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- Volume 44, 1993
Annual Review of Medicine - Volume 44, 1993
Volume 44, 1993
- Review Articles
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Antibiotic Therapy for Chronic Infection of Pseudomonas in the Lung
Vol. 44 (1993), pp. 1–10More LessChronic Pseudomonas aeruginosa lung infection is an endobronchiolitis characterized by the microcolony mode of growth (biofilm). Early colonization is treated with oral ciprofloxacin combinedw ith colistin inhalation. Chronic infection is treated with “maintenance chemotherapy” consisting of β-lactam antibiotics and tobramycin intravenously in combination with colistin inhalation four times yearly.
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Role of Bacterial Cytotoxins in Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura
Vol. 44 (1993), pp. 11–18More LessBacterial cytotoxins, which are produced by Shigella dysenteriae 1 and certain E. coli serotypes, kill mammalian cells by inhibiting protein synthesis. They have been related to hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, probably by initial insult to vascular endothelial cells. This insight opened new avenues of research and possible interventions.
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Management of Primary Hyperparathyroidism
Vol. 44 (1993), pp. 19–26More LessPrimary hyperparathyroidism is a common disease that can be accurately diagnosed and effectively treated in most patients. The diagnosis is established by a persistent elevation of serum calcium and parathyroid hormone and by clinical evaluation. Surgery is the appropriate treatment, and preoperative localization procedures are seldom indicated. Selected patients with mild disease may be followed by procedures devised to identify deterioration of skeletal, neurological, and renal function. The accurate diagnosis and effective treatment of primary hyperparathyroidism are rewarding clinical experiences for the endocrinologist and surgeon.
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Cellular Mechanisms of Acute Ischemic Injury in the Kidney
Vol. 44 (1993), pp. 27–37More LessHypoxic injury to tubular cells represents an early event in acute renal failure. Although important advances have been made in the understanding of hypoxic injury at the cellular level (e.g. loss of cell polarity, production of free radicals, calcium entry, and the activation of genes for protection or regeneration), the basic mechanisms responsible for organ failure remain elusive. The renal medulla, working on the brink of anoxia and being the site of concentration for many toxins, may be an important target for the synergistic events of hypoperfusion and nephrotoxic exposure that often precede human acute renal failure.
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The Diagnosis and Treatment of Panic Disorder
Vol. 44 (1993), pp. 39–51More LessPanic attacks and panic disorder often first present in the emergency room or to the family practitioner. The presentation and differential diagnosis of this disabling disorder are described in this review, together with the etiology and health effects of the syndrome. Both medication and psychological treatments are described, as are the indications, side effects, and expected outcome for each therapy alone and in combination.
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Diagnosis and Treatment of Obsessive Compulsive Disorder
Vol. 44 (1993), pp. 53–61More LessObsessive compulsive disorder (OCD) is a common anxiety disorder that appears to be due to a disturbance in central serotonergic functioning. Drugs, such as clomipramine, that inhibit neuronal reuptake of serotonin are effective in treating OCD. Behavioral therapy techniques are also effective.
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Serum Transferrin Receptor
Vol. 44 (1993), pp. 63–74More LessThe transferrin receptor plays a critical role in iron metabolism by precisely contrOlling the flow of transferrin iron into body cells. A soluble truncated form of the receptor can be detected in human serum using sensitive immunoassays, and the initial clinical experience with this new measurement indicates that it reflects the total body mass of tissue receptor. Serum receptor levels rise significantly with tissue iron deficiency and the heightened demand for iron associated with expansion of the erythroid marrow. The serum receptor provides a quantitative measure of functional iron deficiency and distinguishes the associated anemia from that of chronic disease. If iron deficiency is excluded, the serum receptor provides a quantitative measure of total erythropoiesis that is more sensitive and less invasive than bone marrow examination currently used to assess red cell precursor mass. Performed in conjunction with serum ferritin measurements, the serum receptor will be useful in establishing the true prevalence of iron deficiency anemia in population studies.
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Pathogenesis and Pathophysiology of Bacterial Meningitis
Vol. 44 (1993), pp. 103–120More LessDespite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mortality from bacterial meningitis remains unacceptably high. Animal models have proven to be extremely valuable in the study of the pathogenesis and pathophysiology of bacterial meningitis, with the hopes of providing new information that may lead to an improved outcome from this disorder.
Bacterial meningitis usually begins with nasopharyngeal colonization by a new organism, followed by invasion and bacteremia. Subsequently there is central nervous system invasion, although the exact site and mechanism of meningeal invasion are unknown. The generation of an intense subarachnoids pace inflammatory response, induced by release of bacterial virulence factors and/or inflammatory cytokines, contributes to many of the pathophysiologicc onsequences of bacterial meningitis, including cerebral edema, increased intracranial pressure, and alterations of cerebral blood flow. Attenuation of this inflammatory response ( e.g. by co-administration of antiinflammatory agents) may diminish many of these pathophysiologic consequences of meningitis, and perhaps improve morbidity and mortality from this disorder
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Role of Insulin Resistance in Human Disease (Syndrome X): An Expanded Definition
Vol. 44 (1993), pp. 121–131More LessResistance to insulin-mediated glucose uptake is characteristic of individuals with impaired glucose intolerance or non-insulin-dependent diabetes, and it also occurs commonliyn patients with high blood pressure. The physiological response to a decrease in insulin-mediated glucose uptake is an increase in insulin secretion, and as long as a state of compensatory hyperinsulinemia can be maintained, frank decompensation of glucose tolerance can be prevented. However, it is likely that the defect in insulin action and/or the associated hyperinsulinemia will lead to an increase in plasma triglyceride and a decrease in high density lipoprotein-cholesterol concentration, and high blood pressure. It seems likely that the cluster of changes associated with resistance to insulin-mediated glucose uptake comprise a syndrome, which plays an important role in the etiology and clinical course of patients with non-insulin-dependent diabetes, high blood pressure, and coronary heart disease.
