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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sarcoidosis disease expression differs along racial/ethnic lines and black race has been cited as a poor prognostic factor. Besides genetic, healthcare, and socioeconomic factors, comorbid illnesses may influence sarcoidosis disease expression. We set out to investigate the association between comorbid illnesses and chest radiographic severity in a population of African-American sarcoidosis patients. The study was designed as a retrospective database analysis. The hospital and outpatient databases of the Grady Health System were searched to capture adult patients between November 1999 and December 2003 with the ICD-9 codes of 135 or 519.8, along with all associated secondary and tertiary diagnostic codes. Patient electronic pathology and radiographic reports were reviewed for tissue biopsies showing noncaseating granulomas and for chest radiographic Scadding stage. A total of 165 African-American patients were identified (64% female, 43 +/- 10 years old). Ninety percent (149/165) had comorbid illnesses. The most frequent chronic comorbid illnesses were hypertension (39%), diabetes mellitus (19%), anemia (19%), asthma (15%), gastroesophageal reflux disease (15%), depression (13%), and heart failure (10%). Females had increased frequency and clustering of chronic illnesses. Chest radiographic stages were more severe in patients with anemia, depression, and those less than 40 years old. Males, within each chronic illnesses category, had more severe CXR stages compared to females; however, significance was not achieved. We concluded that most adult patients with sarcoidosis have comorbid illnesses and these, in addition to gender differences, may influence sarcoidosis disease expression. Screening for comorbid illnesses should be an important aspect of sarcoidosis patient management.
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PMID:Comorbid illnesses and chest radiographic severity in African-American sarcoidosis patients. 1738 99

Asthma control is a key point in patient management. GINA's most recent report emphasises the need to investigate uncontrolled asthma, of which non-compliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes. The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE) in cases of difficult- -to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes. In this group (n=254), 28 (11%) had severe persistent asthma and their mean age was 44 +/- SD18 years old. 86% were females. Of these, 57% (n=16) had uncontrolled disease: 35% (n=6) due to non-compliance with treatment; 29% (n=5) pulmonary thrombombolism (scintigraphic confirmation); 12% (n=2) severe rhinosinusitis; 6% (n=1) hypereosinophilic syndrome; 6% (n=1) persistent allergen exposure and 6% (n=1) are still being investigated. Patients with TPE (mean age 56 +/- SD9 years old; 80% females; 80% Caucasians) were diagnosed with asthma as adults (mean age 37 +/- SD14 years old). The mean time until the diagnosis of TPE was 18 +/- SD12 years. Predisposing factors for TPE were venous insufficiency (40%), hypertension (40%) and deficit of functional protein C and S (20%). All these patients received anticoagulant therapy (80% are still medicated). It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group. This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled asthma.
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PMID:[Pulmonary embolism and difficult-to-treat asthma]. 1818 29

As newer, molecularly targeted, anticancer drugs are entering clinical practice, a wide array of previously unrecognised and ill defined side effects of these drugs are increasingly observed. Sorafenib and sunitinib are two of these novel agents, acting on tumour angiogenesis as well as on other key proliferative pathways; recently approved for the treatment of advanced kidney cancer, they may cause peculiar cutaneous, vascular and mucosal toxicities, including hand-foot skin reaction, skin rash, hypertension and GERD-like oesophagitis/gastritis. In this review, we shall deal with these poorly recognised, but sometimes extremely distressing, toxicities; pathophysiologic mechanisms will be discussed and suggestions for treatment of each toxicity will be proposed, based on the few pieces of evidence available and, especially, on our empirical experience.
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PMID:Uncovering Pandora's vase: the growing problem of new toxicities from novel anticancer agents. The case of sorafenib and sunitinib. 1818 24

More than half of the European population are overweight (body mass index (BMI) > 25 and < 30 kg/m2) and up to 30% are obese (BMI > or = 30 kg/m2). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m2 and for those with a BMI of more than 35 kg/m2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research.
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PMID:Surgical treatment of obesity. 1823 Aug 19

