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Self-assessment/CPDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Regarding immediate management the following statement is UNTRUE: meningococcal meningitis is one of the likely causes (Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Tags: Self assessment Source Type: journals

What's new in… Toxicity of drugs of abuseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article is an update on the toxicity of recreational drugs, concentrating on recent research findings and emerging issues. (Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Simon L. Hill, Simon H.L. Thomas Tags: What's new Source Type: journals

Infection in the foetus and neonateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Neonates, particularly when premature, are relatively immunocompromised and are therefore prone to more infections, more severe disease, and infection with unusual organisms. Almost all foetal and many neonatal infections are caused by organisms acquired from the mother. Transmission may be transplacental in utero, perinatal during the birth process or postnatal. Neonates can also acquire infections horizontally. This review provides an overview of the epidemiology, clinical features, diagnosis, prevention and treatment of infections in the foetus and neonate with updates on new developments including the identif...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Shunmay Yeung, Julia M. Kenny Tags: Foetal infections Source Type: journals

Superficial fungal infectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Superficial fungal infections or mycoses are common treatable conditions seen in everyday clinical practice, although they may also present differently in immunosuppressed patients. The dermatophyte or ringworm infections, superficial candidosis of the mouth, skin or genital tract and infections due to Malassezia, such as pityriasis versicolor, are the main conditions. Although they present with typical clinical changes, generally diagnosis is enhanced by direct microscopy or culture of suitable samples. Treatment largely depends on the use of azole (imidazole/triazole) or allylamine antifungals, applied in short...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Roderick Hay Tags: Skin and soft tissue infections Source Type: journals

Skin and soft tissue infectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Skin and soft tissue infections (SSTI) range from relatively common superficial skin infections to rare but life-threatening infections like necrotizing fasciitis or gas gangrene. They can affect all ages and predisposing factors include trauma, pre-existing dermatoses, diabetes, and immunocompromise. SSTI are often caused by organisms that colonize the skin, such as Staphylococcus aureus or group A streptococci, as a result of a breach in the skin's integrity. Community-acquired meticillin-resistant S. aureus (CA-MRSA) is becoming increasingly important as a cause of SSTI. Less common causes include a variety of...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: M.E. Torok, C.P. Conlon Tags: Skin and soft tissue infections Source Type: journals

Protozoal gastrointestinal infectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Human intestinal protozoal infections are found worldwide, in both developing and industrialized countries. Protozoa produce diarrhoeal disease by infecting the small or large intestine, or both. Amoebiasis is an important cause of dysentery and liver abscess worldwide. Giardiasis and cryptosporidiosis are important causes of diarrhoea in children; the latter is particularly associated with growth failure and malnutrition. They also cause water-borne and food-borne outbreaks. Food-borne outbreaks may also be caused by Cyclospora cayetanensis. The importance of intestinal protozoa has increased with the HIV/AIDS p...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Julia M. Kenny, Paul Kelly Tags: Gastrointestinal infections Source Type: journals

Viral gastroenteritisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The virology, immunology, diagnosis, clinical symptoms, treatment, epidemiology and prevention measures relating to the most common viral causes of acute gastroenteritis (rotaviruses, human caliciviruses, astroviruses and enteric adenoviruses) are briefly reviewed. Uncommon viral causes of acute gastroenteritis and viruses causing gastroenteritis in immunodeficient patients are mentioned. The main change over the past three years has been the development, licensing and wide application of new live attenuated rotavirus vaccines. (Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Ulrich Desselberger, Jim Gray Tags: Gastrointestinal infections Source Type: journals

Bacterial gastroenteritisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Infectious diarrhoea is a major public health concern worldwide. In developing countries it leads to around two million deaths per year in the under-five age group alone. In developed countries diarrhoeal disease is rarely fatal, except at extremes of age or in the immunocompromised; however, it remains a cause of significant morbidity. Gastroenteritis refers to syndromes of diarrhoea or vomiting resulting from non-inflammatory infection in the upper small bowel or inflammatory infection in the colon, caused by bacteria, viruses, or parasites. In approximately half of suspected cases, no causal agent is identifie...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: C. Nic Fhogartaigh, J.D. Edgeworth Tags: Gastrointestinal infections Source Type: journals

