low risk for unsuspected malignancy in the unaffected lobe and the possible utility of preoperative thyroid ultrasound.

One hundred and twelve bilateral thyroidectomies for solitary thyroid nodules with suspected malignancy were performed. The incidence of malignancy in the 112 primary nodules was 42%. Twenty-nine of the 112 contralateral lobes (26%) contained malignancy, which was unsuspected in 80%.

Perspectives on osteoporosis.

The goal of this chapter was to provide enough information so that the following questions could be answered in a clinical context: 1. Does the patient have osteoporosis or a risk for it? Is densitometry needed? 2. Why does the patient have osteoporosis? Is the diagnosis "the tip of the iceberg" because of an occult secondary cause? 3.

Perioperative warfarin therapy in combined abdominal lipectomy and intraabdominal gynecological surgical procedures.

The combination of multiple surgical procedures is attractive and convenient to the patient. Increased awareness of wound healing difficulties and pulmonary complications, however, suggest caution with this approach, particularly when combining abdominal lipectomy with intraabdominal procedures. This study confirms the high risk of pulmonary emboli in patients with combined abdominal lipectomy and intraabdominal gynecological procedures.