MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Medicine' source. Mon, 06 Feb 2012 09:02:30 +0100 http://www.medworm.com/index.php?rid=5615416&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003124%2Fabstract%3Frss%3Dyes This CPD section was prepared by Eric Beck FRCP FRCP(Ed) FRCP(Gl) We hope you enjoy the CPD section. Let us know your views by email to: medicine@medicinepublishing.co.uk (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615416 Sat, 21 Jan 2012 13:58:54 +0100 5615416 http://www.medworm.com/index.php?rid=5615415&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002994%2Fabstract%3Frss%3Dyes Abstract: Antidepressant drugs differ in their relative toxicities. The most hazardous are tricyclics, citalopram, venlafaxine and the rarely used monamine oxidase inhibitors. Features include arrhythmias, convulsions and cardiovascular effects. Management should be as active as necessary to reduce arrhythmia risk by aggressive correction of acidosis and use of sodium bicarbonate to shorten QRS duration if prolonged. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615415 Sat, 21 Jan 2012 13:58:54 +0100 5615415 http://www.medworm.com/index.php?rid=5615414&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003070%2Fabstract%3Frss%3Dyes Abstract: Over recent years, there has been rapid expansion of different classes of antihyperglycaemic drugs. These drugs have diverse toxicological profiles because each possesses a unique pharmacological mechanism of action and, correspondingly,. Antidiabetic drugs have the potential to exert severe toxic effects, and patients normally require urgent medical assessment and treatment. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615414 Sat, 21 Jan 2012 13:58:54 +0100 5615414 http://www.medworm.com/index.php?rid=5615413&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003082%2Fabstract%3Frss%3Dyes Abstract: Generally, phenytoin and carbamazepine have greater toxicity in overdose than sodium valproate and the newer anticonvulsants, though case reports confirm that severe toxicity can occur uncommonly. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615413 Sat, 21 Jan 2012 13:58:54 +0100 5615413 http://www.medworm.com/index.php?rid=5615412&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002921%2Fabstract%3Frss%3Dyes Abstract: Ammonia is a frequently used industrial agent. Ammonia is highly soluble in water and has toxic and corrosive actions caused by its alkalinity. It is easily absorbed through mucous membranes. Ammonia affects the upper airways more than the peripheral airways. Following exposure to ammonia, the clinical symptoms appear instantly and may consist of nasal discharge, lacrimation, pain in the upper airways, dyspnoea, bronchospasm, bronchial oedema, glottic oedema, increased mucus production, haemoptysis and cyanosis. Ingestion of ammonia water induces caustic lesions in the oropharynx, oesophagus and stomach. Liquid ammonia is corrosive. Evaporation of liquid ammonia from the eye or skin may cause cold burns. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615412 Sat, 21 Jan 2012 13:58:54 +0100 5615412 http://www.medworm.com/index.php?rid=5615411&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003112%2Fabstract%3Frss%3Dyes Abstract: Ethanol is a central nervous system depressant and a peripheral vasodilator, thereby causing coma, hypothermia and hypotension in severe poisoning. Hypoglycaemia, particularly in children, is observed together with acid–base disturbances, which are common (respiratory acidosis is observed more frequently than metabolic acidosis, and metabolic alkalosis may be observed in those vomiting and hypovolaemic). Lactic acidosis (usually mild) is an uncommon but potentially serious complication. Haemodialysis may be considered if the blood ethanol concentration exceeds 7500 mg/L and severe metabolic acidosis is present.The principal features of severe methanol poisoning are metabolic acidosis and blindness. The first priority of management is to inhibit methanol metabolism using either ... Medicine journals http://www.medworm.com/rss/comments.php?id=5615411 Sat, 21 Jan 2012 13:58:54 +0100 5615411 http://www.medworm.com/index.php?rid=5615410&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002969%2Fabstract%3Frss%3Dyes Abstract: Acetone is a mucous membrane irritant, which can be absorbed by inhalation, ingestion and through the skin. Its metabolism leads to increased glucose production. At high concentrations it is a central nervous system depressant. Haemodialysis to enhance elimination may be indicated in severe poisoning. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615410 Sat, 21 Jan 2012 13:58:54 +0100 5615410 http://www.medworm.com/index.php?rid=5615409&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003045%2Fabstract%3Frss%3Dyes Abstract: The features of amfetamine poisoning are related predominantly to stimulation of central and peripheral adrenergic receptors, and in severe cases, excitability, agitation, paranoid delusions, hallucinations with violent behaviour, hypertonia and hyperreflexia develop. Convulsions, rhabdomyolysis, hyperthermia, intracerebral haemorrhage and cardiac arrhythmias are less common. In addition, hyperthermia and hyponatraemia are features of severe MDMA toxicity.Benzylpiperazine (BZP) has stimulant and amfetamine-like properties. Those severely poisoned may develop seizures, collapse, hyperthermia, myoclonic jerks, extrapyramidal features and respiratory failure.Features of cannabis use include euphoria, distorted and heightened images, colours and sounds, altered tactile sensations, im... Medicine journals http://www.medworm.com/rss/comments.php?id=5615409 Sat, 21 Jan 2012 13:58:54 +0100 5615409 http://www.medworm.com/index.php?rid=5615408&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002933%2Fabstract%3Frss%3Dyes Abstract: Sulphur mustard is a powerful vesicant (blistering agent) which was used extensively in World War I and in the Iran–Iraq conflict (1984–1987). In addition to causing characteristic blistering burns to the skin, exposure may also result in severe conjuctivitis, ulcerative necrosis throughout the respiratory tract and systemic toxicity including bone marrow suppression. There is no specific therapy for sulphur mustard poisoning, but procedures such as laser debridement of established burns have been shown to increase the rate of burn resolution in animal models and may, therefore, be of benefit clinically. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615408 Sat, 21 Jan 2012 13:58:54 +0100 5615408 http://www.medworm.com/index.php?rid=5615407&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002982%2Fabstract%3Frss%3Dyes Abstract: Ricin is derived from the beans of the castor oil plant, Ricinus communis. Many of the features seen in poisoning can be explained by ricin-induced endothelial cell damage, which leads to fluid and protein leakage and tissue oedema, causing so-called ‘vascular leak syndrome’. Ricin’s use as a potential bioterrorism agent makes inhalational exposure the primary concern. Both vaccination (prophylaxis) and antitoxin (therapeutic) approaches against ricin intoxication are being developed. Abrin is a plant toxin obtained from the seeds of Abrus precatorius; its structure and chemical properties are closely related to ricin. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615407 Sat, 21 Jan 2012 13:58:54 +0100 5615407 http://www.medworm.com/index.php?rid=5615406&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003033%2Fabstract%3Frss%3Dyes Abstract: Sarin and VX were released on civilians in Japan on 11 occasions in the period 1994 to 1995. Clinicians must be prepared, therefore, to treat casualties from nerve agent exposure. This requires an understanding of the mechanisms of nerve agent toxicity and the factors that influence their clinical impact. Clinicians need to be able to make a rapid and accurate diagnosis and use atropine, an oxime and diazepam optimally. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615406 Sat, 21 Jan 2012 13:58:54 +0100 5615406 http://www.medworm.com/index.php?rid=5615405&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100301X%2Fabstract%3Frss%3Dyes Abstract: Substances taken to alter the mental state may be ingested, inhaled, absorbed through mucous membranes or injected. Accidental overdose is common. Complications result either from the presence of contaminants or from the pharmacological actions of the substance(s) involved; these include respiratory, neurological, renal and metabolic complications. Body packers often swallow large numbers of packages in the hope of financial gain. Acute intestinal obstruction may result and overdose is a hazard if a packet bursts. Immediate surgery is indicated if acute intestinal obstruction develops, or when packets can be seen radiologically and there is clinical or analytical evidence to suggest leakage, particularly if the drug involved is a central nervous system stimulant (e.g. cocaine). (... Medicine journals http://www.medworm.com/rss/comments.php?id=5615405 Sat, 21 Jan 2012 13:58:54 +0100 5615405 http://www.medworm.com/index.php?rid=5615404&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002945%2Fabstract%3Frss%3Dyes Abstract: Deliberate self-poisoning is one of the most common for general hospital presentation. The majority of the individuals involved are young, with females outnumbering males. Self-poisoning occurs in people from a variety of social backgrounds, but is associated with socio-economic deprivation and social fragmentation. Common precipitants include relationship problems, often in the context of depression and alcohol abuse. The risks of repetition of self-harm and of suicide following self-poisoning are substantial. Psychosocial assessment of patients should include investigation of the events and problems preceding the act, suicidal intent and other motives for the act, psychiatric disorder, personality traits and disorder, family and personal history, psychiatric history, including ... Medicine journals http://www.medworm.com/rss/comments.php?id=5615404 Sat, 21 Jan 2012 13:58:54 +0100 5615404 http://www.medworm.com/index.php?rid=5615403&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003094%2Fabstract%3Frss%3Dyes Abstract: Antidotes exert their beneficial effects by a variety of mechanisms, including forming an inert complex with the poison, accelerating detoxification of the poison, reducing the rate of conversion of the poison to a more toxic compound, competing with the poison for essential receptor sites, blocking essential receptors through which the toxic effects are mediated, and bypassing the effect of the poison. There are specific antidotes for only a small number of poisons and few antidotes are employed regularly in clinical practice. Those that are include acetylcysteine, naloxone and flumazenil. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615403 Sat, 21 Jan 2012 13:58:54 +0100 5615403 http://www.medworm.com/index.php?rid=5615402&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003100%2Fabstract%3Frss%3Dyes Abstract: There is no evidence that the use of single-dose activated charcoal, gastric lavage, syrup of ipecacuanha, cathartics or whole-bowel irrigation improves the clinical outcome in poisoned patients. However, activated charcoal and gastric lavage may be considered in patients who have ingested life-threatening amounts of a toxic agent up to 1 hour previously. To increase elimination, treatment with multiple-dose activated charcoal (in patients who have ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine or theophylline) or urine alkalinization (in patients with moderately severe salicylate poisoning) should be employed. Haemodialysis and haemodialfiltration significantly increase the elimination of ethanol, ethylene glycol, isopropanol, lithium, metha... Medicine journals http://www.medworm.com/rss/comments.php?id=5615402 Sat, 21 Jan 2012 13:58:54 +0100 5615402 http://www.medworm.com/index.php?rid=5615401&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003057%2Fabstract%3Frss%3Dyes Abstract: Initial management involves the treatment of any potentially life-threatening conditions, such as airway compromise, breathing difficulties, haemodynamic instability and serious dysrhythmias. Thereafter, convulsions should be treated, fluid, acid–base and electrolyte abnormalities corrected, and hypothermia managed by using a space blanket. Children under 5 years old who are suspected of having ingested paracetamol, salicylate, iron, an opioid, a tricyclic antidepressant or a substance of abuse require assessment in hospital and, possibly, admission. The need for admission of adult patients depends on the agent(s) ingested, features present, results of investigations and psychological state. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615401 Sat, 21 Jan 2012 13:58:54 +0100 5615401 http://www.medworm.com/index.php?rid=5615400&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100291X%2Fabstract%3Frss%3Dyes Abstract: The serotonin syndrome is the clinical manifestation of serotonin toxicity in patients taking one or more serotonergic agents. It is characterized by features of neuromuscular hyperactivity, autonomic instability and alteration of mental status. Management consists of discontinuation of the offending drug and supportive care. Cyproheptadine and chlorpromazine which have 5-HT2A antagonistic properties may be useful in severe cases. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615400 Sat, 21 Jan 2012 13:58:54 +0100 5615400 http://www.medworm.com/index.php?rid=5615399&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003069%2Fabstract%3Frss%3Dyes Abstract: Non-traumatic rhabdomyolysis may be caused by a direct insult to the cell membrane, affecting its ability to maintain ion gradients, or be secondary to local muscle compression as a result of coma or seizures. Acute renal failure and peripheral nerve damage are the two most common and important complications observed, though hyperkalaemia leading to a dysrhythmia is the main cause of death. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615399 Sat, 21 Jan 2012 13:58:54 +0100 5615399 http://www.medworm.com/index.php?rid=5615398&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002970%2Fabstract%3Frss%3Dyes Abstract: Methaemoglobin is formed when ferrous haemoglobin iron (II) is oxidized to ferric iron (III), which cannot participate in oxygen transport. Methaemoglobin-forming chemical groups of particular importance in poisoning are organic nitrites (e.g. amyl and isobutyl nitrite) and amino- or nitro-derivatives of benzene (e.g. aniline, dapsone and lidocaine). An asymptomatic, apparent ‘cyanosis’ is the earliest clinical feature, occurring when approximately 15% of total haemoglobin is replaced by methaemoglobin. Progressive manifestations of tissue hypoxia ensue at increasing methaemoglobin concentrations and concentrations approaching 80% may be fatal. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615398 Sat, 21 Jan 2012 13:58:54 +0100 5615398 http://www.medworm.com/index.php?rid=5615397&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002957%2Fabstract%3Frss%3Dyes Abstract: Biochemical abnormalities due to disturbed metabolic processes are common in severely poisoned patients. These may be of diagnostic value, but most importantly their recognition and treatment are important in the management of these patients. Acid–base abnormalites, particularly respiratory and metabolic acidoses, are common. Respiratory acidoses due to central nervous system depression or pulmonary toxicity, and metabolic acidoses due to lactic acidaemia or derangements of intermediary metabolism are particular features of poisoning. Plasma electrolyte abnormalities, particularly hyper- or hypokalaemia are found commonly in poisoned patients, most often due to redistribution of potassium across cell membranes. Hypoglycaemia is most frequently due to drug overdose. (Source: Med... Medicine journals http://www.medworm.com/rss/comments.php?id=5615397 Sat, 21 Jan 2012 13:58:54 +0100 5615397 http://www.medworm.com/index.php?rid=5615396&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002891%2Fabstract%3Frss%3Dyes This article includes information on substances found in the house or garden that are of low toxicity when taken by ingestion. Medicines that are of low toxicity when taken in overdose are also described. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615396 Sat, 21 Jan 2012 13:58:54 +0100 5615396 http://www.medworm.com/index.php?rid=5615395&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003021%2Fabstract%3Frss%3Dyes Abstract: Assessment of an acutely poisoned patient involves the taking of an appropriate history, assessment of the level of consciousness, ventilation and circulation, a physical examination, and requesting appropriate toxicological and non-toxicological investigations. Diagnosis is based on the history, circumstantial evidence (if available), a cluster of common features (if present) and, occasionally, the results of biochemical or toxicological analyses. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615395 Sat, 21 Jan 2012 13:58:54 +0100 5615395 http://www.medworm.com/index.php?rid=5615394&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002908%2Fabstract%3Frss%3Dyes This article describes some clinical presentations where poisoning should be considered in the differential diagnosis. Examples are unexplained coma or confusion, hypoglycaemia, abnormal liver function, unexplained convulsions or acidosis or abnormal bleeding. Poisoning should also be suspected if several people present with similar symptoms or in children who have chronic, recurrent or unexplained symptoms. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615394 Sat, 21 Jan 2012 13:58:54 +0100 5615394 http://www.medworm.com/index.php?rid=5615393&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003008%2Fabstract%3Frss%3Dyes Abstract: The epidemiology of poisoning can be studied from different perspectives. These include overall mortality, hospital admission rates, and enquiries to Poisons Information Services. Accidental poisoning is most common in children, but deliberate self-harm becomes predominant in teenage years and early adulthood. Understanding the patterns of poisoning assists in developing suicide prevention strategies and reducing the risks of accidental poisoning. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615393 Sat, 21 Jan 2012 13:58:54 +0100 5615393 http://www.medworm.com/index.php?rid=5615392&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100288X%2Fabstract%3Frss%3Dyes In the minds of many doctors, exposure to a substance is equated with poisoning. However, systemic absorption is usually necessary for there to be a toxic effect and, even if this occurs, the amount absorbed may be too small to produce adverse effects or poisoning. Moreover, to many, the term poisoning suggests an acute event demanding immediate care and attention. This is often so, although the consequences of exposure are not always immediate. For example, distinctive sequelae may not appear until many years have elapsed, as is the case with hepatic haemangiosarcoma from vinyl chloride exposure. Alternatively, features may arise only after prolonged exposure, as with many heavy metals. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615392 Sat, 21 Jan 2012 13:58:54 +0100 5615392 http://www.medworm.com/index.php?rid=5615391&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003598%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615391 Sat, 21 Jan 2012 13:58:54 +0100 5615391 http://www.medworm.com/index.php?rid=5615390&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003574%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5615390 Sat, 21 Jan 2012 13:58:54 +0100 5615390 http://www.medworm.com/index.php?rid=5519455&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002878%2Fabstract%3Frss%3Dyes This CPD section was prepared by Eric Beck FRCP FRCP(Ed) FRCP(Gl) We hope you enjoy the CPD section. Let us know your views by email to: medicine@medicinepublishing.co.uk (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5519455 Tue, 20 Dec 2011 02:10:11 +0100 5519455 http://www.medworm.com/index.php?rid=5519454&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002465%2Fabstract%3Frss%3Dyes Abstract: Cancer symptoms usually arise from a direct effect of a primary tumour or its metastases. Uncommonly, malignancies may present through paraneoplastic syndromes (PNS). These are a heterogeneous group of disorders in which symptoms are caused by an indirect effect of the cancer. The relevance of these conditions is twofold: they may aid earlier diagnosis of malignancies, and may contribute to patient morbidity and mortality. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5519454 Tue, 20 Dec 2011 02:10:11 +0100 5519454 http://www.medworm.com/index.php?rid=5519453&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002568%2Fabstract%3Frss%3Dyes Abstract: Over the last 24 years there has been a burgeoning development of genetic risk assessment and ‘family history’ clinics to deal with the ever-increasing demand from individuals at increased risk of cancer by virtue of their family history. Risk of inherited cancer can be divided into known syndromes, such as familial polyposis, and increased risk of common cancers due to family history alone. Risk of cancer can be assessed in three categories: average, moderate and high. Individuals at high risk and those at risk of syndromes will generally be referred to a regional genetics centre. Moderate-risk individuals may benefit from early surveillance in secondary care particularly for breast and colorectal cancer. Average-risk individuals can be reassured in primary care. Newer surve... Medicine journals http://www.medworm.com/rss/comments.php?id=5519453 Tue, 20 Dec 2011 02:10:11 +0100 5519453 http://www.medworm.com/index.php?rid=5519452&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002489%2Fabstract%3Frss%3Dyes Abstract: Cancer screening is a source of much debate. At the interface between public health, specialist care, economics and policy, it creates tensions between professional groups, politicians, the media and the public. A screening test may be cheap, but applying it to a population (with rigorous quality control and effective processing of patients with abnormal results) creates a huge workload and therefore cost. Screening can also have profound psychological effects on individuals. People with false-positive results require investigation and yet are usually found eventually not to have cancer. Unless screening can be shown to reduce mortality from a specific cancer, the resources used are better spent on improving care, and this has led to disparities in screening recommendations betwe... Medicine journals http://www.medworm.com/rss/comments.php?id=5519452 Tue, 20 Dec 2011 02:10:11 +0100 5519452 http://www.medworm.com/index.php?rid=5519451&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100257X%2Fabstract%3Frss%3Dyes This article gives an overview of these phases of clinical trial, through which almost every new treatment will need to pass on the journey from its discovery on the laboratory bench to its routine use in clinical practice. The aim of the Phase I trial is to establish a dose, the Phase II is to evaluate activity, safety and feasibility and the Phase III is to compare the new treatment against a suitable comparator. Phase 0 and Phase IV clinical trials will also be briefly discussed. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5519451 Tue, 20 Dec 2011 02:10:11 +0100 5519451 http://www.medworm.com/index.php?rid=5519450&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002519%2Fabstract%3Frss%3Dyes Abstract: Bladder cancer is the most frequently occurring tumour of the urinary tract and the eighth-most common cause of cancer death in the UK. Urothelial cell carcinoma of the bladder is characterized by high recurrence rate, pathological progression and poor survival in advanced metastatic disease. Due to the long follow-up period and associated expenses of disease monitoring it is one of the most expensive cancers to manage. Local therapy and surveillance are the mainstays of management of early disease, whilst neoadjuvant chemotherapy, radical surgery and radiotherapy are effective in advanced disease. There remains a great need for effective tumour markers to aid diagnosis, staging, monitoring and predicting prognosis. Novel therapies for advanced metastatic bladder cancer are under... Medicine journals http://www.medworm.com/rss/comments.php?id=5519450 Tue, 20 Dec 2011 02:10:11 +0100 5519450 http://www.medworm.com/index.php?rid=5519449&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002453%2Fabstract%3Frss%3Dyes Abstract: Prostate cancer constitutes a major health problem. It is estimated that the lifetime risk of western men having prostate cancer is about 30%, with the risk of dying from the cancer being 3%. Increasing age is the strongest pre-determinant for the development of prostate cancer. Virtually all cancers are adenocarcinomas, the grade being indicated by the Gleason score. Often, there are no presenting symptoms. Investigations such as serum prostate-specific antigen (PSA), digital rectal examination and biopsies via a transrectal ultrasound probe are required for diagnosis. Staging, if required, consists of magnetic resonance imaging or computed tomography for locally advanced disease and/or a bone scan for detection of bony metastases. Management depends largely on the stage of the ... Medicine journals http://www.medworm.com/rss/comments.php?id=5519449 Tue, 20 Dec 2011 02:10:11 +0100 5519449 http://www.medworm.com/index.php?rid=5519448&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002532%2Fabstract%3Frss%3Dyes Abstract: Breast cancer is the commonest cancer to affect women with a recent estimate of lifetime risk of 1:8. The number of women found to have breast cancer in the UK has risen to 47,000 with the highest rise being in the 50–69 years age group. This is probably attributable to several lifestyle factors such as diet, alcohol consumption, lack of exercise and late pregnancies. Because of earlier diagnosis and major treatment advances, survival rates have been gradually improving; 80% of patients with early breast cancer now survive for 5 years after diagnosis. Recent advances in surgical management include the use of oncoplastic procedures and sentinel node biopsy. The majority of patients will be offered adjuvant treatment, such as radiotherapy, hormones, chemotherapy and biological ag... Medicine journals http://www.medworm.com/rss/comments.php?id=5519448 Tue, 20 Dec 2011 02:10:11 +0100 5519448 http://www.medworm.com/index.php?rid=5519447&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002544%2Fabstract%3Frss%3Dyes Abstract: Adjuvant therapy is used to reduce the risk of cancer recurrence and improve survival. It is usually given after patients have had radical (i.e. potentially curative) treatment targeting the primary tumour, but there are some circumstances where treatment is given beforehand (termed ‘neoadjuvant’). The aim of therapy is either to improve local tumour control, or to reduce the risk of distant relapse. Selecting patients who benefit from treatment can be difficult, and decisions must take into account both the patient and tumour characteristics. In this article we review the basic principles of adjuvant and neoadjuvant therapy, focussing on breast and colorectal cancer. We also discuss the potential adverse effects of therapy and conclude by looking at potential future developm... Medicine journals http://www.medworm.com/rss/comments.php?id=5519447 Tue, 20 Dec 2011 02:10:11 +0100 5519447 http://www.medworm.com/index.php?rid=5519446&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100315X%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5519446 Tue, 20 Dec 2011 02:10:11 +0100 5519446 http://www.medworm.com/index.php?rid=5519445&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911003136%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5519445 Tue, 20 Dec 2011 02:10:11 +0100 5519445 http://www.medworm.com/index.php?rid=5446316&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002738%2Fabstract%3Frss%3Dyes This CPD section was prepared by Eric Beck FRCP FRCP(Ed) FRCP(Gl) We hope you enjoy the CPD section. Let us know your views by email to: medicine@medicinepublishing.co.uk (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5446316 Sat, 26 Nov 2011 02:35:24 +0100 5446316 http://www.medworm.com/index.php?rid=5446315&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002490%2Fabstract%3Frss%3Dyes Abstract: Hormone therapy is an extremely effective and relatively non-toxic therapy for both breast and prostate cancer; some other cancers demonstrate minor levels of hormone sensitivity. Serum concentrations of oestradiol and testosterone are controlled by the hypothalamic–pituitary–gonadal pathway. In premenopausal women, oestradiol is produced primarily from the ovaries, whereas in postmenopausal women peripheral conversion of adrenal androgens by aromatase within peripheral fat predominates. In premenopausal women with breast cancer and men with prostate cancer, hormonal therapy is primarily achieved by castration. In postmenopausal women, selective oestrogen receptor modulators (e.g. tamoxifen) or aromatase inhibitors are used. Hormone therapy is often part of curative therapy,... Medicine journals http://www.medworm.com/rss/comments.php?id=5446315 Sat, 26 Nov 2011 02:35:24 +0100 5446315 http://www.medworm.com/index.php?rid=5446314&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002556%2Fabstract%3Frss%3Dyes Abstract: Cytotoxic chemotherapy drugs damage proliferating cells primarily by interfering with mitosis and we now know the molecular target of most of the drugs in clinical use. Even so, non-specificity of cytotoxic agents is a major drawback and their ability to damage normal as well as malignant cells means that cure with chemotherapy is not often achieved. Various strategies have been adopted to enhance the antitumour effect. These include combining drugs with different mechanisms of action, delivering drug directly to the tumour and overcoming cellular resistance mechanisms. With advances in science, rational drug design is now becoming a reality, and mechanism-driven, targeted anticancer agents are being used alongside conventional cytotoxic chemotherapy. Cancer treatment is therefor... Medicine journals http://www.medworm.com/rss/comments.php?id=5446314 Sat, 26 Nov 2011 02:35:24 +0100 5446314 http://www.medworm.com/index.php?rid=5446313&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002520%2Fabstract%3Frss%3Dyes Abstract: Chemotherapy with cytotoxic anticancer agents remains the mainstay of therapy targeted at specific cellular mechanisms in malignant disease. Increasingly it is being used earlier on in a patient’s treatment as an adjunct to either surgery or radiotherapy. Recent years have seen the introduction of ‘targeted agents’ into clinical use with increasing success. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5446313 Sat, 26 Nov 2011 02:35:24 +0100 5446313 http://www.medworm.com/index.php?rid=5446312&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002507%2Fabstract%3Frss%3Dyes This article will describe the role of radiation therapy in various clinical situations, including the side effects of treatment. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5446312 Sat, 26 Nov 2011 02:35:24 +0100 5446312 http://www.medworm.com/index.php?rid=5446311&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002477%2Fabstract%3Frss%3Dyes Abstract: Radiotherapy is involved in the treatment of at least 40% of cancer patients. Whereas palliative radiotherapy is typically given over 1–10 treatments, radical treatments can extend over 4–8 weeks. Radiation is delivered using external beam machines or by inserting radioactive isotopes. Localization of tumours has been transformed with spiral computed tomography, magnetic resonance imaging and positron emission tomography scanning. Modern imaging, computing and delivery systems have led to dramatic improvements in external-beam radiotherapy such as intensity-modulated radiotherapy (IMRT). Image-guided radiotherapy (IGRT) increases accuracy by imaging moving targets during treatment. Stereotactic radiotherapy allows very high doses to be delivered very precisely in a small numb... Medicine journals http://www.medworm.com/rss/comments.php?id=5446311 Sat, 26 Nov 2011 02:35:24 +0100 5446311 http://www.medworm.com/index.php?rid=5446310&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002593%2Fabstract%3Frss%3Dyes Abstract: Medical imaging techniques are an important element in the early detection for many cancers. They are also essential for determining the location, extension and stage of the lesion for diagnosis, for guiding treatment and therapeutic interventions, and for assessing tumour response during and after treatment. Imaging methods range from anatomical-based methods (ultrasound, conventional plain X-rays with mammography, computed tomography) to the more functional-based methods (magnetic resonance imaging with a spectroscopy option, single-photon emission computed tomography and positron emission tomography). The principles of these image acquisition methods with examples of clinical indications are described. Advances in medical imaging have also been widely applied in the field of r... Medicine journals http://www.medworm.com/rss/comments.php?id=5446310 Sat, 26 Nov 2011 02:35:24 +0100 5446310 http://www.medworm.com/index.php?rid=5446309&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002581%2Fabstract%3Frss%3Dyes Abstract: Cancer is caused by aberrant patterns of gene expression. Most common cancers are caused by acquired mutations in somatic cells. In contrast, specific germline mutations can account for rare hereditary cancer syndromes. In general, the genes affected in cancers can be divided into two groups: oncogenes and tumour suppressor genes. Oncogenes undergo activation and are phenotypically dominant, while tumour suppressor genes undergo inactivation and are phenotypically recessive. Oncogenic activation can occur by specific point mutations within the sequence of a gene, by amplification of the number of copies of the gene or by translocation of DNA to a site where transcription is more active or where the formation of a new fusion gene generates a protein with enhanced biological activi... Medicine journals http://www.medworm.com/rss/comments.php?id=5446309 Sat, 26 Nov 2011 02:35:24 +0100 5446309 http://www.medworm.com/index.php?rid=5446308&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002763%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5446308 Sat, 26 Nov 2011 02:35:24 +0100 5446308 http://www.medworm.com/index.php?rid=5446307&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100274X%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5446307 Sat, 26 Nov 2011 02:35:24 +0100 5446307 http://www.medworm.com/index.php?rid=5353598&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002441%2Fabstract%3Frss%3Dyes This CPD section was prepared by Eric Beck FRCP FRCP(Ed) FRCP(Gl) We hope you enjoy the CPD section. Let us know your views by email to: medicine@medicinepublishing.co.uk (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353598 Thu, 27 Oct 2011 14:48:00 +0100 5353598 http://www.medworm.com/index.php?rid=5353597&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002258%2Fabstract%3Frss%3Dyes Abstract: Facing potential loss (of health, bodily functions, independence, a future, hope for a cure, control) can be overwhelming for all individuals involved, including healthcare professionals. However, understanding the profound impact of loss and how it can be managed enables those involved to gain a sense of control and hopefulness. Doctors can use their relationship with patient and family to help individuals facing loss to feel heard, understood and less worried about themselves, their family and their future. Isolating specific responses to a complex psychosocial event and conducting research into these is difficult, but many retrospective and prospective analyses and studies of clinical practice highlight the significant issues for those working with individuals who are managing... Medicine journals http://www.medworm.com/rss/comments.php?id=5353597 Thu, 27 Oct 2011 14:48:00 +0100 5353597 http://www.medworm.com/index.php?rid=5353596&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002143%2Fabstract%3Frss%3Dyes Abstract: In those with life-threatening disease, prognosis is unpredictable. Communication with the patient and family must guide the clinician, who must always be weighing up the benefits against the risks and burdens of any intervention and recognizing when interventions are futile in the face of irreversible deterioration. There is no evidence that patients’ lives are shortened when opioids and other drugs are used to control pain and other symptoms, which challenges the usual examples for double effect that appear in many standard textbooks.Patients and relatives can derive considerable benefit from involvement in the planning of palliative care. However, whereas many patients undertake informal care planning in collaboration with primary and specialist palliative care teams, only a... Medicine journals http://www.medworm.com/rss/comments.php?id=5353596 Thu, 27 Oct 2011 14:48:00 +0100 5353596 http://www.medworm.com/index.php?rid=5353595&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002210%2Fabstract%3Frss%3Dyes Abstract: Spiritual and cultural issues at the end of life are common and a natural part of the process of life and death. They often present as distress or agitation in the patient and should be considered when pain control is difficult to manage. Spirituality can be defined as our sense of meaning in life. It is often influenced by, and regularly confused with, religion and culture. While it can be suggested that society is becoming more secular and less religious, it can also be argued that it is the structure and practice of religion rather than the faith itself that is being rejected, with people picking and choosing the elements from different religions and cultures on which to base their sense of meaning. Identifying and assessing spiritual and cultural issues require healthcare pro... Medicine journals http://www.medworm.com/rss/comments.php?id=5353595 Thu, 27 Oct 2011 14:48:00 +0100 5353595 http://www.medworm.com/index.php?rid=5353594&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002131%2Fabstract%3Frss%3Dyes Abstract: Care in the last hours and days of life is an important part of medical practice. Ensuring a dignified death for patients with appropriate support for carers is a core activity of all healthcare professionals. Once a patient has entered the dying phase it is important that pain and other symptoms are managed appropriately. All medication that needs to be continued should be converted to the subcutaneous route when administration via the oral route is no longer possible. As required medication should be prescribed for the key symptoms that occur in dying patients, such as pain, agitation, respiratory tract secretions, dyspnoea, and nausea and vomiting. Futile treatments should also be discontinued at this time and consideration should be given to the discontinuation of antibiotics... Medicine journals http://www.medworm.com/rss/comments.php?id=5353594 Thu, 27 Oct 2011 14:48:00 +0100 5353594 http://www.medworm.com/index.php?rid=5353593&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002222%2Fabstract%3Frss%3Dyes Abstract: The most common symptoms of advanced disease, such as pain, nausea and dyspnoea, are readily assessed and often the focus of consultations. However, many prevalent symptoms remain that may be ignored if not specifically sought by the healthcare professional and, unaddressed, these symptoms may have a significant impact on remaining quality of life. This paper will focus on the assessment and management of symptoms such as asthenia, constipation, oral problems, wound care, hyperhidrosis, lymphoedema, ascites, pruritus and venous thromboembolism. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353593 Thu, 27 Oct 2011 14:48:00 +0100 5353593 http://www.medworm.com/index.php?rid=5353592&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002192%2Fabstract%3Frss%3Dyes This article discusses how a palliative care approach can be incorporated into standard active treatment, outlines the management of important symptoms and discusses the importance of advance care planning. The particular problems experienced by patients with chronic neurodegenerative disease are discussed, and swallowing and respiratory difficulties are explored in the context of potential loss of mental capacity and ability to communicate. The importance of excellent communication skills is highlighted in particular regard to advance planning for end-of-life issues. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353592 Thu, 27 Oct 2011 14:48:00 +0100 5353592 http://www.medworm.com/index.php?rid=5353591&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002155%2Fabstract%3Frss%3Dyes Abstract: During the last phase of life, a patient’s condition can change suddenly and require urgent assessment. The most likely reasons for this include spinal cord compression, shortness of breath, haemorrhage, metabolic disturbance, fractures and neurological conditions. Appropriate treatment of these events can make a big difference to how the patient and family cope and anticipation of potential problems is advocated. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353591 Thu, 27 Oct 2011 14:48:00 +0100 5353591 http://www.medworm.com/index.php?rid=5353590&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002167%2Fabstract%3Frss%3Dyes Abstract: Psychiatric conditions are common among patients with advanced illness who are referred to palliative care services. Psychiatric illness can cause considerable distress to both patients and their families. In order to improve end-of-life care for patients, it is necessary to diagnose psychiatric conditions and treat them appropriately. This review considers delirium, dementia, depression, anxiety, and suicidal ideation. It considers the prevalence, aetiology, diagnosis and management of these conditions. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353590 Thu, 27 Oct 2011 14:48:00 +0100 5353590 http://www.medworm.com/index.php?rid=5353589&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002271%2Fabstract%3Frss%3Dyes Abstract: Breathlessness is a distressing symptom that arises in many diseases. It has several pathophysiological causes, involving the interplay between peripheral and central chemoreceptors, pulmonary and bronchial receptors, chest wall and diaphragmatic muscles, and cortical processing. Older people and patients with cachexia are more susceptible to breathlessness on exertion. Most patients can be assessed by physical examination and simple investigations including haemoglobin, oxygen saturation, ECG, and imaging (X-ray and ultrasound). Research has shown that opioid receptors are important in the central medullary chemoreceptors but also in the cortical areas, and that careful use of opioids can reduce the sensation of breathlessness without compromising ventilatory control. Benzodiaze... Medicine journals http://www.medworm.com/rss/comments.php?id=5353589 Thu, 27 Oct 2011 14:48:00 +0100 5353589 http://www.medworm.com/index.php?rid=5353588&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002209%2Fabstract%3Frss%3Dyes Abstract: Nausea and vomiting are common problems in palliative care, occurring in 40–70% of patients with advanced incurable disease. They may be disease- or treatment-related, and require a holistic approach to their management. Careful assessment of the problem, with a focused history and a limited range of key investigations, is essential to effective management. Knowledge of the likely receptors involved in this complex phenomenon is vital to ensure the proper pharmacological measures are employed. Although many of the drugs used have been available for many years, newer agents have improved the management of some types of nausea and vomiting (especially surgery-, chemotherapy- and radiotherapy-related emesis). Non-pharmacological measures, including stenting, laser and venting gast... Medicine journals http://www.medworm.com/rss/comments.php?id=5353588 Thu, 27 Oct 2011 14:48:00 +0100 5353588 http://www.medworm.com/index.php?rid=5353587&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002234%2Fabstract%3Frss%3Dyes Abstract: Pain can usually be managed using conventional oral analgesics and co-analgesics according to the WHO analgesic ladder. However, about 10% of patients have pain that is more difficult and they may benefit from interventions, such as nerve blocks, intrathecal drug delivery (ITDD) or percutaneous cordotomy. Early referral for specialist pain management is needed if interventional techniques are being considered. It is important to manage pain with the simplest methods possible and to consider all available alternatives to an invasive technique. Simple nerve blocks may be easy to organize and are usually readily accepted by the patient. More complex nerve blocks may need hospital admission, radiological imaging and coordinated aftercare. ITDD is a demanding technique that requires a... Medicine journals http://www.medworm.com/rss/comments.php?id=5353587 Thu, 27 Oct 2011 14:48:00 +0100 5353587 http://www.medworm.com/index.php?rid=5353586&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002246%2Fabstract%3Frss%3Dyes Abstract: Despite medical advances over the past 20 years, pain remains a problem in 60% of patients with advanced cancer and end-of-life care. In this article, we focus on how to assess and diagnose pain, and explore basic pharmacological and other pain-relieving interventions. Important issues highlighted are the need for skilled assessment and timely decisions in getting to grips with pain control quickly. Strategies include the use of the WHO analgesic ladder, effective management of side effects and how to decide which route of drug administration is appropriate in different situations. We discuss pain that is unresponsive to opioids and outline the role of non-pharmacological methods.Systematic assessment, rapid diagnosis and early effective treatment are crucial. Radiotherapy, chemo... Medicine journals http://www.medworm.com/rss/comments.php?id=5353586 Thu, 27 Oct 2011 14:48:00 +0100 5353586 http://www.medworm.com/index.php?rid=5353585&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100226X%2Fabstract%3Frss%3Dyes Abstract: Palliative care developed in the later part of the 20th century as a social movement and medical speciality. Central to its modern development were the ideas of Dr Cicely Saunders, whose vision for improving the care of the dying encompassed the physical, psychological, social and spiritual domains while emphasizing the importance of rigorous clinical practice, training and research. St Christopher’s Hospice, which she founded, inspired generations of practitioners and influenced the expansion of hospices nationally and internationally. Terminal care evolved into the discipline of palliative care, which applied holistic principles to the care of those earlier in their disease trajectory and in different settings, such as hospitals and the community. Some countries now have nati... Medicine journals http://www.medworm.com/rss/comments.php?id=5353585 Thu, 27 Oct 2011 14:48:00 +0100 5353585 http://www.medworm.com/index.php?rid=5353584&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002179%2Fabstract%3Frss%3Dyes Abstract: Forty years on from the opening of St Christopher’s Hospice and 20 years after the speciality was formally recognized as a medical speciality, palliative medicine remains as diverse as ever. No longer a terminal care service, the speciality continues to evolve its role into supportive care and the management of non-malignant disease. Future challenges will include ongoing partnership working between the independent and statutory sector, undertaking rigorous research and looking after an increasingly ageing population. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353584 Thu, 27 Oct 2011 14:48:00 +0100 5353584 http://www.medworm.com/index.php?rid=5353583&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002623%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353583 Thu, 27 Oct 2011 14:48:00 +0100 5353583 http://www.medworm.com/index.php?rid=5353582&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100260X%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5353582 Thu, 27 Oct 2011 14:48:00 +0100 5353582 http://www.medworm.com/index.php?rid=5256067&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100212X%2Fabstract%3Frss%3Dyes This CPD section was prepared by Eric Beck FRCP FRCP(Ed) FRCP(Gl) We hope you enjoy the CPD section. Let us know your views by email to: medicine@medicinepublishing.co.uk (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256067 Mon, 26 Sep 2011 18:52:24 +0100 5256067 http://www.medworm.com/index.php?rid=5256066&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001927%2Fabstract%3Frss%3Dyes Abstract: The major malignant hepatobiliary cancers comprise hepatocellular carcinoma (HCC) and cholangiocarcinoma. HCC has a high incidence in the developing world (Asia and sub-Saharan Africa) and a less common, but rapidly increasing cause of death in the West. The incidence of cholangiocarcinoma is also increasing. The major risk factors for HCC include chronic hepatitis B and C infection and any type of chronic liver disease. Vaccination at birth against hepatitis B virus (HBV) is an effective prevention strategy. Patients may present with abdominal pain and weight loss or with hepatic decompensation in the presence of chronic liver disease, but the condition is increasingly being diagnosed by ultrasound screening in asymptomatic patients. Characteristic radiological appearances and s... Medicine journals http://www.medworm.com/rss/comments.php?id=5256066 Mon, 26 Sep 2011 18:52:24 +0100 5256066 http://www.medworm.com/index.php?rid=5256065&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001897%2Fabstract%3Frss%3Dyes Abstract: Gallstones are common, but most are asymptomatic and need no treatment. Typical presentations include biliary colic and acute cholecystitis. Chronic symptoms overlap with irritable bowel syndrome and non-ulcer dyspepsia, which may lead to uncertainty in identifying the cause of the symptoms. Complications of gallstones include empyema and mucocoele of the gallbladder, acute pancreatitis and obstructive jaundice due to bile duct stones or Mirizzi syndrome. The diagnosis of gallbladder stones requires ultrasonography. Duct stones can be confirmed non-invasively by magnetic resonance imaging. Symptomatic gallbladder stones are treated by laparoscopic cholecystectomy. Occasionally, empyema of the gallbladder in an unfit patient is managed by percutaneous cholecystostomy. Cholangitis ... Medicine journals http://www.medworm.com/rss/comments.php?id=5256065 Mon, 26 Sep 2011 18:52:24 +0100 5256065 http://www.medworm.com/index.php?rid=5256064&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001940%2Fabstract%3Frss%3Dyes Abstract: Liver transplantation is an established component of the management of most primary diseases involving the liver. Disease-specific indications have been defined, but access to transplantation is restricted by limited access to donor organs. Technical complications and recurrent disease represent the biggest challenges while modern immunosuppression regimens have almost eliminated rejection as a cause of graft failure. There is a morbidity associated with immunosuppression, generally as well as specific to individual drugs. Despite these issues, the outcomes after liver transplantation are excellent. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256064 Mon, 26 Sep 2011 18:52:24 +0100 5256064 http://www.medworm.com/index.php?rid=5256063&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001915%2Fabstract%3Frss%3Dyes This article explores the current thoughts and evidence base in this area and the potential role of existing therapies such as lactulose, and newer therapies such as rifaximin, which may abrogate systemic inflammation in patients with, or at risk of developing HE. The development of HE is often unpredictable and its management, particularly in a ward environment, remains challenging and patients frequently require augmented levels of care in a high-dependency or intensive care arena. The probability of maintaining a transplant-free survival after a first episode of HE at 3 years is only 23% and therefore referral for liver transplantation should be considered early. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256063 Mon, 26 Sep 2011 18:52:24 +0100 5256063 http://www.medworm.com/index.php?rid=5256062&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100199X%2Fabstract%3Frss%3Dyes Abstract: The development of ascites and/or the hepatorenal syndrome in liver disease signifies the beginning of the end of liver function (decompensation). These patients need careful medical management to reverse these abnormalities, and identify any precipitating cause such as sepsis or complication such as spontaneous bacterial peritonitis. Once ascites develops, all patients should be considered for liver transplantation since the long-term prognosis is poor. Patients should start modest salt restriction, and spironolactone as the first-line diuretic drug. Patients with alcoholic liver disease need to stop drinking.The development of hepatorenal syndrome is due to a combination of vasodilatation causing a lowering of blood pressure, activation of the sympathetic nervous system, impair... Medicine journals http://www.medworm.com/rss/comments.php?id=5256062 Mon, 26 Sep 2011 18:52:24 +0100 5256062 http://www.medworm.com/index.php?rid=5256061&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100185X%2Fabstract%3Frss%3Dyes Abstract: The risk of variceal bleeding can be estimated by the size of varices, the presence of endoscopic red signs and the degree of liver dysfunction. All patients with large varices, and those with cirrhosis and severe liver disease, irrespective of the size of varices, should be given primary prophylaxis with non-selective β-blockers. Banding ligation is equivalent and is used if there are contraindications or intolerance to these drugs. Acute variceal bleeding should be managed in a gastrointestinal bleeding unit. Prophylactic third-generation cephalosporins and vasoactive drugs should always be given. Ligation or sclerotherapy should take place at diagnostic endoscopy. Secondary prophylaxis of variceal bleeding is mandatory with combined β-blockers and ligation. Hepatic outflow o... Medicine journals http://www.medworm.com/rss/comments.php?id=5256061 Mon, 26 Sep 2011 18:52:24 +0100 5256061 http://www.medworm.com/index.php?rid=5256060&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001903%2Fabstract%3Frss%3Dyes Abstract: Cholestasis (impairment of, or reduction in, bile flow) can both predispose to the development of chronic liver disease and result in its own specific symptoms. The severity of cholestatic symptoms (which themselves can often impair quality of life) is typically independent of the severity of the underlying liver disease, the link with cholestasis frequently being missed as a result. The most characteristic symptoms of cholestasis are pruritus and fatigue, the former being the most responsive to treatment. Following exclusion of surgically or endoscopically treatable biliary tree obstruction, the first-line treatment for cholestatic pruritus is colestyramine. Rifampicin and the oral opiate antagonist, naltrexone, are extremely effective second-line treatments. The treatment of fa... Medicine journals http://www.medworm.com/rss/comments.php?id=5256060 Mon, 26 Sep 2011 18:52:24 +0100 5256060 http://www.medworm.com/index.php?rid=5256059&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002180%2Fabstract%3Frss%3Dyes Abstract: Wilson's disease is an autosomal recessive disorder of hepatic copper disposition caused by mutations in the gene ATP7B, located on chromosome 13. This gene encodes a P-type adenosine triphosphatase (ATPase), known as the Wilson ATPase, which functions within hepatocytes to move copper across intracellular membranes. The copper-transporting action directly supports production of the ferroxidase caeruloplasmin, in which copper is incorporated, as well as excretion of copper into bile. Consequently, in Wilson's disease, serum concentrations of copper are low and hepatic retention of copper develops, leading to liver injury. Wilson's disease can present as hepatic, neurological or psychiatric disease; clinical phenotypes are highly varied. Other organ systems may also be involved. A... Medicine journals http://www.medworm.com/rss/comments.php?id=5256059 Mon, 26 Sep 2011 18:52:24 +0100 5256059 http://www.medworm.com/index.php?rid=5256058&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001873%2Fabstract%3Frss%3Dyes Abstract: The discovery of the principal gene associated with hereditary haemochromatosis (HFE) in 1996 led to the complete revision of our understanding of this condition. The impact of homozygosity for the C282Y mutation, accounting for the majority of cases, cannot be underestimated. Early accurate diagnosis is now possible and the disease entirely preventable through phlebotomy. Liver biopsy is mainly reserved to identify cases for hepatoma surveillance. Presentation with classical signs relating to end-organ damage is less typical, though joint symptoms are common and impair quality of life in patients with haemochromatosis. Penetrance is much lower in females and immediate treatment is not always required in the presymptomatic state. A low clinical index of suspicion avoids delay in ... Medicine journals http://www.medworm.com/rss/comments.php?id=5256058 Mon, 26 Sep 2011 18:52:24 +0100 5256058 http://www.medworm.com/index.php?rid=5256057&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001976%2Fabstract%3Frss%3Dyes Abstract: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver dysfunction in the Western world. It defines the spectrum from steatosis to cirrhosis and hepatocellular carcinoma. The predominant cause of NAFLD is obesity. Its pathogenesis involves insulin resistance, hepatic fat deposition, consequent increased oxidant stress, activation of matrix producing cells and propagation of fibrogenesis with increasing indication for liver transplantation. NAFLD rates are rising in tandem with the population prevalence of obesity. Mechanistically, there is emerging evidence that maternal obesity may program offspring obesity with ensuing increased susceptibility to NAFLD in adulthood, via permanent changes to structure and/or physiology in utero and lactation. Presently, NAFLD ca... Medicine journals http://www.medworm.com/rss/comments.php?id=5256057 Mon, 26 Sep 2011 18:52:24 +0100 5256057 http://www.medworm.com/index.php?rid=5256056&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001861%2Fabstract%3Frss%3Dyes Abstract: Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease caused by diffuse inflammation and fibrosis that can involve the entire biliary tree. The progressive pathological process obliterates intrahepatic and extrahepatic bile