The prophylaxis and treatment of bacterial infective endocarditis in adultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Infective endocarditis is a relatively rare disease that has an associated high morbidity and mortality. The basic pathology involves the adherence of micro-organisms to areas of endothelial damage, causing local infection resulting in the formation of vegetations. Complications include sepsis, valvular failure and embolization. The diagnosis is based on the Duke criteria but can be difficult to establish, particularly when blood cultures are negative or transthoracic echocardiography images are non-diagnostic. There has recently been a change in guidance regarding which patients should be given antibiotics to pr...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: R.W. Watkin, T.S.J. Elliott Tags: Cardiovascular infections Source Type: journals

Prion diseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Human prion diseases are a rare and diverse group of neurodegenerative diseases that have long provoked interest from physicians and scientists. Initially, this related to the enigma of a group of diseases with inherited, sporadic and acquired forms, and then subsequently to the proposition that the infectious agent comprised an abnormally folded but widely expressed cell-surface protein. More recently, the epidemic of bovine spongiform encephalopathy in cattle and its transmission to humans as variant Creutzfeldt–Jakob disease has raised major public health concerns in the UK and other European countries. From...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Diego Kaski, Simon Mead Tags: Nervous system infections Source Type: journals

Viral meningitis and encephalitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Meningitis and encephalitis due to virus infections occur at all stages of life from the neonate to the elderly and may represent disease due to the primary site of replication, e.g. rabies, or be part of a wider infection syndrome, e.g. HIV. A large proportion of cases go unconfirmed by laboratory diagnosis despite use of sensitive techniques (such as the polymerase chain reaction). They may be both sporadic and epidemic in nature, but with changing environmental and societal conditions, agents may emerge anew, e.g. Nipah and Hendra viruses, or reappear after a period of good control through vaccination, e.g. mu...
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: Philip Rice Tags: Nervous system infections Source Type: journals

Bacterial meningitis and brain abscessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews recent changes in the epidemiology caused by new immunisations; the clinical manifestations at different ages; advances in the understanding of the pathophysiology; and current treatment strategies including the use of adjunctive therapies such as corticosteroids. (Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Authors: K. Ananth Ramakrishnan, Michael Levin, Saul N. Faust Tags: Nervous system infections Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - November 1, 2009 Category: Internal Medicine Source Type: journals

Self-assessment/CPDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - September 22, 2009 Category: Internal Medicine Tags: Self assessment Source Type: journals

SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Sepsis is the systemic response to infection, usually caused by bacterial infections (both Gram positive and Gram negative). It is a common condition with an overall mortality of about 30%, even when treated appropriately. It can be difficult to recognize at the early stages. Sepsis and septic shock are characterised by multiorgan failure, in the main caused by a dysregulated immune response to the infection. Effective management depends on early initiation of treatment. All patients should receive oxygen and fluids. Most will require vasopressor. Pus should be drained. Antibiotics need to be given as quickly as ...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Jonathan Cohen Tags: Sepsis Source Type: journals

Nosocomial infectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Hospital patients are susceptible to infection because of their underlying diseases and medical interventions such as surgery, intubation or antibiotic use, and also their exposure to micro-organisms from other patients, the hospital environment or hospital staff. An average of 5–10% of in-patients have a nosocomial infection, with highest rates in surgical and intensive care units. Most of these infections fall into one of five categories: line-associated infections and bacteraemia, surgical wound infection, nosocomial pneumonia, catheter-associated urinary tract infection, and gastrointestinal infection, incl...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Aodhán S. Breathnach Tags: Nosocomial Source Type: journals

Antibiotic resistanceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article deals with current knowledge about resistance: molecular biology methods have been very useful in revealing mechanisms. However, whatever is written today will be out of date when you read this because evolution in bacteria happens at a phenomenal rate. (Source: Medicine)
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Geoff Scott Tags: Antibiotics Source Type: journals

