Inhaled corticosteroids in chronic obstructive pulmonary disease: is there a long-term benefit?

PURPOSE OF REVIEW: The use of inhaled corticosteroids is one of the most controversial issues in COPD pharmacotherapy. Experts disagree about the benefits and harms of ICS for patients with COPD, yet a majority of patients with COPD are being treated with inhaled corticosteroids. This is a review of the most recent literature on this subject. RECENT FINDINGS: Evidence suggests that ICS, with or without a long-acting beta2-agonist, are cost-effective in reducing exacerbation rates and retarding the decline in health status of COPD patients, although they do not significantly modify the rate of decline in FEV1 or change mortality. This discrepancy is likely related to the differences in pathology of COPD when compared with asthma. Evidence also suggests that ICS may be safe regarding the effects on adrenals and bone mineral density. We have yet to identify reliable criteria for predicting a response to ICS in COPD, but it has become clear that in mild disease, no beneficial effect has been demonstrated. SUMMARY: In contrast to asthma, inhaled corticosteroids should not be used as a first-line medication in patients with COPD. Identification of patients with COPD who might benefit from long-term treatment with ICS remains paramount.     

Molecular analysis of pancreatic juice: a helpful tool to differentiate benign and malignant pancreatic tumors?

Chronic pancreatitis is an important predisposing condition leading to pancreatic carcinoma. As the differential diagnosis between these diseases may be difficult in 1 patient, the detection of specific tumor markers in pancreatic juice is an attractive diagnostic tool. Many studies have investigated tumor-mediated molecular alterations of the pancreatic juice, as k-ras mutations, telomerase reactivation, or promoter methylation of the tumor-suppressor genes p16INK4a and p14ARF. In this overview, we summarize these studies and conclude that molecular analysis of pancreatic juice is not useful for everyday care today. The high specificity of molecular alterations in pancreatic cancer in some pilot studies is waiting to be reproduced in large prospective trials, and has the potential to be a strong complementary marker of malignancy in patients with a pancreatic mass of uncertain dignity.     

E-cadherin and calretinin as immunocytochemical markers to differentiate malignant from benign serous effusions

AIM:To investigate the expressions of E-cadherin and calretininin exfoliated cells of serous effusions and evaluate their valuesin distinguishing malignant effusions from benign ones.METHODS:Fresh serous effusion specimens werecentrifuged and exfoliated cells were collected.Cells werethen processed with a standardized procedure,includingparaformaldehyde fixation,BSA-PBS solution washing andsmears preparation.E-cadherin and calretinin were detectedby immunocytochemistry (ICC).RESULTS:In the exfoliated cells of serous effusions,mostof carcinoma cells only expressed E-cadherin,and most ofmesothelial cells only expressed calretinin,and benign cells(lymphocytes and granulocytes) did not express either ofthem.For E-cadherin,85.7% (30/35) of malignant effusionsand 8.1% (3/37) of benign fluids were ICC-positive (P<0.001).The sensitivity of E-cadherin ICC in the diagnosis ofmalignant effusions was 85.7%,specificity 91.9%,anddiagnostic rate 88.9%.For calretinin,94.6% (35/37) ofbenign effusions and 11.4% (4/35) of malignant effusionswere ICC-positive (P<0.001).The sensitivity of calretininICC in the diagnosis of benign effusions was 94.6%,specificity 88.6%,and diagnostic rate 91.7%.For diagnosisof benign and malignant effusions by combining E-cadherinICC and calretinin ICC,the specificities were up to 100%and 97.1%,respectively.CONCLUSION:E-cadherin ICC and calretinin ICC aresensitive and specific in differential diagnosis of benignand malignant serous effusion specimens and specificitiesare evidently improved when both markers are combined.     

Prehypertension and the cardiometabolic syndrome: is there any value in pharmacologic intervention?

The potential benefit of drug therapy for prehypertension and the cardiometabolic syndrome has previously not been confirmed. This case represents a patient who may show slowing or avoiding progression from prehypertension to hypertension based on recent trial evidence and assists the clinician in identifying the risk associated with blood pressure elevation before a conventional cut point of 140/90 mm Hg.     

Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas?

OBJECTIVE: The aim of this study was to evaluate the ability of endoscopic ultrasound (EUS) alone to predict and differentiate malignant from benign cystic lesions of the pancreas. METHODS: From January, 1995, to August, 1999, 98 cases of pancreatic cystic lesions were evaluated by EUS; all of these were originally imaged by cross-sectional modalities that were not diagnostic. Among these, surgical/pathological correlation was available in 48 patients. The original endosonographic images were reviewed by two endosonographers who were blinded to each other's interpretation and to the surgical and pathological interpretation. The EUS images were assessed for the presence or absence of the following characteristics: 1) wall, 2) solid component, 3) septae, 4) lymphadenopathy, and 5) number of cysts. These characteristics were then correlated with the surgical and pathological findings and were assessed to determine if any were predictors of the lesion being benign or malignant. RESULTS: For reviewer A, the presence of a solid component by EUS was the only statistically significant predictor of malignancy (odds ratio = 4.73, 95% CI = 1.13-19.68, p = 0.03). However, 61% of patients with benign lesions were also interpreted by EUS to have a solid component. For reviewer B, none of the features were found to be significant predictors of a malignant lesion. When the results of both reviewers were combined, the presence of a solid component was not found to be a statistically significant predictor of malignancy (odds ratio = 1.046, 95% CI = 0.99-1.09, p = 0.07). CONCLUSION: Endosonographic features cannot reliably differentiate between benign and malignant cystic lesions of the pancreas after a nondiagnostic cross-sectional modality.     

Serum cortisol in dengue and dengue hemorrhagic fever: is there any clinical implication?

Dengue is an important mosquito-borne viral infection. This infection can be seen in many tropical countries and caused many infectious cases annually. The biochemical profile change during infection is very interesting. Here, the authors studied on a rarely mentioned parameter, serum cortisol. The levels of serum cortisol in the cases with dengue and dengue hemorrhagic fever were studied, reported and discussed.