Latest Updates

Chronic Lymphocytic Leukemia and other Chronic Lymphoid Leukemias

    • Lymphocyte immunophenotyping by flow cytometry can distinguish between malignant (clonal) and nonmalignant (nonclonal) causes of lymphocytosis and eliminates the need to rely on the duration or magnitude of the lymphocyte count elevation to differentiate CLL and other lymphoproliferative disorders from reactive causes of lymphocytosis.
    • Chromosome analysis by FISH predicts patient survival. In a retrospective analysis of a heterogeneous patient population, many of whom had advanced-stage disease and were previously treated, Dohner and colleagues developed a hierarchical system that assigns patients to one of five categories with widely different median survival.
    • The development and therapeutic application of anti-CD20 monoclonal antibodies in the 1990s revolutionized the care of patients with lymphoid malignancy. Several trials evaluated the efficacy of combining monoclonal antibodies with chemotherapy (CIT) for patients with CLL.

Chronic Lymphocytic Leukemia and other Chronic Lymphoid Leukemias

    • Lymphocyte immunophenotyping by flow cytometry can distinguish between malignant (clonal) and nonmalignant (nonclonal) causes of lymphocytosis and eliminates the need to rely on the duration or magnitude of the lymphocyte count elevation to differentiate CLL and other lymphoproliferative disorders from reactive causes of lymphocytosis.
    • Chromosome analysis by FISH predicts patient survival. In a retrospective analysis of a heterogeneous patient population, many of whom had advanced-stage disease and were previously treated, Dohner and colleagues developed a hierarchical system that assigns patients to one of five categories with widely different median survival.
    • The development and therapeutic application of anti-CD20 monoclonal antibodies in the 1990s revolutionized the care of patients with lymphoid malignancy. Several trials evaluated the efficacy of combining monoclonal antibodies with chemotherapy (CIT) for patients with CLL.

Injuries to the Upper Urogenital Tract

    • Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
    • Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
    • A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy

Visceral Artery Aneurysms

    • Visceral artery aneurysms are increasingly identified with the widespread use of advanced imaging techniques.
    • Increasing incidence is thought to be linked with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma.
    • Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies. 

Psoriasis

    • Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
    • Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
    • Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.

Management of Depression, Part 1: Identification and Diagnosis

    • The two leading classification systems for diagnosing mental illness are the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association and the ICD-10, the most recent edition of the International Classification of Diseases published by the World Health Organization.
    • There is no standard medical workup for a patient presenting with depression. Health care providers use their clinical judgment in conjunction with a good history, review of medical systems, and physical examination. Indiscriminate ordering of laboratory tests in depressed patients rarely yields useful results. A pooled analysis of psychiatric inpatients showed the rates of clinically significant laboratory findings to be remarkably low.
    • Single-photon emission CT (SPECT) has been promoted by some as a reliable tool in diagnosing and treating a number of psychiatric disorders, including depression. SPECT measures regional cerebral blood flow using a gamma-emitting tracer in the blood.

Noncandidal Fungal Infections

    • Members of the European Organisation for Research and Treatment of Cancer–Invasive Fungal Infection Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for invasive fungal infections for clinical research.
    • The development of standardized methodology for antifungal susceptibility testing is another recent advance in the laboratory evaluation of Aspergillus species. Although azole resistance by Aspergillus species is unusual, patients exposed chronically to antifungal triazoles have been reported to have refractory infection caused by isolates with elevated minimum inhibitory concentrations.
    • Fusarium and Scedosporium species are increasingly common causes of infections in surgical patients, especially in recipients of stem cell or organ transplants.

Psoriasis

    • Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
    • Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
    • Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.
« Previous | Next »
Updates per yearSpecialty updatesNumber of sections