Update on the diagnosis and management of pulmonary embolism

Pulmonary embolism (PE) is a common and often fatal disease. In the US, an estimated 40-53 people per 100,000 are diagnosed with PE annually and approximately 60,000 die from the disease. Diagnosis is difficult because symptoms are non-specific; however, a quick and accurate diagnosis is critical because, with appropriate therapy, the risk of recurrent (and potentially fatal) PE can be greatly reduced. Recent publication of prediction rules and improved non-invasive diagnostic tools have simplified diagnostic algorithms for PE. The efficacy of the standard treatment for PE, initial administration of continuous i.v. unfractionated heparin overlapped with long-term oral anticoagulation, is well established. However, newer treatment options such as low-molecular-weight heparins and the pentasaccharides may offer similar efficacy with improved convenience.     

Imaging studies in the diagnosis and management of vasculitis

The term vasculitis encompasses a number of distinct clinicopathologic disease entities. Final diagnosis should be supported by histologic study in most cases. However, different imaging modalities offer the potential for an early visualization of inflammatory vascular abnormalities, provide some diagnostic clues, and allow for an adequate assessment of therapeutic response. This review discusses recent advances in imaging techniques and refinements in vascular imaging methods, as well as a brief mention of research modalities that are increasingly used in studies of pathogenesis or in the assessment of disease progression.     

Update on the diagnosis and management of prostate cancer

Early detection of prostate adenocarcinoma (prostate cancer) through screening tests such as a serum prostate-specific antigen (PSA) test and a digital rectal examination (DRE) enables primary care physicians and urologists to offer patients a broader choice of treatments that are also more likely to provide a cure. Whether men are being over treated or over diagnosed through the widespread use of screening tests remains controversial. This review aims to provide general practitioners with a better understanding of different prostate cancer tests that can be performed and to help them decide which patients should be referred to a urologist for an ultrasound-guided biopsy.     

Update of imaging in the diagnosis and management of axial spondyloarthritis

Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests.This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.     

Update on diagnosis and treatment of pulmonary alveolar microlithiasis

Pulmonary alveolar microlithiasis(PAM)(MIM265100)is a rare disease characterized by the diffuse deposit of microlithiasis in alveolar spaces.PAM could occur worldwide with high prevalence in Asia and Europe.Familial occurrence indicates its autosomal recessive trait and the SLC34A2 gene was identified as the responsible gene for the disease.In spite of the versatile mutation sites in patients from other countries,exon 7and exon 8 might be the most liable gene in Chinese and Japanese patients.Most mutations caused the premature termination of proteins and produced truncated proteins,leading to the blocking of the recycling and degrading of outdated surfactant which is full of phospholipids.The most outstanding clinical feature of PAM is the discrepancy between the paucity of symptoms and the degree of pulmonary involvement.Diagnosis is easy to establish based on typical chest radiograph image and nuclear medicine improves its early diagnosis and active evaluation.Pathology of the unique intra-alveolar lamellar microliths gives strong support for diagnosis.No effective treatment is considered valid currently.However,lung transplantation is effective for advanced-stage patients,and long term treatment of disodium etidronate seems promising.     

Update on diagnosis and treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.     

内分泌性高血压的现状及诊治

近年来我国高血压的患病率迅速上升,患者已达1亿6千万,居世界之首,但其知晓率、治疗率和控制率却很低,据1998年高血压流行病学调查结果,上述“三率”在我国城市分别为56%、27%、4%;在农村分别为40%、18%、3%,较之美国九十年代初的68%、54%、27%,有很大差距。2001年“中国心血管     

Update on diagnosis and management of chronic pancreatitis

Chronic pancreatitis should be considered in all patients with unexplained abdominal pain. The importance of small duct disease without obvious radiographic abnormalities is an important new concept. It is meaningful for the clinician to define whether the patient with chronic pancreatitis has small duct or large duct disease. Diagnostic evaluations should begin with a simple, noninvasive, inexpensive test such as serum trypsinogen, to be followed by more complicated testing such as the secretin stimulation test, particularly in those patients with small duct disease. Non-enteric-coated pancreatic enzyme preparations are preferred for the treatment of pain whereas enteric-coated pancreatic enzyme preparations are the drugs of choice for treating steatorrhea. Octreotide may become an important therapy for treating abdominal pain unresponsive to pancreatic enzyme therapy. Endoscopic treatment of the pain of chronic pancreatitis should be used only in highly selected patients and may cause damage to the pancreas. Surgical ductal decompression is appropriate in selected patients.     

