Difficult cases in heart failure: Raison d'Être behind ACE inhibitors and AT1 receptor combinations in chronic heart failure: chemical nuances or clinical significance?

The following case description serves to illustrate the difficulties often faced in clinical practice in implementing what appear to be fairly simple and clear evidence-based guidelines regarding angiotensin-converting enzyme (ACE) inhibitors and no clear guidelines regarding angiotensin receptor blocker (ARB) use or, more importantly, ACE inhibitor and ARB combinations in chronic heart failure. (c)2001 by CHF, Inc.

Delayed epidural hematoma: presentation in a pediatric patient.

Epidural hematomas remain at the pinnacle of neurosurgical emergencies, representing approximately 3% to 8% of all serious head injuries. Mortality from this entity is usually prevented once the diagnosis is clear. Although readily recognized on non-contrast head CT, the occasional patient may go on to develop a clinically significant hematoma after an initial negative CT.

Colles-Stokes contributions to the concept of heart failure.

"Colles fracture," "Colles law," "Stokes-Adams syndrome," "Cheyne-Stokes respiration," and "Corrigan pulse" are some of the contributions of the Irish school that are utilized for teaching purposes in medical schools and training programs, as well as in daily practice of medicine. We wish to add an important description by Drs. Colles and Stokes that personifies the considerable personal contributions of these 2 physicians in our understanding of the pathophysiologic expression of the syndrome of heart failure.

Octreotide in hyperinsulinism.

In a limited number of case reports in infants, octreotide raised the blood glucose concentrations and decreased glucose requirements sufficiently to avoid pancreatectomy. This response occurs in the presence of frequent feedings and diazoxide therapy, and lasts from 1 month to greater than 5 years. As expected, octreotide reduces growth indices such as growth factors and growth rate in short-term assessment.

The Tulane University Medical Center/Columbia partnership: opportunities and challenges for pathology.

A joint venture between the largest health-care corporation in the country (Columbia/HCA) and Tulane University Hospital/Clinic was established about 1 year ago. Early indications are that the partnership is successful and mutually beneficial. For Tulane University Medical Center, the joint venture provides financial stability and support for academic centers of excellence.