Annual review of medicine
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Annual review of medicine · Jan 1996
ReviewThe immunotherapy of solid cancers based on cloning the genes encoding tumor-rejection antigens.
Cellular immune reactions play a major role in the host reaction to growing cancers. Tumor infiltrating lymphocytes (TIL) can be isolated from melanomas and can specifically recognize unique tumor antigens. The adoptive transfer of TIL plus interleukin-2 can mediate tumor regression in patients with metastatic melanoma. ⋯ Active immunization can be performed using either the immunodominant peptides present in these proteins or by incorporating the tumor antigen genes into recombinant viruses. Cancer vaccine trials using many of these approaches have recently begun. Attempts to apply a similar strategy to epithelial tumors such as breast and ovarian cancer are underway.
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Tuberculosis (TB) remains an important public health problem worldwide, resulting in a estimated 8 to 10 million new cases and 2 to 3 million deaths each year. Between 1953 and 1985, the number of TB cases in the US declined by an average of 6% per year. However, since 1985, TB has been increasing in the US. ⋯ The unusual radiographic findings and the increased likelihood of extrapulmonary TB in HIV-infected persons make diagnosis of the disease problematic. Lastly, concomitant with the resurgence of TB has been the emergence of drug resistance. All of these factors make successful control of TB in the US difficult.
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Although older individuals drink less and report fewer alcohol-related problems than do younger individuals, alcohol use and abuse are significant health issues for older patients. The signs and symptoms of alcohol problems and dependence in the elderly may not only differ from those of young problem drinkers, but may also be present at lower levels of alcohol consumption. Older alcoholics do well in alcohol treatment. Therefore, discussion of alcohol consumption is a critical part of every history and physical examination for all patients, including older individuals.
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Annual review of medicine · Jan 1993
ReviewNeuromodulation techniques for medically refractory chronic pain.
Advances in our knowledge of the physiology of pain transmission and modulation have created new surgical options for the control of chronic pain. The pain modulation network can be activated by administration of spinal opiates or by electrical stimulation of the nervous system with transcutaneous, peripheral nerve, spinal cord, and deep brain stimulation. The theoretical basis and the clinical applications of neurostimulation for the treatment of medically intractable chronic pain are reviewed.
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Erythropoietin is the only hematopoietic growth factor that behaves like a hormone. Produced in the kidneys and the liver, erythropoietin interacts with erythroid progenitor cells in the bone marrow to promote their proliferation and maintain their viability. Erythropoietin production is regulated at the level of its gene by tissue oxygenation; hypoxia or anemia stimulates erythropoietin production, and erythrocytosis suppresses it, but never completely. The plasma erythropoietin concentration reflects erythropoietin production and can be used to define erythropoietin-deficient states in which anemia may be amenable to correction by administration of recombinant human erythropoietin.