ducts, ultimately leading to biliary cirrhosis, portal hypertension and hepatic failure.The cause is unknown but it is closely associated with inflammatory bowel disease, particularly ulcerative colitis, which occurs in about 70% of cases. Approximately 5–10% of patients with total ulcerative colitis will have co-existing PSC.Clinical symptoms include fatigue, intermittent jaundice, weight loss, right upper quadrant abdominal pain and pruritus. The clinical course of PSC is variable. Serum biochemical tests usually indicate cholestasis... Medicine journals http://www.medworm.com/rss/comments.php?id=5256056 Mon, 26 Sep 2011 18:52:24 +0100 5256056 http://www.medworm.com/index.php?rid=5256055&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001939%2Fabstract%3Frss%3Dyes Abstract: Primary biliary cirrhosis (PBC) is a chronic, progressive, cholestatic disease of unknown aetiology that affects mainly women. There is a strong association with antimitochondrial antibodies (AMA) and the disease is characterized by granulomatous cholangitis, which leads to progressive destruction of the small and middle-sized intrahepatic bile ducts, leading to fibrosis and cirrhosis. Patients with PBC may present with itching or tiredness: both symptoms are commonly seen in practice, but PBC is seldom the cause. However, because of the benefit of making a diagnosis, the opportunity for treatment and diagnosis of complications of liver disease and other autoimmune conditions associated with PBC (such as thyroid disease, sicca syndrome, Raynaud’s and coeliac disease), the condi... Medicine journals http://www.medworm.com/rss/comments.php?id=5256055 Mon, 26 Sep 2011 18:52:24 +0100 5256055 http://www.medworm.com/index.php?rid=5256054&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001885%2Fabstract%3Frss%3Dyes Abstract: Autoimmune hepatitis (AIH) is a progressive necro-inflammatory liver disease associated with significant morbidity and mortality. It affects mainly females and has a varied clinical presentation from minor symptomatology to acute liver failure. The diagnosis should be considered in anyone with abnormal liver function tests. Diagnostic features include biochemical evidence of transaminitis, elevated immunoglobulin G and positive autoantibodies. Liver biopsy may show interface hepatitis with portal-based plasma cell infiltrates. AIH responds promptly to immunosuppression therapy including corticosteroids (prednis(ol)one or budesonide) with azathioprine. Joint care between primary healthcare and hepatology services is required to monitor treatment efficacy and adverse effects, in ad... Medicine journals http://www.medworm.com/rss/comments.php?id=5256054 Mon, 26 Sep 2011 18:52:24 +0100 5256054 http://www.medworm.com/index.php?rid=5256053&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001952%2Fabstract%3Frss%3Dyes Abstract: The presence of deranged liver function tests is common in pregnancy, but it can be a challenge to elucidate the cause. The history and clinical assessment provide useful tools for distinguishing between pregnancy-related causes, such as pre-eclampsia, acute fatty liver of pregnancy and obstetric cholestasis, and non-pregnancy-related causes such as acute viral infection, autoimmune liver disease and Budd–Chiari syndrome. Pregnancy can also affect the natural course of liver conditions, for example by increasing the risk of bleeding of a hepatic adenoma, a flare in autoimmune hepatitis, or the severity of hepatitis E infection.It is important for clinicians to be aware of the impact of liver disorders and the drugs used to treat them on pregnancy and to understand the influence... Medicine journals http://www.medworm.com/rss/comments.php?id=5256053 Mon, 26 Sep 2011 18:52:24 +0100 5256053 http://www.medworm.com/index.php?rid=5256052&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001988%2Fabstract%3Frss%3Dyes Abstract: Acute liver disease or failure in children is most often due to viral hepatitis (A, B, E or sero-negative), paracetamol overdose or inherited metabolic liver disease. The clinical presentation includes jaundice, coagulopathy and encephalopathy. Uncomplicated acute hepatitis resolves spontaneously, but progressive acute liver failure is fatal in 70% of cases and requires referral to specialized units to prevent complications and for consideration for liver transplantation. Chronic liver disease may be due to unresolved neonatal liver disease, either inherited cholestasis or α1-antitrypsin. Chronic viral hepatitis B and C are rare but significant diseases, which require family support and long-term monitoring. Treatment for hepatitis B remains unsatisfactory, but combination ther... Medicine journals http://www.medworm.com/rss/comments.php?id=5256052 Mon, 26 Sep 2011 18:52:24 +0100 5256052 http://www.medworm.com/index.php?rid=5256051&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001964%2Fabstract%3Frss%3Dyes Abstract: Liver disease in infancy is a relatively rare but serious cause of morbidity and mortality. Since jaundice is a common finding in the neonatal period, the immediate priority is to differentiate between unconjugated hyperbilirubinaemia, which is generally a benign developmental phenomenon, and conjugated hyperbilirubinaemia (conjugated fraction >20%), which is always pathological. Conjugated hyperbilirubinaemia, suggested by yellow urine and stools that are not yellow or green in an infant of any age, is pathognomonic of liver parenchymal or bile duct disease and warrants prompt investigation since some of its causes require urgent treatment and/or genetic counselling. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256051 Mon, 26 Sep 2011 18:52:24 +0100 5256051 http://www.medworm.com/index.php?rid=5256050&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002301%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256050 Mon, 26 Sep 2011 18:52:24 +0100 5256050 http://www.medworm.com/index.php?rid=5256049&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002283%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5256049 Mon, 26 Sep 2011 18:52:24 +0100 5256049 http://www.medworm.com/index.php?rid=5153246&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001824%2Fabstract%3Frss%3Dyes Investigations: full blood count and reticulocyte count normal. Urea, electrolytes, calcium and fasting glucose normal. Liver function tests (LFTs); bilirubin 40, alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT) and albumin all within normal limits. Urine did not contain protein, glucose or bilirubin. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5153246 Thu, 25 Aug 2011 00:23:17 +0100 5153246 http://www.medworm.com/index.php?rid=5153245&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001575%2Fabstract%3Frss%3Dyes This article will outline the epidemiology, presentation and management of hepatitis A and E viruses, Epstein–Barr virus, cytomegalovirus, and herpes simplex virus. In certain groups such as pregnant women, and patients in immunocompromised states, these viruses can, albeit rarely, cause fulminant hepatic failure. While some antiviral therapies can be used, the majority of cases can be managed expectantly. At-risk populations (travellers and the immunocompromised) should be offered vaccination where available. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5153245 Thu, 25 Aug 2011 00:23:17 +0100 5153245 http://www.medworm.com/index.php?rid=5153244&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100154X%2Fabstract%3Frss%3Dyes This article describes some hepatic and biliary problems that are seen in the tropics, or which may be imported from resource-poor settings. The epidemiology of hepatitis A is changing in some areas and hepatitis E is now recognised in an increasing range of tropical and non-tropical settings. Vaccines have been developed against hepatitis E. Hepatitis B and C continue to cause chronic liver disease, cirrhosis and hepatocellular carcinoma, but these may be eclipsed in epidemiological importance by the sequelae of the emerging epidemic of non-alcoholic fatty liver disease in many parts of the tropics. The pathophysiology of acute and chronic liver disease due to aflatoxins is better understood, as is the relationship of veno-occlusive disease of the liver to pyrrolizidine alkaloids. Self-p... Medicine journals http://www.medworm.com/rss/comments.php?id=5153244 Thu, 25 Aug 2011 00:23:17 +0100 5153244 http://www.medworm.com/index.php?rid=5153243&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001599%2Fabstract%3Frss%3Dyes Abstract: Hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Over 180 million people worldwide have chronic HCV infection and are at risk of developing its life-threatening complications. Acute infection is usually asymptomatic with most patients unaware that they have contracted the virus. Some patients clear the virus spontaneously, but most become chronic carriers. If carriers are identified they may be candidates for antiviral therapy, the main goal being prevention of cirrhosis, liver failure and hepatocellular carcinoma by eradicating the virus. During the past decade there has been impressive progress in the efficacy of treatment. With the current standard of care, pegylated interferon alpha and ribavirin, a sustained virological r... Medicine journals http://www.medworm.com/rss/comments.php?id=5153243 Thu, 25 Aug 2011 00:23:17 +0100 5153243 http://www.medworm.com/index.php?rid=5153242&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001666%2Fabstract%3Frss%3Dyes Abstract: Hepatitis B virus (HBV) infection is a global health problem. Around 400 million people are chronically infected with HBV, which is a major cause of liver cirrhosis and liver failure. The interaction between the virus and host immune responses defines the clinical course of infection. The natural history of HBV is not linear and the clinical spectrum varies from an asymptomatic carrier state to fulminant hepatic failure. Immunization programmes have resulted in a dramatic decline in the incidence and prevalence of chronic hepatitis B infection in many countries. For those with infection, the timing of treatment and the choice of antiviral therapy depend on the patient profile. The main goal of antiviral therapy is to prevent liver cirrhosis. Antiviral treatment is with interfero... Medicine journals http://www.medworm.com/rss/comments.php?id=5153242 Thu, 25 Aug 2011 00:23:16 +0100 5153242 http://www.medworm.com/index.php?rid=5153241&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001617%2Fabstract%3Frss%3Dyes Abstract: Patients with liver disease often require drug therapy. Since the liver is the main site of drug detoxification and elimination in the body, patients must be carefully assessed for the need for therapy. If a drug is needed for a patient with liver disease, the choice of drug, its dose, and duration of therapy must be carefully considered in order to avoid adverse effects. Ideally, in patients with liver disease, it is better to choose a drug that has a large therapeutic index, is largely devoid of pharmacokinetic and pharmacodynamic interactions, is devoid of hepatotoxic effects and is renally eliminated. However, the ideal drug with these properties is often not available, and in such cases, the dose and drug should be individualized to the patient, who should then be carefully ... Medicine journals http://www.medworm.com/rss/comments.php?id=5153241 Thu, 25 Aug 2011 00:23:16 +0100 5153241 http://www.medworm.com/index.php?rid=5153240&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001551%2Fabstract%3Frss%3Dyes Abstract: Drug-induced liver injury (DILI) accounts for 9.5% of all suspected adverse drug reactions (ADRs) and for a significant proportion of fatal ADRs. DILI may be a direct toxic effect or an immunological reaction to either the drug or an active metabolite. Drugs can cause a diverse array of liver injury, which may be acute or chronic. Adaptation to injurious effects, with only a transient increase in liver function, can occur. Inherited or acquired factors affect the risk of DILI. There is marked geographic variation in responsible agents; in the West antibiotics, anticonvulsants, psychotropic and recreational drugs are the most common offending agents, whereas in Asia, herbal and dietary supplements are more common. This contribution focuses on the pathogenesis and consequences of D... Medicine journals http://www.medworm.com/rss/comments.php?id=5153240 Thu, 25 Aug 2011 00:23:16 +0100 5153240 http://www.medworm.com/index.php?rid=5153239&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001654%2Fabstract%3Frss%3Dyes Abstract: Hospital admission with alcoholic liver disease (ALD) has become increasingly common. Although a clear dose-relationship exists between the risk of ALD and alcohol consumed, additional risk factors include genetic predisposition, gender, nutritional status, obesity, and co-existing liver diseases such as hepatitis C.ALD ranges from steatosis to alcoholic steatohepatitis and established cirrhosis. Several mechanisms are involved in the pathophysiology of ALD, including oxidative damage secondary to alcohol metabolism, endotoxaemia leading to tumour necrosis factor α-mediated cell damage and death, and the formation on cell membranes of protein adducts that initiate an inflammatory response.Diagnosis requires a combination of appropriate history, clinical and laboratory results, a... Medicine journals http://www.medworm.com/rss/comments.php?id=5153239 Thu, 25 Aug 2011 00:23:15 +0100 5153239 http://www.medworm.com/index.php?rid=5153238&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001563%2Fabstract%3Frss%3Dyes Abstract: Asymptomatic abnormal liver function tests (LFTs) are common, affecting 8% of the population. The commonest causes are alcoholic and non-alcoholic fatty liver disease (NAFLD). They may be transient and should be repeated after weight reduction or cessation of alcohol or potentially hepatotoxic drugs. A careful history will help to exclude non-hepatic causes of abnormal liver blood tests as well as indicating a potential hepatic cause. Abnormal LFTs in patients taking statins are common and are more likely to be caused by co-existent NAFLD than by the treatment. Investigations are intended to identify patients with progressive liver disease, recognizing that cirrhosis can be clinically silent in the early stages. Concurrent clinical hepatomegaly, thrombocytopenia and splenomegaly ... Medicine journals http://www.medworm.com/rss/comments.php?id=5153238 Thu, 25 Aug 2011 00:23:15 +0100 5153238 http://www.medworm.com/index.php?rid=5153237&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001587%2Fabstract%3Frss%3Dyes Abstract: Histopathological assessments play an important role in the diagnosis and management of patients with liver disease. For some conditions, liver biopsy is still used routinely to establish or confirm the cause of liver disease. In other circumstances, evaluation