Antimicrobial therapy: principles of useEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Antibiotics are unique among therapeutic agents. While their use is directed at treating or preventing microbial disease, their efficacy is continuously threatened by drug resistance. Such resistance is readily transmitted between micro-organisms that in turn may disseminate in the healthcare or wider environment. Infectious disease varies in severity by age and underlying risk factors. Choice of therapy requires a risk assessment to ensure safe and effective prescribing practice. A set of principles that supports good prescribing practice has evolved specific to infectious disease management. Drug selection is b...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Roger Finch Tags: Antibiotics Source Type: journals

Viruses and cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: About 15% of human cancers can be attributed to virus infection, and viruses are second only to tobacco as a risk factor for cancer. In the future, a major proportion of these infections may be preventable by immunization, significantly reducing the worldwide cancer burden. There are two major mechanisms by which oncogenic viruses induce tumours: indirect oncogenesis, the virus infects a progenitor of the clonal tumour cell population, and usually persists in the tumour cells; indirect oncogenesis occurs when the virus does not necessarily infect the tumour progenitor cell, but exerts an indirect effect on cell a...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Simon J. Talbot, Dorothy H. Crawford Tags: Viruses and cancer Source Type: journals

Molecular diagnostic techniquesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Clinical microbiology laboratories increasingly rely on molecular diagnostic techniques. The various formats of nucleic acid amplification are the most frequently used molecular tests in the diagnosis of infectious diseases. In many clinical settings, polymerase chain reaction (PCR) is clearly the method of choice due to its exquisite sensitivity and specificity. Today, many conventional PCR methods are being replaced by real-time PCR, which allows more rapid detection and quantification of the PCR product, as well as detection of different strains of the pathogen by melting curve analysis. The ability to measure...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Satu Kurkela, David W.G. Brown Tags: Diagnosis of infection Source Type: journals

ImmunizationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Immunization against infectious agents to induce a specific, protective immune response can be achieved actively or passively.Passive immunization is the administration of preformed protective antibodies; this immunity is short lived. Active immunization involves the administration of antigens to induce humoral and/or cell-mediated immune responses to a specific micro-organism; this provides more enduring immunity. The first description of active immunization is attributed to Edward Jenner, who, in 1796, induced protective immunity to smallpox by inoculating cowpox (vaccinia) vesicle fluid into the skin of suscep...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Matthijs Backx, Andrew Freedman Tags: Defence against infection Source Type: journals

Infection and malnutritionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Malnutrition and infection operate in a vicious mutual synergism. Malnutrition predisposes to infection and increases the severity and mortality of infections. Infection reduces nutrient intake, interferes with substrate utilization and promotes tissue breakdown. Malnutrition and infection tend to occur in the same populations: resource-poor settings, poverty, and extremes of age are major risk factors; hospitalized patients are also at significant risk. A history of weight loss is an important indicator of macronutrient deficiency. Body mass index (BMI) is a useful indicator of wasting and mid-upper arm circumfe...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Derek Macallan Tags: Defence against infection Source Type: journals

The immunocompromised patient: infection in cancer and transplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Patients with cancer and organ graft recipients remain highly susceptible to life-threatening infections. Specific defects in one or more of the host defence mechanisms are associated with characteristic infections with particular pathogens. In addition, certain infections follow temporal patterns. Diagnosis of infection requires careful examination, concentrating on selected body sites and systems. Radiology, microbial culture, antigen detection and molecular tests are of particular value but serology tests are less useful. Empirical therapy based on local epidemiology is the mainstay of treatment but these regi...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Rick Holliman Tags: Defence against infection Source Type: journals

The immunocompromised patient: primary immunodeficienciesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The field of primary immunodeficiency diseases (PID) has grown dramatically over the past 10 years, the number of defined genetic causes almost doubling to a current total of about 130 different defects. These often are very rare disorders which have taught us much about the crucial cellular pathways required for protection against infection from a wide variety of microbes. Although most clinicians do not need a detailed knowledge of the different types of PID, they should be aware of the possibility of PID in patients presenting with recurrent or persistent infection, and be able to refer patients to a regional ...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: A. David B. Webster Tags: Defence against infection Source Type: journals

