The American journal of the medical sciences
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Focal segmental glomerulosclerosis (FSGS) is a common primary glomerulopathy in African Americans. Prolonged treatment with steroids is recommended for FSGS in those with nephrotic-range proteinuria, but strong evidence for this recommendation, especially in African-American adults, is lacking. We reviewed our experience with steroids in FSGS in a predominantly African-American cohort. ⋯ Renal function, severity of the renal lesion, and blood pressure determine renal survival in FSGS. A beneficial effect of steroids was not observed in this predominantly African-American adult cohort.
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Spinal hydatid cysts account for 1% of all cases of hydatid disease; primary intradural hydatid cysts are uncommon. We present a case of pathologically confirmed intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. ⋯ An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after surgical removal. To our knowledge, this is the 25th case of hydatid cyst at an intradural extramedullary location reported in the literature.
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The popularity of gastric bypass surgery for treatment of morbid obesity has been increasing in recent years. Osteomalacia and osteoporosis are commonly observed in patients who have had partial gastric resections for treatment of peptic ulcer disease. Recently, we encountered four patients with previous gastric bypass surgery who had metabolic bone disease similar to that reported in the older literature in patients who had partial gastrectomies. ⋯ Relatively little has been published in the general medical literature about this postoperative complication of bariatric surgery. Yet, nearly all patients after bariatric surgery will receive their long-term follow-up from a primary care physician. Physicians and patients need to be aware of this complication and take measures to identify and prevent it.
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Diffuse large B-cell lymphoma initially appears with intrathoracic manifestations in up to 26% of patients. However, pulmonary involvement with hematologic malignancies rarely manifests clinically as acute respiratory distress syndrome (ARDS). ⋯ This case illustrates the importance of including lymphoma in the differential diagnosis of otherwise unexplained ARDS. Early recognition and prompt treatment may affect survival.
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Randomized Controlled Trial Meta Analysis Comparative Study Clinical Trial
A comparison of bedtime insulin glargine with bedtime neutral protamine hagedorn insulin in patients with type 2 diabetes: subgroup analysis of patients taking once-daily insulin in a multicenter, randomized, parallel group study.
Basal insulin is frequently administered once daily. This subgroup analysis of a multicenter, randomized, parallel study compared insulin glargine (Lantus Aventis Pharmaceuticals, Bridgewater, NJ) with neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes, evaluating only patients treated previously with once-daily NPH insulin. ⋯ Bedtime insulin glargine is as effective as bedtime NPH insulin in improving glycemic control, with significantly less hypoglycemia.