of morphological changes provides additional information that is useful for clinical management – for example, when assessing disease severity in chronic viral hepatitis and non-alcoholic fatty liver disease. However, with the increased use of non-invasive methods for assessing the severity of liver injury, particularly fibrosis, the role of liver biopsy in this respect is changing. In cases where a dual pathology is suspected, histological assessment may help to identify the main cause of liver injury. In addition, live... Medicine journals http://www.medworm.com/rss/comments.php?id=5153237 Thu, 25 Aug 2011 00:23:15 +0100 5153237 http://www.medworm.com/index.php?rid=5153236&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001605%2Fabstract%3Frss%3Dyes Abstract: Jaundice is an important clinical sign reflecting the accumulation of bilirubin in blood. It is frequently associated with significant underlying disease. It can result from increased bilirubin production (due to haemolysis); inability of the liver to take up and/or conjugate bilirubin (in Gilbert’s syndrome or parenchymal liver disease); or failure to excrete bilirubin into biliary canaliculi and/or into the biliary tree (when the bile ducts are obstructed). Appropriate investigation of a jaundiced patient starts with a detailed history that will often give vital clues to the diagnosis. Clinical examination should look for the presence of stigmata of chronic liver disease to determine the possible chronicity of liver injury. Liver function tests (LFTs) include a variety of dif... Medicine journals http://www.medworm.com/rss/comments.php?id=5153236 Thu, 25 Aug 2011 00:23:14 +0100 5153236 http://www.medworm.com/index.php?rid=5153235&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001812%2Fabstract%3Frss%3Dyes Abstract: Several imaging modalities are used to investigate the liver and biliary tract. The commonest is ultrasound, which is safe, cheap and readily available. It is often used as a screening modality. Computed tomography or magnetic resonance imaging or both are often the next modalities of choice, and are used to explore any unusual findings detected on ultrasound. Fluoroscopic imaging procedures, such as percutaneous cholangiography and endoscopic retrograde cholangiopancreatography, are often used when intervention is required, usually for therapeutic reasons.In this article, we describe the role of the each of these imaging modalities in benign and malignant hepatobiliary disease, summarize their use in commonly encountered conditions, such as gallstones, cirrhosis and focal liver ... Medicine journals http://www.medworm.com/rss/comments.php?id=5153235 Thu, 25 Aug 2011 00:23:14 +0100 5153235 http://www.medworm.com/index.php?rid=5153234&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001629%2Fabstract%3Frss%3Dyes Abstract: Chronic liver disease is increasingly common in the UK, and now causes in excess of 5000 deaths per year. The natural history of liver injury is of increasing fibrosis in response to hepatocellular injury, which is usually asymptomatic until decompensation occurs. Up until this point, elevated liver enzyme concentrations are the only indicators of disease. Thorough investigation of abnormal liver function tests is therefore essential to produce a diagnosis at a stage where the underlying disease is likely to be treatable. Clinical stigmata of chronic liver disease are not present in the absence of severe fibrotic liver disease and, if present, should cause concern. Non-alcoholic fatty liver disease is now the commonest cause of elevated liver enzymes, whereas alcohol remains the ... Medicine journals http://www.medworm.com/rss/comments.php?id=5153234 Thu, 25 Aug 2011 00:23:14 +0100 5153234 http://www.medworm.com/index.php?rid=5153233&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002027%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5153233 Thu, 25 Aug 2011 00:23:14 +0100 5153233 http://www.medworm.com/index.php?rid=5153232&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911002003%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5153232 Thu, 25 Aug 2011 00:23:14 +0100 5153232 http://www.medworm.com/index.php?rid=5046475&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001538%2Fabstract%3Frss%3Dyes in 3% of cadaveric grafts the kidney will never function (primary non-function) (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046475 Thu, 21 Jul 2011 21:50:17 +0100 5046475 http://www.medworm.com/index.php?rid=5046474&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001344%2Fabstract%3Frss%3Dyes This article describes the late endocrine effects that may occur following treatment for cancer and discusses the issues surrounding the long-term follow-up of this particular group of patients. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046474 Thu, 21 Jul 2011 21:50:17 +0100 5046474 http://www.medworm.com/index.php?rid=5046473&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001319%2Fabstract%3Frss%3Dyes Abstract: Women with renal disease should be counselled about the risks pregnancy may pose to them and their fetus before they conceive. Although worse baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised whether their medication needs to be modified, whether they are likely to suffer irreversible renal damage, and that they have a higher risk of pre-eclampsia with its attendant risks to the fetus. They need to consider the implications of the possibility of having a premature baby. Pregnancy-induced renal disease is less common and renal failure is rare. The commonest causes are those associated with severe pre-eclampsia and are usually managed by early delivery. Proteinuria can persist for months after pre-eclampsia. Women w... Medicine journals http://www.medworm.com/rss/comments.php?id=5046473 Thu, 21 Jul 2011 21:50:16 +0100 5046473 http://www.medworm.com/index.php?rid=5046472&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001277%2Fabstract%3Frss%3Dyes Abstract: Renal dysfunction frequently complicates liver disease and, when present, adversely affects prognosis. While a number of conditions can affect both the liver and the kidney acutely (e.g. paracetamol), many hepatotoxic insults (e.g. alcohol or viral hepatitis) cause more problems associated with cirrhosis. This review focuses mainly on the renal dysfunction associated with this chronic liver damage. Chronic liver disease is implicated in changes in vascular reactivity and tone, resulting in a systemic vasodilatation and renal vasoconstriction. In its extreme form it leads to the most feared of all renal complications of liver disease, the hepatorenal syndrome (HRS), which is frequently fatal. The recognition and early management of both the renal dysfunction and liver disease are ... Medicine journals http://www.medworm.com/rss/comments.php?id=5046472 Thu, 21 Jul 2011 21:50:16 +0100 5046472 http://www.medworm.com/index.php?rid=5046471&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001393%2Fabstract%3Frss%3Dyes Abstract: Multi-system autoimmune diseases, including systemic lupus erythematosus (SLE) and vasculitis, are inflammatory conditions of unknown cause. Renal involvement can occur in a variety of forms and usually represents a severe disease manifestation. SLE is frequently complicated by renal involvement (lupus nephritis). The main renal manifestation of vasculitis is pauci-immune, necrotizing, crescentic glomerulonephritis. This is potentially reversible but, if left untreated, results in end-stage renal failure and death within days to weeks. Vasculitis is the most common cause of the syndrome of rapidly progressive glomerulonephritis (RPGN), but this can also be seen in SLE and anti-glomerular basement membrane disease. Other less frequent examples of renal involvement in multi-system ... Medicine journals http://www.medworm.com/rss/comments.php?id=5046471 Thu, 21 Jul 2011 21:50:16 +0100 5046471 http://www.medworm.com/index.php?rid=5046470&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001289%2Fabstract%3Frss%3Dyes Abstract: Paraproteins are produced by a wide spectrum of haematological conditions, most commonly by plasma cell dyscrasias. Paraprotein production is frequently incidental in patients with renal disease but can directly cause renal impairment through a variety of underlying pathological processes. Diagnosis is usually through the detection of a monoclonal protein, either in the serum or urine. Monoclonal free light chain assays are more sensitive than electrophoresis or immunofixation and are useful in monitoring clonal response to treatment. Renal biopsy is necessary to establish a definitive diagnosis. The general supportive management of all paraprotein-related renal lesions is meticulous fluid balance, early treatment of infections and avoidance of nephrotoxic insults. Patients with ... Medicine journals http://www.medworm.com/rss/comments.php?id=5046470 Thu, 21 Jul 2011 21:50:15 +0100 5046470 http://www.medworm.com/index.php?rid=5046469&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001368%2Fabstract%3Frss%3Dyes Abstract: The thrombotic microangiopathies are a group of conditions characterized by microvascular bed thrombosis, haemolytic anaemia and thrombocytopenia. Renal involvement, due to occlusion of glomerular capillaries and renal arterioles by platelet-fibrin thrombi, is a common though not universal finding. Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are examples of thrombotic microangiopathies that illustrate learning points for the diagnosis, pathogenesis, management and prognosis for this group of conditions. There have been significant advances in understanding the separate aetiologies of these conditions in the last 10 years, which will increasingly influence treatment.HUS has prominent renal involvement and is classified into two major subtypes. ... Medicine journals http://www.medworm.com/rss/comments.php?id=5046469 Thu, 21 Jul 2011 21:50:14 +0100 5046469 http://www.medworm.com/index.php?rid=5046468&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001332%2Fabstract%3Frss%3Dyes Abstract: The glomerular basement membrane (GBM) is the vital barrier between blood and glomerular filtrate. Diseases that damage it generally cause haematuria initially, but as architecture becomes disordered proteinuria becomes an increasing feature. Inflammatory glomerulonephritis most commonly does this, but genetic abnormalities of GBM components are another important mechanism.Alport’s syndrome, a hereditary nephritis associated with deafness, is the second commonest genetic cause of renal failure. Thin basement membrane nephropathy is thought to be the underlying diagnosis in 25% of patients presenting to nephrologists with microscopic haematuria. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046468 Thu, 21 Jul 2011 21:50:14 +0100 5046468 http://www.medworm.com/index.php?rid=5046467&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001320%2Fabstract%3Frss%3Dyes This article sets out to define the natural history of the disease and its significance in terms of patient morbidity and mortality. Therapeutic strategies are discussed with particular emphasis on the relative importance of glycaemic control, blood pressure treatment and blockade of the renin–angiotensin system. In addition, guidelines are presented on screening, diagnosis and referral to specialist services. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046467 Thu, 21 Jul 2011 21:50:14 +0100 5046467 http://www.medworm.com/index.php?rid=5046466&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001356%2Fabstract%3Frss%3Dyes Abstract: Chronic kidney disease (CKD) is accompanied by tubulo-interstitial atrophy and fibrosis, regardless of the underlying cause. Disorders of the renal vasculature, the glomeruli or urinary drainage all culminate in chronic tubulo-interstitial damage, the severity of which is the histological feature that correlates best with progression to end-stage renal failure (ESRF). However, there are diverse conditions in which the tubulo-interstitium is the primary site of damage; these may be considered together without inferring a common aetiology or pathogenesis. The diseases classified as tubulo-interstitial nephritis are considered in this article. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046466 Thu, 21 Jul 2011 21:50:14 +0100 5046466 http://www.medworm.com/index.php?rid=5046465&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001290%2Fabstract%3Frss%3Dyes Abstract: Secondary glomerular diseases are common worldwide and can manifest in many ways. Bacterial and viral infections, especially hepatitis and HIV, can cause a variety of patterns of glomerular injury often presenting with nephrotic syndrome, as can tumours and drugs. Diabetes and systemic lupus erythematosus are also important causes. Identifying underlying agents leads to specific treatments and can lead to resolution of the glomerular injury. In this review we explore the commonest secondary glomerular diseases and their management. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046465 Thu, 21 Jul 2011 21:50:14 +0100 5046465 http://www.medworm.com/index.php?rid=5046464&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001307%2Fabstract%3Frss%3Dyes This article reviews the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). This can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease, so early diagnosis is vital to allow timely referral to specialist units where renal biopsy can be performed. Proteinuria and/or haematuria are typical findings. Pathogenesis involves cells and mediators of the immune system, including the complement pathway. Intrinsic glomerular cells, especially podocytes, are important in glomerular injury and the response to it. I present schemes for appropriate... Medicine journals http://www.medworm.com/rss/comments.php?id=5046464 Thu, 21 Jul 2011 21:50:14 +0100 5046464 http://www.medworm.com/index.php?rid=5046463&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100137X%2Fabstract%3Frss%3Dyes Abstract: Renal transplantation is the preferred form of renal replacement therapy. It restores quality of life and increases longevity for individuals with end-stage renal failure (ESRF). Unfortunately, only 30% of patients who develop ESRF are fit enough to be listed for transplantation, because of excessive co-morbidities. The rejection process blighted initial attempts at human transplantation, but the advent of potent immunosuppression has markedly improved 1-year graft survival rates to over 90%. Nevertheless, the chronic deterioration of graft function after the first year remains a problem with only minor improvements in this respect over the last three decades. This is compounded by the deterioration in cadaveric donor organ quality, as donors have become progressively older, with... Medicine journals http://www.medworm.com/rss/comments.php?id=5046463 Thu, 21 Jul 2011 21:50:14 +0100 5046463 http://www.medworm.com/index.php?rid=5046462&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001381%2Fabstract%3Frss%3Dyes Abstract: The outcomes of kidney transplantation have improved dramatically over recent decades such that kidney transplantation is now the treatment of choice for end-stage renal failure. This success is attributable to improvements in histocompatibility testing, organ procurement and preservation, as well as more effective and safer immunosuppression. Kidneys are usually obtained from deceased donors, but the proportion of live donors has substantially increased. The increasing demand for organs has also necessitated the use of kidneys from less ideal deceased donors including older donors and donors with history of cardiovascular disease. Complications of kidney transplantation may be related to the surgery or sequelae of long-term immunosuppression such as malignancy and infections. Ch... Medicine journals http://www.medworm.com/rss/comments.php?id=5046462 Thu, 21 Jul 2011 21:50:14 +0100 5046462 http://www.medworm.com/index.php?rid=5046461&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001691%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046461 Thu, 21 Jul 2011 21:50:14 +0100 5046461 http://www.medworm.com/index.php?rid=5046460&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001678%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=5046460 Thu, 21 Jul 2011 21:50:14 +0100 5046460 http://www.medworm.com/index.php?rid=4966290&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100140X%2Fabstract%3Frss%3Dyes the chewing of betel nut in Asian communities is a recognized risk factor (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966290 Sun, 26 Jun 2011 15:14:34 +0100 4966290 http://www.medworm.com/index.php?rid=4966289&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100106X%2Fabstract%3Frss%3Dyes Abstract: The aim of renal replacement therapy (RRT) is to prolong the quantity of life without diminishing the quality of remaining years. Unfortunately, in some patients, this is far from reality. Maximal conservative management is the support of patients with end-stage kidney disease (ESKD) without resorting to RRT. This support addresses the patient’s physical, emotional and spiritual needs until the end of life: a multi-disciplinary approach is, therefore, essential. Medical therapy includes the treatment of underlying renal pathology and other manoeuvres to prolong residual renal function, such as anti-hypertensive medication. As renal function declines, the treatment of renal anaemia with erythropoietin and optimization of fluid balance with diuretics can become more important. Pa... Medicine journals http://www.medworm.com/rss/comments.php?id=4966289 Sun, 26 Jun 2011 15:14:34 +0100 4966289 http://www.medworm.com/index.php?rid=4966288&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000934%2Fabstract%3Frss%3Dyes Abstract: Peritoneal dialysis (PD) is a home-based renal replacement therapy for patients with end-stage kidney disease, offering some degree of autonomy and flexibility of lifestyle. After the placement of a catheter into the peritoneal cavity under either general or local anaesthetic, the patient is instructed how to perform dialysis exchanges where dialysate is instilled into the peritoneal cavity. These exchanges can either be performed manually (continuous ambulatory or CAPD), or using a machine (automated or APD). During the dialysis exchange small solutes (such as urea, potassium and creatinine) diffuse from the circulation into the dialysate and are removed when the effluent is drained out. On CAPD the standard approach is to perform four exchanges during the 24-hour period using 2... Medicine journals http://www.medworm.com/rss/comments.php?id=4966288 Sun, 26 Jun 2011 15:14:34 +0100 4966288 http://www.medworm.com/index.php?rid=4966287&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000958%2Fabstract%3Frss%3Dyes Abstract: The haemodialysis population continues to increase and is becoming more elderly and dependent. Despite major advances in technology, long-term clinical outcomes are disappointing, even in low-risk patients. Current definitions of dialysis adequacy, based on urea clearance, need to be broadened to encompass parameters such as β2-microglobulin clearance, salt and water balance, and phosphate control. More frequent treatments may be necessary to adequately control uraemia and can improve survival. Haemodiafiltration provides improved β2-microglobulin clearance over haemodialysis, and may improve survival. Failures in access provision, particularly over-dependence on tunnelled lines, contribute significantly to morbidity and excess mortality. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966287 Sun, 26 Jun 2011 15:14:33 +0100 4966287 http://www.medworm.com/index.php?rid=4966286&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001009%2Fabstract%3Frss%3Dyes Abstract: Anaemia is a common complication of chronic kidney disease. Of the various contributory factors, the most important is an inappropriately low circulating concentration of erythropoietin, a hormone largely produced by the peritubular cells of the kidney. Chronic anaemia causes debilitating symptoms, particularly if severe, including tiredness and lethargy, muscle fatigue, reduced exercise capacity and breathlessness on exertion. There are adverse consequences for a number of physiological systems, particularly those of the heart and brain. The anaemia of kidney disease tends to develop once the glomerular filtration rate falls below 60 ml/minute, and anaemic patients with a lesser degree of renal impairment should be screened carefully for another cause of anaemia. Synthetic eryth... Medicine journals http://www.medworm.com/rss/comments.php?id=4966286 Sun, 26 Jun 2011 15:14:33 +0100 4966286 http://www.medworm.com/index.php?rid=4966285&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001022%2Fabstract%3Frss%3Dyes Abstract: Chronic kidney disease (CKD) is common and increasingly recognized as a risk factor for premature cardiovascular disease (CVD). In patients with end stage renal disease (ESRD) requiring dialysis the risk of CVD is even greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and hyperlipidaemia exacerbate both CKD and CVD. Other factors, more specific to CKD, such as proteinuria, left ventricular hypertrophy, impaired calcium–phosphate homeostasis, anaemia and inflammation contribute to cardiovascular risk in this population. Atypical relationships exist between blood pressure, cholesterol and mortality in ESRD. Although CKD is a state of accelerated atherosclerosis, the commonest mode of ca... Medicine journals http://www.medworm.com/rss/comments.php?id=4966285 Sun, 26 Jun 2011 15:14:33 +0100 4966285 http://www.medworm.com/index.php?rid=4966284&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001058%2Fabstract%3Frss%3Dyes Abstract: Sustained loss of kidney function leads to the evolution of progressive secondary hyperparathyroidism associated with a characteristic high-turnover form of metabolic bone disease. The drivers to hyperparathyroidism include the failure of renal bioactivation of vitamin D, phosphate retention and, in some cases, hypocalcaemia. As renal impairment becomes more severe, some patients, particularly under the influence of treatment and especially if diabetic, evolve in a different direction with the development of low-turnover adynamic bone disease associated with relative suppression of the parathyroid glands. Uraemic patients also develop an internal milieu that favours soft tissue calcification involving peri-articular tissue, skin, and the vasculature. Arterial calcification is ass... Medicine journals http://www.medworm.com/rss/comments.php?id=4966284 Sun, 26 Jun 2011 15:14:33 +0100 4966284 http://www.medworm.com/index.php?rid=4966283&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001034%2Fabstract%3Frss%3Dyes This article focuses on congenital and acquired causes of renal tract obstruction, including posterior urethral valves (PUV), pelvi-ureteric junction (PUJ) obstruction, prune belly syndrome, neuropathic bladder and renal tract calculi. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966283 Sun, 26 Jun 2011 15:14:32 +0100 4966283 http://www.medworm.com/index.php?rid=4966282&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000971%2Fabstract%3Frss%3Dyes Abstract: Management of chronic kidney disease (CKD) requires a systematic approach that includes all components of the chronic disease model. National guidelines are now available for the identification, management and referral of CKD. Some causes of CKD require specific additional management directed at the underlying cause. For many patients, control of cardiovascular risk factors is the most important intervention, as these risk factors also promote progressive loss of kidney function. More intensive reduction of blood pressure and/or the use of inhibitors of the renin/angiotensin axis are recommended in the treatment of proteinuric kidney disease, including diabetic nephropathy. In these patients, treatment should be adjusted to achieve maximum reduction of urine protein excretion. Di... Medicine journals http://www.medworm.com/rss/comments.php?id=4966282 Sun, 26 Jun 2011 15:14:32 +0100 4966282 http://www.medworm.com/index.php?rid=4966281&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000983%2Fabstract%3Frss%3Dyes Abstract: Chronic kidney disease (CKD) is a common condition that has significant implications for patients’ health and healthcare budgets. CKD is diagnosed if evidence of kidney damage has been present for more than 3 months; it is divided into five stages depending on the glomerular filtration rate (GFR). CKD is asymptomatic and determining its prevalence relies on screening populations, so the reported prevalence depends on the population studied and screening methods used. Risk factors for CKD can be divided into initiating and perpetuating factors, and include genetic factors, ethnicity, socio-economic factors and age. There are several causes of CKD, the most common being diabetes mellitus. In order to reduce the burden of CKD, it is essential to recognize which patients are at mo... Medicine journals http://www.medworm.com/rss/comments.php?id=4966281 Sun, 26 Jun 2011 15:14:32 +0100 4966281 http://www.medworm.com/index.php?rid=4966280&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001046%2Fabstract%3Frss%3Dyes Abstract: Acute kidney injury is a commonly encountered condition in the hospital setting. Often accurate history-taking, careful physical examination and meticulous monitoring of volume balance are enough to reverse this process. However, acute kidney injury does present a unique set of metabolic derangements that, if untreated, will result in death. We outline the initial management of acute kidney injury as well as specific treatments that may be required. Some consideration is also given to the use of renal replacement therapies. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966280 Sun, 26 Jun 2011 15:14:32 +0100 4966280 http://www.medworm.com/index.php?rid=4966279&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001010%2Fabstract%3Frss%3Dyes Abstract: Acute kidney injury (AKI) is a common and dangerous complication of hospital admission; even mild degrees of dysfunction reduce the chances of survival. Unfortunately, as confirmed by the UK's National Confidential Enquiry into Patient Outcome and Death (NCEPOD), its recognition is often delayed and management frequently sub-optimal. A failure to recognize relevant risk factors may expose patients, unnecessarily, to the chance of developing AKI. In this review article, we present a structured approach to prevention, diagnosis and initial management that should provide a framework for routine clinical care. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966279 Sun, 26 Jun 2011 15:14:32 +0100 4966279 http://www.medworm.com/index.php?rid=4966278&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000946%2Fabstract%3Frss%3Dyes Abstract: Urinary tract infection is one of the commonest infections to affect humans. Uncomplicated infections occur most commonly in otherwise healthy women when uropathogenic bacteria, usually Escherichia coli, ascend from the perineum into the bladder and overcome host innate immunity. Complicated infections occur in patients with an anatomical or functional abnormality of the urinary tract. The diagnosis is made on the basis of symptoms and diagnostic precision is improved by urinalysis. Urine culture is important with severe, recurrent or complicated infection and when the diagnosis is unclear, for example, in children and the elderly. Most women with symptoms that resolve quickly do not require further investigation but in children, men and patients with recurrent or severe infectio... Medicine journals http://www.medworm.com/rss/comments.php?id=4966278 Sun, 26 Jun 2011 15:14:32 +0100 4966278 http://www.medworm.com/index.php?rid=4966277&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000995%2Fabstract%3Frss%3Dyes Abstract: Lower urinary tract symptoms (LUTS) affect more than 60% of men and women aged over 40. Symptoms may be classed as storage, voiding or post-micturition and have a variety of systemic, neurological, drug-related or urological causes. There is growing evidence that the metabolic syndrome is linked to LUTS.Evaluation of LUTS should follow a structured system, with symptom scores and frequency/volume charts used in initial assessment. Several features have been identified as risk factors for progression of LUTS and risk stratification using these factors can aid in planning management. For example, a high-normal prostate-specific antigen may suggest a higher risk of progression to acute urinary retention.Many patients with LUTS will require no treatment. If indicated, first-line trea... Medicine journals http://www.medworm.com/rss/comments.php?id=4966277 Sun, 26 Jun 2011 15:14:31 +0100 4966277 http://www.medworm.com/index.php?rid=4966276&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100096X%2Fabstract%3Frss%3Dyes Abstract: Renal stone disease (urolithiasis, nephrolithiasis) covers many conditions causing kidney, ureteric or bladder stones. These include metabolic and inherited disorders, anatomical defects of the upper or lower urinary tract, and chronic urinary infection. However, most cases of renal stones are idiopathic and present with loin or abdominal pain, and macro- or microscopic haematuria; leading to the eventual passage of a stone and resolution, or the need for further investigation and intervention. Renal stones often recur, and the underlying causes need to be looked into, particularly as stones can be related to lifestyle and they are often associated with diseases such as hypertension or diabetes. Although clinical management may seem simple, and largely surgical, the increasing pr... Medicine journals http://www.medworm.com/rss/comments.php?id=4966276 Sun, 26 Jun 2011 15:14:31 +0100 4966276 http://www.medworm.com/index.php?rid=4966275&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001435%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966275 Sun, 26 Jun 2011 15:14:31 +0100 4966275 http://www.medworm.com/index.php?rid=4966274&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001411%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4966274 Sun, 26 Jun 2011 15:14:31 +0100 4966274 http://www.medworm.com/index.php?rid=4859951&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001150%2Fabstract%3Frss%3Dyes Initially assessed in A/E he was catheterized and his urine output noted to be extremely low despite normal BP, pulse and the administration of intravenous saline. The urine was deep red in colour with mild glycosuria and proteinuria; though negative for red blood cells it was positive for haemoglobin on dipstick testing. