Pheochromocytoma and extra-adrenal paraganglioma: updates.

Context: Advances in genetics and gene expression profiling have led to new ways of thinking about the pathobiology of pheochromocytoma and extra-adrenal paraganglioma. These developments are concurrent with the publication and dissemination of the 2004 World Health Organization bluebook on pathology and genetics of endocrine tumors.

Objective: To summarize new information required by pathologists for effective participation in patient management and research.

Helminths and the IBD hygiene hypothesis.

Helminths are parasitic animals that have evolved over 100,000,000 years to live in the intestinal track or other locations of their hosts. Colonization of humans with these organisms was nearly universal until the early 20th century. More than 1,000,000,000 people in less developed countries carry helminths even today.

Screening practices in cancer survivors.

Introduction: Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors' screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors' screening beliefs and practices compared to those without a cancer history.

Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

This chapter about antithrombotic therapy for valvular heart disease is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patient values might lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2008; 133[suppl]:123S-131S).

Grades of recommendation for antithrombotic agents: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

This chapter describes the system used by the American College of Chest Physicians to grade recommendations for antithrombotic and thrombolytic therapy as part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Clinicians need to know if a recommendation is strong or weak, and the methodologic quality of the evidence underlying that recommendation. We determine the strength of a recommendation by considering the balance between the desirable effects of an intervention and the undesirable effects (incremental harms, burdens, and for select recommendations, costs).

Sudden cardiac death in athletes.

Sudden cardiac death in athletes is an uncommon but extremely visible event because of the high profile of amateur and professional athletes and the expected excellent health of these athletes. However, paradoxically, athletic performance may immediately increase the risk of ventricular arrhythmias and sudden cardiac death while run reducing atherosclerosis, which thus improves cardiovascular health and longevity. In athletes younger than 30 years, the most common underlying causes are due to inherited heart disease.

Decision analytic models for Alzheimer's disease: state of the art and future directions.

Decision analytic policy models for Alzheimer's disease (AD) enable researchers and policy makers to investigate questions about the costs and benefits of a wide range of existing and potential screening, testing, and treatment strategies. Such models permit analysts to compare existing alternatives, explore hypothetical scenarios, and test the strength of underlying assumptions in an explicit, quantitative, and systematic way. Decision analytic models can best be viewed as complementing clinical trials both by filling knowledge gaps not readily addressed by empirical research and by extrapolating beyond the surrogate markers recorded in a trial.

Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results.

Objective: Endovascular stent graft (SG) deployment offers a useful vessel-preserving strategy for vascular wall lesions such as pseudoaneurysms and fistulae. Although deployment of expanded polytetrafluoro-ethylene-covered SGs within the carotid and vertebral arteries is technically feasible, data on long-term efficacy, safety, and patency rate remain sparse.

Methods: Six patients with traumatic (n = 4), iatrogenic (n = 1), or spontaneous (n = 1) internal carotid and vertebral artery injuries (direct carotid-cavernous fistula, n = 2; pseudoaneurysms, n = 4) were treated with nine balloon-mounted coronary expanded polytetrafluoro-ethylene SGs.

C1-C2 arthrodesis after transoral odontoidectomy and suboccipital craniectomy for ventral brain stem compression in Chiari I patients.

Chiari I malformations are often associated with congenital craniocervical anomalies such as platybasia, basilar invagination, and retroflexion of the odontoid process. Management of ventral brain stem compression associated with Chiari I malformations remains controversial, but several authors report a significant rate of failure with suboccipital decompression alone in the presence of pronounced ventral brain stem compression (VBSC). Treatment options described in the literature for these patients involve anterior, posterior, or combined decompressions with or without concurrent arthrodesis.

Postoperative carotid spasm in the setting of head and neck surgery.

Delayed arterial spasm is a clinical and angiographic condition frequently observed after subarachnoid hemorrhage. It has long been associated with a local myogenic reaction to prolonged arterial contact with fresh blood. Carotid spasm from direct manipulation of the petrous carotid during skull base procedures is also a rare but known response to longitudinal arterial traction.

Comparison of permanent and nonpermanent staple line buttressing materials for linear gastric staple lines during laparoscopic Roux-en-Y gastric bypass.

Background: Several publications have suggested that staple line buttressing might decrease staple line bleeding, increase burst pressure, and decrease the likelihood of acute failure resulting in leak. Currently, permanent and nonpermanent options are available. However, concern has been raised about the permanent buttress material and its potential for delayed strip expulsion.

Risk factors for albicans and non-albicans candidemia in the intensive care unit.