Epidemiologic data indicate that obesity increases the prevalence and incidence of asthma and reduces asthma control. Obese mice exhibit innate airway hyperresponsiveness and augmented responses to certain asthma triggers, further supporting a relationship between obesity and asthma. Here I discuss several mechanisms that may explain this relationship. In obesity, lung volume and tidal volume are reduced, events that promote airway narrowing. Obesity also leads to a state of low-grade systemic inflammation that may act on the lung to exacerbate asthma. Obesity-related changes in adipose-derived hormones, including leptin and adiponectin, may participate in these events. Comorbidities of obesity, such as dyslipidemia, gastroesophageal reflux, sleep-disordered breathing, type 2 diabetes, or hypertension may provoke or worsen asthma. Finally, obesity and asthma may share a common etiology, such as common genetics, common in utero conditions, or common predisposing dietary factors. Novel therapeutic strategies for treatment of the obese patient with asthma may result from an increased understanding of the mechanisms underlying this relationship.
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PMID:Obesity and asthma: possible mechanisms. 1840 59

The risk factors of cardiovascular disease and other disease comorbidities appear to be more common in patients with psoriasis compared with the general population. To support this concept, the association between psoriasis and cardiovascular disease and other comorbidities was analyzed using data collected from 40 730 patients in the National Health and Wellness Survey (NHWS) during May and June 2004. A case-control study was conducted with data from 1127 patients with psoriasis and a matched cohort of nonpsoriasis patients. Psoriasis patients were significantly more likely to have cardiovascular comorbidities, including hypertension, hypercholesterolemia, and diabetes, compared with nonpsoriasis patients. Other comorbidities significantly associated with psoriasis were arthritis, depression, sleep disorder/insomnia, chronic obstructive pulmonary disease, and gastroesophageal reflux disease. Responses to this large survey confirm that patients with psoriasis have a higher rate of cardiovascular risk factors and other comorbidities compared with patients without psoriasis.
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PMID:Psoriasis: cardiovascular risk factors and other disease comorbidities. 1845 19

A 42-year-old right-handed man with major depression, posttraumatic stress disorder, gastroesophageal reflux disease, and hypertension received 7 treatments of right unilateral electroconvulsive therapy, with the only complications being elevated blood pressure up to 180/120 mm Hg and agitation upon awakening. During eighth treatment, he experienced blood pressures as high as 210/130 mm Hg with severe agitation upon awakening from anesthesia followed by pulmonary edema. Pulmonary edema is rarely seen as a complication in electroconvulsive therapy, but if the airway becomes obstructed or there is excessive sympathetic discharge during the procedure, pulmonary edema may be more likely to occur.
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PMID:Pulmonary edema after electroconvulsive therapy. 1861 64

The mechanisms underlying the triggers and maintenance of atrial fibrillation (AF) are not fully understood. One potential unproved mechanism is that gastroesophageal reflux disease (GERD), in which acid reflux induces local and systemic inflammation, may increase triggered activity in the myocardium and pulmonary veins and increase AF risk. A self-report questionnaire was mailed to a random sample of 5,288 residents of Olmsted County, Minnesota, aged 25 to 74 years to assess the presence and frequency of GERD from 1988 to 1994. The long-term risk for AF over a period of 11.4 +/- 5.0 years was determined through review of clinical evaluations and the electrocardiographic database in those without previous AF. The average age was 53 +/- 17 years, and 2,571 subjects (49%) were man. Of these patients, 741 developed AF (cumulative probability of AF at 18 years 20%, 95% confidence interval [CI] 17% to 22%). Age (hazard ratio [HR] 1.09, 95% CI 1.08 to 1.10, p <0.001), male gender (HR 1.81, 95% CI 1.53 to 2.14, p <0.001), hypertension (HR 1.36, 95% CI 1.14 to 1.61, p = 0.0006), and heart failure (HR 1.74, 95% CI 1.16 to 2.60, p = 0.007) were independently associated with the risk of AF. The presence of any GERD was not associated with risk for AF (HR 0.81, 95% CI 0.68 to 0.96, p = 0.014) after adjustment for other risk factors. The frequency of GERD did not significantly affect the risk for AF, although patients with more frequent GERD had a slightly higher AF risk. Esophagitis increased the risk for AF (HR 1.94, 95% CI 1.35 to 2.78, p <0.001), but the association did not persist when accounting for other risk factors (p = 0.72). In conclusion, in this large population-based study of patients surveyed for GERD, no association was found with the presence or frequency of symptoms and AF. Patients with esophagitis were more likely to develop AF, although this association requires further study.
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PMID:Long-term risk of atrial fibrillation with symptomatic gastroesophageal reflux disease and esophagitis. 1894 Feb 93

