The Medical clinics of North America
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Med. Clin. North Am. · Jan 2013
Pancreas transplantation and reversal of diabetic nephropathy lesions.
Pancreas transplantation is the only available treatment that has restored long-term (10 or more years) normoglycemia without the risks of severe hypoglycemia, allowing testing of the reversibility of diabetic nephropathy lesions. The authors studied renal structure before and 5 and 10 years after pancreas transplantation in nonuremic patients with long-term type 1 diabetes, with established diabetic nephropathy lesions at baseline. Diabetic glomerular lesions were not significantly changed at 5 years but were dramatically improved after 10 years, with most patients' glomerular structure returning to normal at the 10-year follow-up. These studies also showed that tubulointerstitial remodeling was also possible.
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NSTI is a life-threatening, surgical, and medical emergency. Clinical presentation, at least in the initial phase, can be misleading. ⋯ A high index of suspicion is important in early recognition and in instituting prompt therapy without delay. Early diagnosis, aggressive surgical debridement, aggressive supportive care, and optimal presumptive antibiotic therapy significantly improve morbidity and mortality associated with NSTIs.
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The diversity in intra-abdominal/pelvic infections is more than any other organ system. Several clinical scenarios can end up in intra-abdominal infections. ⋯ Intra-abdominal infections can masquerade as fever of obscure origin or as dysfunction of neighboring organs, such as lower lobe pneumonia related to a subphrenic abscess or an abscess causing small bowel obstruction. An urgent surgical intervention is the mainstay of the management of serious intra-abdominal infections.
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Med. Clin. North Am. · Nov 2012
ReviewRole of molecular diagnostics in the management of infectious disease emergencies.
In the setting of infectious disease emergencies, rapid and accurate identification of the causative agent is critical to optimizing antimicrobial therapy in a timely manner. It is clearly evident that the age of molecular diagnostics is now upon us, with real-time PCR becoming the standard of diagnosis for many infectious disease emergencies in either monoplex or multiplex format. Other molecular techniques such as whole or partial genome sequencing, microarrays, broad-range PCR, restriction fragment length polymorphisms, and molecular typing are also being used. ⋯ These new technologies will not substitute for a proper history and physical examination leading to a thoughtful differential diagnosis. None the less, these new molecular tests increase the capability of the diagnostician to rapidly identify the microbiological etiology of an infection. An added advantage of rapid diagnostic tests often not emphasized is the capability to rule out certain diagnoses for which unnecessary antimicrobial therapy may otherwise be instituted and/or continued.
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The prevalence of chemotherapy-related cardiac disease is increasing and management demands a multidisciplinary approach from cardiologists and oncologists. Pretreatment identification of predisposing risk factors and assessment of cardiac function before and at intervals during and after therapy with cardiotoxic agents are necessary. In clinical practice, surveillance is largely performed using transthoracic echocardiography or multi-gated radionuclide angiography. Imaging strategies that detect cardiac injury before overt left ventricular systolic dysfunction provide an opportunity for early intervention and improved cardiac outcomes.