Refractory Nonvariceal Upper Gastrointestinal Bleeding Requiring Surgical Intervention.

Nonvariceal upper gastrointestinal (GI) bleeds are a common emergency. Mortality in patients with an upper GI bleed has been reported to be as high as 30% for those who bleed inpatient. Definitive management after resuscitation can be done with endoscopy, transcatheter arterial embolization (TAE), and/or surgery.

Clinical Course and Quality of Life in High-Risk Patients With Hypertrophic Cardiomyopathy and Implantable Cardioverter-Defibrillators.

Background: High-risk patients with hypertrophic cardiomyopathy (HCM) are identified by contemporary risk stratification and effectively treated with implantable cardioverter-defibrillators (ICDs). However, long-term HCM clinical course after ICD therapy for ventricular tachyarrhythmias is incompletely understood.

Methods And Results: Cohort of 486 high-risk HCM patients with ICDs was assembled from 8 international centers.

Systematic oral hydration with water is similar to parenteral hydration for prevention of contrast-induced nephropathy: an updated meta-analysis of randomised clinical data.

Background: Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired kidney injury and is related to increased long-term morbidity and mortality. Adequate intravenous (IV) hydration has been demonstrated to lessen its occurrence. Oral (PO) hydration with water is inexpensive and readily available but its role for CIN prevention is yet to be determined.

The Healing Effects of Belief in Medical Practices and Spirituality.

Shamans and other healing practitioners have used placebos from earliest recorded history to treat those who were ill. As modern scientific theories of disease developed, the use of placebos was considered to be an ineffective and deceptive practice. Later, medical researchers used placebos primarily as an inactive treatment standard against which scientifically based ("real") medicines could be evaluated.

Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device: A Systematic Review of Published Reports and Analytic Review of the FDA MAUDE Database.

Importance: The Lariat device has received US Food and Drug Administration (FDA) 510(k) clearance for soft-tissue approximation and is being widely used off-label for left atrial appendage (LAA) exclusion. A comprehensive analysis of safety and effectiveness has not been reported.

Objectives: To perform a systematic review of published literature to assess safety and procedural success, defined as successful closure of the LAA during the index procedure, of the Lariat device.

The transcription factor NFAT promotes exhaustion of activated CD8⁺ T cells.

During persistent antigen stimulation, CD8(+) T cells show a gradual decrease in effector function, referred to as exhaustion, which impairs responses in the setting of tumors and infections. Here we demonstrate that the transcription factor NFAT controls the program of T cell exhaustion. When expressed in cells, an engineered form of NFAT1 unable to interact with AP-1 transcription factors diminished T cell receptor (TCR) signaling, increased the expression of inhibitory cell surface receptors, and interfered with the ability of CD8(+) T cells to protect against Listeria infection and attenuate tumor growth in vivo.

Immunolabeling for p16, WT1, and Fli-1 in the assignment of growth phase for cutaneous melanomas.

Distinction between radial growth phase (RGP) and vertical growth phase (VGP) in cutaneous melanomas is prognostically significant. Despite established morphological criteria, molecular markers to separate RGP and VGP have not been well established. The goal of this study was to investigate associations of p16, WT1, and Fli-1 with RGP-to-VGP progression, by immunohistochemistry.

Trends in hospitalizations among children and young adults with perinatally acquired HIV.

Background: Contemporary trends in hospitalization patterns among perinatally HIV-infected (PHIV) patients are unknown. We describe rates and reasons for hospitalizations stratified by age group during 2003-2010 within a large cohort of PHIV patients.

Methods: 579 PHIV patients engaged in care at 6 geographically diverse pediatric HIV centers affiliated through the HIV Research Network were included.

Air pollution exposure as a risk factor for cardiovascular disease morbidity and mortality.

There is growing evidence of an association between increasing exposure to air pollutants (both short-term and long-term exposures) and elevated risk of mortality and incidence of cardiovascular diseases in certain high-risk populations and throughout different geographic regions. The pathophysiologic mechanisms of air pollutant-induced cardiovascular morbidity and mortality are actively being studied, with autonomic system dysregulation and inflammatory pathway activation believed to be among the key culprits. Policy changes at the local and global levels are addressing the need for more stringent air pollution standards.

Positive Chlamydia trachomatis serology result in women seeking care for infertility is a negative prognosticator for intrauterine pregnancy.

Background: There are no prior studies that assess the non-in vitro fertilization (IVF) pregnancy rates in chlamydia serology-positive versus serology-negative women. Therefore, we wanted to determine whether a positive Chlamydia trachomatis immunoglobulin G serology result predicts reduced clinical pregnancy rates without IVF.

Methods: A prospective observational study was performed at a university-affiliated reproductive center.

Middle-aged man with left neck pain and swelling.

Background: Disorders of the salivary glands can be evaluated by bedside ultrasonography and should be considered in patients presenting with undifferentiated neck swelling.

Objective: Our aim was to describe the sonographic findings present in sialolithiasis and sialadenitis.

Case Report: A 61-year-old man presented to the emergency department with 2 days of neck swelling.

Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology.

Background: We investigated the patient characteristic factors that correlate with identification of i.v. cannulation sites with normal eyesight.

Copper levels in patients with celiac neuropathy.

Objective: Neurological complications of celiac disease (CD) include neuropathy, myeloneuropathy, and cerebellar degeneration. The cause of neuropathy in patients with CD is not known. Prior publications describe copper deficiency in CD patients with myeloneuropathy and neuropathy and posit that hypocupremia is the cause of these neurological conditions.

Anesthesia management of patients with hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy presents a challenge to the anesthesiologist. Because the condition is relatively prevalent, it is important for anesthesiologist to be aware of the pathophysiology. In this review, we draw upon case reports and studies of the anesthesia management of patients with hypertrophic obstructive cardiomyopathy to enhance medical decision making.

Surgical myectomy for hypertrophic cardiomyopathy in the 21st century, the evolution of the "RPR" repair: resection, plication, and release.

Since its first description in the 1950s, the pathophysiology of hypertrophic cardiomyopathy has been clarified by advanced echocardiographic technologies. Improved pharmacotherapy now successfully treats most afflicted individuals. Along with these advances, surgical management has also evolved, as the role of the mitral valve and the subvalvular structures in causing obstruction has been identified.

Clostridium septicum aortitis in a patient with extensive atheromatous disease of the aorta.

A 69-year man presented with 3 days of progressively worsening abdominal pain, radiating to his back, with nausea and vomiting. Computed tomography scan of the abdomen showed evidence of aortitis, for which he eventually underwent surgery. The surgical specimen of the aorta grew Clostridium septicum that was treated with antibiotics.

Screening mammography in men with BRCA mutations: is there a role?

Male breast cancer is rare, with an estimated incidence of 1.08 per 100,000 men, and a death rate less than one third of that. However, the incidence of breast cancer in men with the BRCA2 mutation is significantly higher, 7.

Activity of topotecan 21-day infusion in patients with previously treated large cell lymphoma: long-term follow-up of an Eastern Cooperative Oncology Group study (E5493).

The purpose of this study was to determine the activity of topotecan given by 21-day continuous infusion in patients previously treated with one prior therapy for a diffuse large-cell lymphoma or immunoblastic lymphoma. Patients with appropriate histology and measurable disease who had been treated with one prior chemotherapy regimen were eligible for study. Slides of tumor biopsies were submitted for central review of pathology.

Single-agent rituximab in treatment-refractory or poor prognosis patients with chronic lymphocytic leukemia.

Objective: Rituximab in combination with fludarabine and cyclophosphamide has significantly improved outcomes for patients with chronic lymphocytic leukemia (CLL) and an improvement in overall survival has recently been shown for the first time in the history of CLL treatment. However, the chemotherapy portion of this regimen may be unsuitable for elderly patients or those with significant comorbidities. We investigated the safety and tolerability of single-agent rituximab in 23 consecutive patients presenting with CLL at a single institution.

Increased utilization of flexible endoscopic methods during colorectal resection over a 3-year period.

Introduction: Intraoperative endoscopy (IE) is performed during some colorectal resections (CRR) mainly to inspect circular stapled anastomoses (CSA) and to locate small neoplasms. This study's purpose was to determine how often rigid and flexible lower endoscopic methods were used during CRR by one colorectal surgeon over three 1-year periods.

Methods: Data concerning the indication for surgery and IE, type of resection, and the use of rigid and flexible methods were obtained from a prospective database and from hospital charts during Period 1 (P1), 1/1/05 to 12/31/05; P2, 7/1/06 to 6/31/07; and P3, 7/01/07 to 6/30/08.

Gait analysis of knee arthritis treated with hyaluronic acid.

Self-reported studies have demonstrated efficacy of hyaluronic acid (HA) therapy. Gait analysis may objectively demonstrate changes associated with HA therapy. Fifty-three consecutive patients with unilateral osteoarthritis (OA) of the knee were evaluated with a validated and sensitive gait laboratory previously used for gonarthrosis.

Clival chordomas: clinical management, results, and complications in 71 patients.

Object: Chordomas are rare malignant neoplasms arising predominantly at the sacrum and skull base. They are uniformly lethal unless treated with aggressive resection and proton beam irradiation. The authors present results of the surgical management of a large number of patients with clivus chordomas.

AN-2728, a PDE4 inhibitor for the potential topical treatment of psoriasis and atopic dermatitis.

Cytokines are signaling molecules that are believed to be key factors in perpetuating the inflammatory process in psoriasis and atopic dermatitis. AN-2728, being developed by Anacor Pharmaceuticals Inc, is a topically administered, boron-containing, anti-inflammatory compound that inhibits PDE4 activity and thereby suppresses the release of TNFalpha, IL-12, IL-23 and other cytokines. At the time of publication, three phase Ib clinical trials, a IIa trial and a IIb trial of AN-2728 in patients with psoriasis had been completed; the compound was also undergoing phase II development for atopic dermatitis, but no data were available for this indication.