Laparoscopic Roux-en-Y gastric bypass (LGB) is one of the most popular surgeries for morbid obesity. Robotic use is also on the rise. Data concerning outcomes is limited, hence the need for more information. The first 100 robotic-assisted bypasses by one surgeon in one institution were studied. Data obtained from clinic notes and hospital records included all who underwent the procedure. There were 79 females and 21 males. Mean age and body mass index were 42 years and 48 kg/m2, respectively. Comorbidities included diabetes, 22 per cent; hypertension, 47 per cent, gastroesophageal reflux disease, 40 per cent; obstructive sleep apnea, 53 per cent; dyslipidemia, 17 per cent; and heart disease, 8 per cent. Prior surgeries included cesarean -section, 26 per cent; cholecystectomy, 17 per cent; hysterectomy, 3 per cent; hernia, 1 per cent, and other abdominal surgery, 27 per cent. Intraoperatively procedures included adhesiolysis, 22 per cent; cholecystectomy, 16 per cent; and herniorrhaphy, 3 per cent. Average time was 177.7 minutes. Mean stay was 1.51 days. Thirty-day mortality was 0. Emergency department re-evaluations included 13. Most were minor problems. There was one gastrojejunal leak. Early complications included leak, thrombosis, and bleeding requiring transfusion in four patients. There were four strictures. Overall follow up was greater than 90 per cent. Average weight loss was 21.2 per cent of excess body weight by Month 1, 33.8 per cent by Month 3, and 50.7 per cent by Month 6. Learning curves for time and major complications were 30 and 50 cases, respectively (P = 0.03, 0.04). Robotic use in bariatrics is possible in community hospitals. Although technologies are still in their infancy, complication rates and weight loss are comparable to nonrobotic procedures.
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PMID:100 robotic-assisted laparoscopic gastric bypasses at a community hospital. 1894 36

Systemic sclerosis (systemic scleroderma) is a chronic connective tissue disease of unknown etiology that causes widespread microvascular damage and excessive deposition of collagen in the skin and internal organs. Raynaud phenomenon and scleroderma (hardening of the skin) are hallmarks of the disease. The typical patient is a young or middle-age woman with a history of Raynaud phenomenon who presents with skin induration and internal organ dysfunction. Clinical evaluation and laboratory testing, along with pulmonary function testing, Doppler echocardiography, and high-resolution computed tomography of the chest, establish the diagnosis and detect visceral involvement. Patients with systemic sclerosis can be classified into two distinct clinical subsets with different patterns of skin and internal organ involvement, autoantibody production, and survival. Prognosis is determined by the degree of internal organ involvement. Although no disease-modifying therapy has been proven effective, complications of systemic sclerosis are treatable, and interventions for organ-specific manifestations have improved substantially. Medications (e.g., calcium channel blockers and angiotensin-II receptor blockers for Raynaud phenomenon, appropriate treatments for gastroesophageal reflux disease) and lifestyle modifications can help prevent complications, such as digital ulcers and Barrett esophagus. Endothelin-1 receptor blockers and phosphodiesterase-5 inhibitors improve pulmonary arterial hypertension. The risk of renal damage from scleroderma renal crisis can be lessened by early detection, prompt initiation of angiotensin-converting enzyme inhibitor therapy, and avoidance of high-dose corticosteroids. Optimal patient care includes an integrated, multidisciplinary approach to promptly and effectively recognize, evaluate, and manage complications and limit end-organ dysfunction.
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PMID:Systemic sclerosis/scleroderma: a treatable multisystem disease. 1895 73


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