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859951 Wed, 25 May 2011 21:24:40 +0100 4859951 http://www.medworm.com/index.php?rid=4859950&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000685%2Fabstract%3Frss%3Dyes Abstract: In Western populations, fibromuscular disease (FMD) accounts for around 10% of all cases of renal artery stenosis (RAS), usually presenting as hypertension in young patients, most often women, and there is often a successful response after angioplasty. Atherosclerotic renovascular disease (ARVD) is very common, and accounts for the remaining 90% of cases of RAS. ARVD is frequently associated with hypertension and renal dysfunction, and is a disease of ageing. It is commonly accompanied by atherosclerotic macrovascular disease in other parts of the body, such as coronary artery disease, peripheral vascular disease, cerebrovascular disease and aortic aneurysms. Clinical presentations include hypertension, chronic or acute kidney disease and heart failure, although many patients wit... Medicine journals http://www.medworm.com/rss/comments.php?id=4859950 Wed, 25 May 2011 21:24:40 +0100 4859950 http://www.medworm.com/index.php?rid=4859949&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000703%2Fabstract%3Frss%3Dyes Abstract: The management of hypertension in renal disease is best understood by classifying patients according to the stage of their chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD 3/4 are a slowing in the rate of progression of renal disease and a reduction in cardiovascular morbidity and mortality. There is evidence that reducing blood pressure to 130/80 mmHg or below will attenuate the rate of progression of the renal disease. In CKD 5, the aim is solely to reduce cardiovascular morbidity and mortality; the evidence of benefit here is more controversial, with several studies showing worse outcomes in patie... Medicine journals http://www.medworm.com/rss/comments.php?id=4859949 Wed, 25 May 2011 21:24:40 +0100 4859949 http://www.medworm.com/index.php?rid=4859948&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000715%2Fabstract%3Frss%3Dyes Abstract: A wide variety of pharmacological agents, drugs of misuse and environmental pollutants can cause an equally wide variety of renal disease. Drug-induced renal disease can range from renal-vasculitis, to insidious, progressive chronic kidney disease to ureteric obstruction. Consequently, the clinician should always consider these as a potential cause for any newly diagnosed case of renal disease. Therefore a thorough drug history, including recent changes in medications, over-the-counter medications and abused drugs, is mandatory. In this contribution we present some of the commoner and more important presentations. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859948 Wed, 25 May 2011 21:24:40 +0100 4859948 http://www.medworm.com/index.php?rid=4859947&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000727%2Fabstract%3Frss%3Dyes Abstract: Renal insufficiency induces profound pharmacokinetic and pharmacodynamic changes. The widespread reporting of estimated glomerular filtration rate (eGFR) has alerted clinicians to the incidence of renal insufficiency and the need for drug dose amendment. For drugs with a high therapeutic index, the eGFR can be used as a guide to dose adjustment. However, for drugs with a low therapeutic index, pending further experimental data relating drug excretion to the modification of diet in renal disease (MDRD) determination of eGFR, the Cockcroft and Gault equation using the patient’s ideal body weight is the most reliable way to determine dose adjustment. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859947 Wed, 25 May 2011 21:24:39 +0100 4859947 http://www.medworm.com/index.php?rid=4859946&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000739%2Fabstract%3Frss%3Dyes This article focuses on four conditions, cystinosis, methylmalonic aciduria (MMA), primary hyperoxaluria type I and Fabry’s disease. The majority of these conditions present with renal impairment predominantly in childhood but with appropriate treatments, survival into adult life is becoming more common. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859946 Wed, 25 May 2011 21:24:39 +0100 4859946 http://www.medworm.com/index.php?rid=4859945&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000740%2Fabstract%3Frss%3Dyes Abstract: Inherited disorders of renal structure and function are relatively common causes of end-stage renal disease requiring renal replacement therapy. A family history of haematuria, urinary tract infection or renal failure can alert the clinician to the possible diagnosis of underlying renal genetic abnormalities. In practice, the commonest inherited renal disorder is autosomal dominant polycystic kidney disease (ADPKD), characterized by multiple kidney cysts associated with hypertension and renal failure. Insights into the cell biology of ADPKD are informing new therapeutic approaches to limit cyst growth and prevent progressive renal failure. Non-visible haematuria is a clinical finding that presents a diagnostic challenge because it has so many possible causes. Mutations in the gen... Medicine journals http://www.medworm.com/rss/comments.php?id=4859945 Wed, 25 May 2011 21:24:39 +0100 4859945 http://www.medworm.com/index.php?rid=4859944&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000673%2Fabstract%3Frss%3Dyes Abstract: The renal biopsy is of fundamental importance in nephrology and transplantation. Using appropriate guidelines for including or excluding patients it is generally safe with the commonest complication being bleeding. The adequacy and safety have been improved using real-time ultrasound imaging and automated biopsy needles. To fully interpret the pathological findings and understand their significance, discussion between clinicians and pathologists is required. The biopsy must be processed and stained for standard haematoxylin and eosin sections as well as for immunohistochemistry and electron microscopy so as to provide a complete picture of the underlying pathological process. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859944 Wed, 25 May 2011 21:24:39 +0100 4859944 http://www.medworm.com/index.php?rid=4859943&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000697%2Fabstract%3Frss%3Dyes Abstract: The renal tract is investigated mainly to identify the underlying cause in patients with abnormal renal function, renal colic or haematuria. Increasing use of ultrasound and computed tomography has limited the role of plain radiographs, but these are still used in the initial assessment of abdominal colic to evaluate potential renal or bowel abnormalities. Intravenous urography – radiological examination of the urinary tract performed following the intravenous injection of iodinated contrast – is the classical means by which to assess the kidneys and ureters. Ultrasound is often the first imaging modality used to interrogate and follow up renal abnormalities. Computed tomography (CT) can be useful to evaluate renal masses and determine the site of ureteric obstruction by calc... Medicine journals http://www.medworm.com/rss/comments.php?id=4859943 Wed, 25 May 2011 21:24:38 +0100 4859943 http://www.medworm.com/index.php?rid=4859942&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000922%2Fabstract%3Frss%3Dyes Abstract: Electrolyte disorders are common, confer significant morbidity and may be life threatening. They are frequently multifactorial and are both caused by and causative of dysfunction of multiple organ systems. There is considerable co-dependence in electrolyte homeostasis and several abnormalities may emerge simultaneously. Effective treatment is dependent on early recognition, an understanding of physiological principles underlying the disorder, judicious corrective therapy and adequate monitoring. Decades of research has shed considerable light on the molecular mechanisms underlying the pathophysiology of these conditions. This has led to recent therapeutic advances such as the use of V2 receptor blockade in the treatment of the syndrome of inappropriate antidiuretic hormone (SIADH... Medicine journals http://www.medworm.com/rss/comments.php?id=4859942 Wed, 25 May 2011 21:24:38 +0100 4859942 http://www.medworm.com/index.php?rid=4859941&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000636%2Fabstract%3Frss%3Dyes Abstract: Disturbances of fluid and electrolyte balance are common in clinical practice, especially in a hospital setting, and may be iatrogenic or compounded by inappropriate medical or surgical treatment. Their recognition and appropriate management are not necessarily difficult or complex; while specific formulae and standard protocols can be helpful at the bedside, there is no substitute for an understanding, and application, of some basic principles of renal and endocrine physiology, which is what this article tries to provide. Some knowledge of basic renal physiology (including transport function along the nephron and its regulation) is useful, because it makes it easier to work through, and understand, most clinical disorders of fluid and electrolyte balance. Unfortunately, patients... Medicine journals http://www.medworm.com/rss/comments.php?id=4859941 Wed, 25 May 2011 21:24:38 +0100 4859941 http://www.medworm.com/index.php?rid=4859940&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000648%2Fabstract%3Frss%3Dyes Abstract: For centuries, physicians have attempted to use urine as a non-invasive means of assessing disease. Today, urinalysis and, in particular, identification and measurement of proteinuria underpin the routine assessment of patients with renal disease. Urine dipstick analysis can also be used to screen for urinary tract infections (nitrites and leucocyte esterase), diabetes mellitus (glucose) and confirm pregnancy (β-hCG; human chorionic gonadotropin). Apart from intrinsic renal disease, an abnormal urine dipstick result may indicate malignancy in the genitourinary tract, so it is important to be clear when and who to refer for further investigation. Included in this section are guidelines for the initial assessment and referral of patients with haematuria and proteinuria. Formal ass... Medicine journals http://www.medworm.com/rss/comments.php?id=4859940 Wed, 25 May 2011 21:24:37 +0100 4859940 http://www.medworm.com/index.php?rid=4859939&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS135730391100065X%2Fabstract%3Frss%3Dyes Abstract: Kidney function is typically assessed by measuring the glomerular filtration rate (GFR) and many approaches have been used. Accuracy demands complex techniques involving the use of exogenous filtration markers (e.g. inulin, iohexol, 99mTc-diethylenetriaminepentaacetic acid, 125I-iothalamate, and 51Cr-ethylenediaminetetraacetic acid). For most clinical purposes, accuracy is sacrificed for practicality and a blood marker, creatinine (concentration of which has an inverse relationship to GFR) is used. Serum (or plasma) creatinine has many limitations as a kidney function test, being affected by a variety of non-renal and analytical factors. Serum cystatin C measurement has been proposed as an alternative marker. Recently, widespread application of creatinine-based GFR-estimating ... Medicine journals http://www.medworm.com/rss/comments.php?id=4859939 Wed, 25 May 2011 21:24:37 +0100 4859939 http://www.medworm.com/index.php?rid=4859938&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000661%2Fabstract%3Frss%3Dyes This article provides the reader with a straightforward and logical approach to patients presenting with renal disease, by dividing them into three categories: acute kidney injury (AKI), sub-acute or intrinsic renal disease, such as glomerulonephritis, and chronic kidney disease (CKD). For each of these we outline the critical points in the history and examination, the key investigations that are required for further assessment, as well as suggesting the appropriate time to seek expert nephrological advice on further management and investigation. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859938 Wed, 25 May 2011 21:24:37 +0100 4859938 http://www.medworm.com/index.php?rid=4859937&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001113%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859937 Wed, 25 May 2011 21:24:37 +0100 4859937 http://www.medworm.com/index.php?rid=4859936&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911001095%2Fabstract%3Frss%3Dyes (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4859936 Wed, 25 May 2011 21:24:37 +0100 4859936 http://www.medworm.com/index.php?rid=4730715&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000752%2Fabstract%3Frss%3Dyes in screening for bowel cancer there is a lesser reduction in mortality using one-off flexible sigmoidoscopy in the age group 55–64 years than in targeting colonoscopy at faecal occult blood (FOB) positive subjects aged 60–75 years (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4730715 Wed, 20 Apr 2011 11:27:36 +0100 4730715 http://www.medworm.com/index.php?rid=4730714&cid=s_34322_49_f&fid=34322&url=http%3A%2F%2Fwww.medicinejournal.co.uk%2Farticle%2FPIIS1357303911000442%2Fabstract%3Frss%3Dyes Abstract: Gastrointestinal endoscopy is extensively used in the diagnosis and treatment of a range of conditions by both specialists and generalists. A number of issues will be discussed in this article including the appropriate use of gastroscopy in the management of patients with dyspepsia, the role of endoscopy in the management of upper GI haemorrhage, reducing the risk of harm with bowel preparation, the current state of bowel cancer screening in England, management of patients on anticoagulants and antiplatelet agents in the peri-endoscopic period, techniques for deep small bowel enteroscopy and the role of endoscopic ultrasound. (Source: Medicine) Medicine journals http://www.medworm.com/rss/comments.php?id=4730714 Wed, 20 Apr 2011 11:27:36 +0100 4730714