Objective: To determine risk factors for bloodstream infections (BSI) with Candida non-albicans (C-NA) species and Candida albicans (CA) among critically ill patients.

Design: Case-control study.

Setting: Adult medical and surgical intensive care units (ICUs) at two university hospitals.

The safety of niacin in the US Food and Drug Administration adverse event reporting database.

Of currently approved drugs, niacin is the most effective in raising high-density lipoprotein cholesterol levels, either as monotherapy or in combination with other agents. The US Food and Drug Administration's (FDA) Adverse Event Reporting System provides 1 mechanism to evaluate the safety of niacin as it is used in common clinical practice. In this report, the authors review recent analyses of adverse events reported to the FDA demonstrating that the extended-release formulation of niacin (niacin-ER) has a significantly better safety profile compared with other niacin formulations and compares favorably with other commonly used lipid-altering drugs, including 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and fibrates.

Probiotics for prevention of antibiotic-associated diarrhea.

Antibiotic-associated diarrhea (AAD) occurs in approximately 25% of patients receiving antibiotics. Hospitalized patients with AAD are at increased risk for nosocomial infections and have a higher mortality. Probiotics are living microorganisms used to restore gut health by changing the intestinal microbiota.

Synthesis of genetic association studies for pertinent gene-disease associations requires appropriate methodological and statistical approaches.

Objective: The aim of the study was to consider statistical and methodological issues affecting the results of meta-analysis of genetic association studies for pertinent gene-disease associations. Although the basic statistical issues for performing meta-analysis are well described in the literature, there are remaining methodological issues.

Study Design And Setting: An analysis of our database and a literature review were performed to assess issues such as departure of Hardy-Weinberg equilibrium, genetic contrasts, sources of bias (replication validity, early extreme contradictory results, differential magnitude of effect in large versus small studies, and "racial" diversity), utility of cumulative and recursive cumulative meta-analyses.

Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient.

Background And Objective: Injury to the carotid and vertebral arteries is an identified risk to patients after blunt high-energy cranio-cervical trauma with an associated risk of thromboembolic stroke. We sought to determine the incidence, features, and risk factors of arterial injury using selective cerebral angiography in a high-risk trauma patient subset.

Methods: Blunt trauma patients with a high-energy mechanism were selected to undergo screening cerebral angiography if they met one of the following criteria: (1) cervical spine hyperextension/hyperflexion injury, (2) skull-base or facial fracture, (3) lateralizing neurologic deficit, ischemic deficit, or cerebral infarction, or (4) hemorrhage of arterial origin.

Waist-to-hip ratio, body mass index, and subsequent kidney disease and death.

Background: Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality.

Study Design: Cohort study.

Interleukin-12 (IL-12) and IL-23 induction of substance p synthesis in murine T cells and macrophages is subject to IL-10 and transforming growth factor beta regulation.

Substance P is a tachykinin that enhances pathways of inflammation. Leukocytes at sites of intestinal inflammation make substance P. This study explored the role of interleukin-12 (IL-12), IL-23, and the regulatory cytokines IL-10 and transforming growth factor beta (TGF-beta) in controlling leukocyte substance P production.

Cell cycle control and adhesion signaling pathways in the development of metastatic melanoma.

Metastatic melanoma is a fatal malignancy which is remarkably resistant to treatment. It is not entirely clear what determines transition from primary local to metastatic melanoma. Recent gene profiling studies shed light onto the complexity of pathogenesis of melanoma progression.

Tai Chi improves pain and functional status in adults with rheumatoid arthritis: results of a pilot single-blinded randomized controlled trial.

Background/aims: Rheumatoid arthritis (RA) is a serious health problem resulting in significant morbidity and disability. Tai Chi may be beneficial to patients with RA as a result of effects on muscle strength and 'mind-body' interactions. To obtain preliminary data on the effects of Tai Chi on RA, we conducted a pilot randomized controlled trial.

Midtrimester heterotopic abdominal pregnancy diagnosed and managed with imaging guidance: a case report.

Background: An abdominal pregnancy coexisting with an intrauterine pregnancy is a rare variant of heterotopic pregnancy.

Case: An abdominal heterotopic pregnancy was diagnosed at 22 weeks' gestation. Magnetic resonance imaging, magnetic resonance angiography and sonography were performed to elucidate the anatomy.

Patch testing a patient with allergic contact hand dermatitis who is taking infliximab.

We report the case of a patient who developed allergic contact hand dermatitis while receiving infliximab infusions for psoriasis and psoriatic arthritis. Patch testing showed multiple positive allergens. To our knowledge, this is the first case report of successful patch testing in a patient receiving tumor necrosis factor-alpha (TNF-alpha) blockade therapy.