Update on diagnosis and management of chronic pancreatitis

Chronic pancreatitis should be considered in all patients with unexplained abdominal pain. The importance of small duct disease without obvious radiographic abnormalities is an important new concept. It is meaningful for the clinician to define whether the patient with chronic pancreatitis has small duct or large duct disease. Diagnostic evaluations should begin with a simple, noninvasive, inexpensive test such as serum trypsinogen, to be followed by more complicated testing such as the secretin stimulation test, particularly in those patients with small duct disease. Non-enteric-coated pancreatic enzyme preparations are preferred for the treatment of pain whereas enteric-coated pancreatic enzyme preparations are the drugs of choice for treating steatorrhea. Octreotide may become an important therapy for treating abdominal pain unresponsive to pancreatic enzyme therapy. Endoscopic treatment of the pain of chronic pancreatitis should be used only in highly selected patients and may cause damage to the pancreas. Surgical ductal decompression is appropriate in selected patients.     

Parkinson's disease. Update in diagnosis and symptom management

Parkinson's disease (PD) is a progressive neurodegenerative disorder with a high burden of morbidity. Because no diagnostic test exists for PD, clinical knowledge and skill are key to making an early, accurate diagnosis. Diagnostic criteria for PD require at least two of three motor signs: tremor, rigidity, or bradykinesia. Levodopa and the dopamine agonists are considered first-line drug therapy. Recent studies have shown a lower incidence of dyskinesia in patients who began therapy with a dopamine agonist, although levodopa may be better tolerated by patients age 70 or older. Combinations of medications and rehabilitative, alternative, and surgical therapies can often help patients achieve adequate control of PD motor symptoms and maintain a high quality of independent living.     

侵袭性肺真菌病诊治的再认识

近年来,侵袭性肺真菌病(invasive pulmonary fungal diseases,IPFD)已经逐渐为广大医务工作者所认识,尤其是国内外各种有关侵袭性真菌感染的诊治指南不断问世,如欧洲癌症研究和治疗组织/侵袭性真菌感染协作组(EORTC/IFICG)和美国真菌病研究组(MSG)制定的共识[1],美国感染病学会(IDSA)制定的曲霉病和念珠菌病临床实践指南[2-3],我国血液、呼吸和ICU等专业委员会制定的有关侵袭性真菌感染(IFI)的诊治原则以及中华医学会呼吸病学分会制定的"肺真菌病诊断和治疗专家共识"[4]等,极大地提高了临床医生对侵袭性真菌病的认识和诊治水平,但同时我们在临床工作中也发现,即使按照共识或指南的要求去做,依然还有许多问题不能解决,如早期诊断的可靠性、生物标志物的临床诊断价值、经验性治疗的时机和疗程等.随着近年来循证医学证据的不断增多,这些问题逐渐有了新的解释和认识,现结合自己的临床诊治体会谈点浅知拙见,供大家参考指正.     

Update on research, diagnosis and management of alphal-antitrypsin deficiency

Formed in response to a World Health Organization recommendation, the Alpha One International Registry (AIR) is a multinational research program focused on alphal-antitrypsin (AAT) deficiency. Each of the nearly 20 participating countries maintains a National Registry of patients with AAT deficiency and contributes to an international database in Malm?, Sweden, that is designed to increase understanding of AAT deficiency as well as safeguard patient confidentiality. AIR members are engaged in active and wide-ranging investigations to improve the diagnosis, monitoring and therapy of the disease. The AIR membership meets biennially to exchange views and research findings. The third biennial meeting was held in Barcelona, Spain, June 11 -13, 2003. A wide range of AAT deficiency-related topics were addressed, encompassing molecular and cellular pathophysiologic mechanisms, clinical epidemiology, diagnostic advances, current and investigational therapeutic approaches, and progress in registry development. Valuable cross-fertilization of concepts and scientific observations was apparent between AAT deficiency research and other fields of biomedicine. The proceedings of the meeting are summarized in this report.     

Update on the immunology, diagnosis and management of systemic lupus erythematosus

Abstract Lupus occurs with a prevalence of 2?9 in 10 000 people, targeting female and indigenous populations in particular. Lupus and related systemic autoimmune syndromes (scleroderma, Sjögren's syndrome, rheumatoid arthritis and polymyositis) result from a similar set of genetically and environmentally modulated immune disturbances, and the diagnostic and management approach to these conditions is broadly comparable. Evanescent , vague symptoms, restrictive diagnostic criteria and low diagnostic suspicion might have resulted in the under‐diagnosis of these problems in the past, imposing considerable burdens on sufferers and the community. Serological screening should be employed cautiously and wisely, given the rapidly occurring changes in methodology, which have lowered their specificity. Close liaison with the immunology laboratories performing these tests is therefore advisable. Clinicians should emphasize the improving prognosis of lupus and related conditions as a result of earlier disease detection, improved educational support systems and refined medical therapies. (Intern Med J 2004: 34: 338?347)