The American journal of medicine
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Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner.
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Historically, treatment for symptomatic lower extremity varicose veins has consisted primarily of surgical stripping of pathologic veins. Over the past 2 decades, therapeutic options for lower extremity varicose veins has greatly expanded and now includes several percutaneous and endovascular techniques. This article will discuss the pathophysiology, clinical significance and current therapy for varicose veins.
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Angiogenesis has become an innovative target in cancer therapy. Agents that inhibit vascular endothelial growth factor (VEGF), one of the most potent promoters of angiogenesis, and its receptor have significant implications for clinical practice. Bevacizumab, sorafenib, sunitinib and other anti-VEGF drugs are frequently complicated by mild proteinuria and hypertension. ⋯ Glomerular injury may develop from loss of VEGF effect on maintaining the filtration barrier. Adverse effects of anti-VEGF class of drugs are manageable but require close attention and follow-up. Understanding the fundamentals of anti-VEGF drugs' mechanism of action and their clinical implications is crucial when caring for patients receiving anti-VEGF therapy.
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Review Case Reports
The management of hyperkalemia in patients with cardiovascular disease.
The development of hyperkalemia is common in patients with cardiac and kidney disease who are administered drugs that antagonize the renin-angiotensin-aldosterone system (RAAS). As the results of large-scale clinical trials in hypertension, chronic kidney disease, and congestive heart failure demonstrate benefits of RAAS blockade alone or, in some cases, in combination therapies, the incidence of hyperkalemia has increased in clinical practice. Although there is potential for adverse events in the presence of hyperkalemia, there also are potential benefits of RAAS blockers that support their use in high-risk patient populations. Management of hyperkalemia may be improved by identifying the levels of potassium that may potentially induce harm and using appropriate strategies to avert the levels that may be dangerous or life threatening.
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Recent studies have called into question the benefit of perioperative beta blockade, especially in patients at low to moderate risk of cardiac events. Once considered standard of care, the role of beta-blocker therapy now lies mired in conflicting data that are difficult to apply to the at-risk patient. We provide an overview of the evolution of perioperative beta blockade, beginning with the physiology of the adrenergic system, with emphasis on the biologic rationale for the perioperative implementation of beta-blockers. ⋯ This paradigm holds true especially in those at low-to-moderate cardiovascular risk profiles. Potential explanations for these paradoxical results are discussed, stressing the key differences between earlier and current studies that may explain these divergent outcomes. We conclude by commenting on performance measures as they relate to perioperative beta-blockers and make recommendations for the continued safe implementation of this practice.