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Nonatheromatous Arterial Thrombosis
A I Schafer, and M H KrollVol. 44 (1993), pp. 155–170More Less
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Physiologic Role of the Normal Pericardium
Vol. 44 (1993), pp. 171–180More LessBecause of the characteristics of the parietal pericardial tissue, the intact pericardial sac has a limited reserve volume, becoming relatively non-compliant when the heart volume is at the high end of the normal physiologic range. Pericardial restraint of the heart is best considered as a contact force. Measured with flattened balloons, the magnitude of pericardial contact pressure is probably several mmHg less than right atrial pressure. The diastolic pressure-volume relationship of the right ventricle, and to a lesser degree of the left ventricle, shifts downward following pericardiectomy. In dogs, the pericardium has been shown to limit maximal cardiac output. Some disease states associated with a rapid increase in total heart volume, including subacute mitral regurgitation and right ventricular infarction, demonstrate an increased pericardial influence on cardiac filling.
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Prognostic Factors and Therapeutic Decisions in Axillary Node-Negative Breast Cancer
Vol. 44 (1993), pp. 201–210More LessThe incidence of node-negative breast cancer is increasing, and it is becoming a more commonly encountered clinical problem. Prognostic factors such as tumor size, histopathological characteristics, receptor status, proliferative markers, biochemical alterations, and gene abnormalities can be useful in assessing the risk of cancer recurrence after primary local therapy. By accurately assessing the risk of recurrence, informed decisions can be made about whether or not to treat with adjuvant systemic therapy.
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Primary Sclerosing Cholangitis
Vol. 44 (1993), pp. 221–227More LessPrimary sclerosing cholangitis (PSC) is an inflammatory disease of unknown etiology. It affects the biliary system and is characterized by fibrosis and progressive obliteration of extrahepatic and intrahepatic bile ducts. Its frequent coexistence with antibody-mediated diseases, certain human leukocyte antigens, and altered lymphocyte mechanisms suggests a strong autoimmune and genetic etiology. Other conditions such as recurrent cholangitis, acquired immunodeficiency syndrome, previous bile duct surgery, bile duct anomalies, or biliary stone disease may result in similar clinical patterns and radiologic profiles. PSC can be asymptomatic and slowly progressive over years, or it may develop rapidly with an inexorable progression to cirrhosis and portal hypertension. Clinical and biochemical abnormalities may suggest PSC, but it is the characteristic radiological pattern that secures the diagnosis. Once viewed as a rare entity, the widespread use of radiological and endoscopic methods have increased physician awareness. There is no successful medical treatment for PSC. While traditional surgical approaches have been directed at the relief of cholangitis and biliary obstruction, liver transplantation has emerged as definitive therapy for patients with PSC complicated by cirrhosis or recurrent bouts of cholangitis.
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Previous Volumes
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Volume 76 (2025)
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Volume 75 (2024)
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Volume 74 (2023)
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Volume 73 (2022)
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Volume 72 (2021)
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Volume 71 (2020)
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Volume 70 (2019)
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Volume 69 (2018)
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Volume 68 (2017)
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Volume 67 (2016)
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Volume 66 (2015)
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Volume 65 (2014)
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Volume 64 (2013)
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Volume 63 (2012)
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Volume 62 (2011)
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Volume 61 (2010)
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Volume 60 (2009)
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Volume 59 (2008)
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Volume 58 (2007)
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Volume 57 (2006)
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Volume 56 (2005)
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Volume 55 (2004)
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Volume 54 (2003)
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Volume 53 (2002)
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Volume 52 (2001)
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Volume 51 (2000)
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Volume 50 (1999)
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Volume 49 (1998)
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Volume 48 (1997)
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Volume 47 (1996)
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Volume 46 (1995)
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Volume 45 (1994)
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Volume 44 (1993)
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Volume 43 (1992)
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Volume 42 (1991)
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Volume 41 (1990)
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Volume 40 (1989)
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Volume 39 (1988)
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Volume 38 (1987)
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Volume 37 (1986)
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Volume 36 (1985)
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Volume 35 (1984)
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Volume 34 (1983)
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Volume 33 (1982)
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Volume 32 (1981)
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Volume 31 (1980)
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Volume 30 (1979)
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Volume 29 (1978)
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Volume 28 (1977)
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Volume 27 (1976)
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Volume 26 (1975)
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Volume 25 (1974)
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Volume 24 (1973)
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Volume 23 (1972)
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Volume 22 (1971)
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Volume 21 (1970)
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Volume 20 (1969)
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Volume 19 (1968)
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Volume 18 (1967)
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Volume 17 (1966)
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Volume 16 (1965)
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Volume 15 (1964)
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Volume 14 (1963)
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Volume 13 (1962)
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Volume 12 (1961)
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Volume 11 (1960)
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Volume 10 (1959)
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Volume 9 (1958)
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Volume 8 (1957)
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Volume 7 (1956)
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Volume 6 (1955)
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Volume 5 (1954)
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Volume 4 (1953)
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Volume 3 (1952)
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Volume 2 (1951)
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Volume 1 (1950)
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Volume 0 (1932)