The immunology of infectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: When micro-organisms invade, conserved pattern recognition receptors activate innate defences including phagocytes, cytokines and complement followed by acquired immune responses mediated by T cells and B cells. Many pathogens have evolved specific mechanisms that enable them to evade host defences. An increasing number of individual human genes that influence the outcome of specific infections have been identified. Deficiency of specific components of the immune system (as a result of either genetic or acquired disorders) can predispose to characteristic patterns of infection. The immune response may also contri...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Andrew Carmichael, Mark Wills Tags: Defence against infection Source Type: journals

Mathematical prediction in infectionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: It is now increasingly common for infectious disease epidemics to be analysed with mathematical models. Modelling is possible because epidemics involve relatively simple processes occurring within large populations of individuals. Modelling aims to explain and predict trends in disease incidence, prevalence, morbidity or mortality.Epidemic models give important insight into the development of an epidemic. Following disease establishment, epidemic growth is approximately exponential. The rate of growth in this phase is primarily determined by the basic reproduction number, R0, the number of secondary cases per pri...
Source: Medicine - September 22, 2009 Category: Internal Medicine Authors: Neil M. Ferguson Tags: Defence against infection Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - September 22, 2009 Category: Internal Medicine Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - September 22, 2009 Category: Internal Medicine Source Type: journals

Self-assessment/CPDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Tags: Self assessment Source Type: journals

Prescribing in pregnancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an update on prescribing during pregnancy, concentrating on the management of hypertension, hypercholesterolaemia, diabetes, epilepsy and depression, as well as treatments for autoimmune disease and organ transplantation. (Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Sally Stephens, Ken Hodson, Simon H.L. Thomas Tags: What's new Source Type: journals

HyperlipidaemiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Hyperlipidaemia is very common and refers to the following biochemical states: hypercholesterolaemia, hypertriglyceridaemia and mixed hyperlipidaemia. Hypercholesterolaemia is commonly polygenetically inherited. Familial hypercholesterolaemia (FH) is commonly characterized by an autosomal dominant low-density lipoprotein receptor mutation, with significantly greater risk of premature cardiovascular disease (CVD). Severe hypertriglyceridaemia (>10.0 mmol/litre, often diabetic and alcohol-related) can cause pancreatitis. Potential causes of secondary hyperlipidaemia have to be investigated. Serum fasting full lipid...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Adrian Park Tags: Hyperlipidaemia Source Type: journals

Disorders of pubertyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Disorders of puberty are either an abnormality of timing – being too early or too late – or loss of the normal harmony of the sequence of acquisition of various secondary sexual characteristics. Those conditions which are gonadotrophin-dependent usually require neuroradiological imaging to exclude a hypothalamic pituitary tumour. Treatments for advancing or arresting sexual maturation are available. The end-point of puberty is the attainment of fertility. (Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Richard Stanhope Tags: Growth and puberty Source Type: journals

Disorders of growthEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Most children who have short or tall stature do not have any abnormality and are simply at the extremes of the normal range. Children settle on to a centile position by 2 or 3 years of age and after this a normal child will grow fast enough to maintain themselves on the same centile until puberty. During puberty, sex steroids stimulate increased growth hormone (GH) secretion, and sex steroids and GH produce the pubertal growth spurt. Most short children are growing in a normal pattern and do not have any underlying pathology. Any short child whose pattern of growth is abnormal (reduced growth velocity) should be ...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Nicola Bridges Tags: Growth and puberty Source Type: journals

Rickets and osteomalaciaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Rickets is the clinical consequence of impaired mineralization of bone matrix throughout the growing skeleton in children, whilst osteomalacia is the result of this disturbance after the growth plates have fused in adults. The three major causes of rickets and osteomalacia are vitamin D deficiency, renal tubular dysfunction, and abnormalities of chondrocyte, osteoblast or bone matrix function. Rickets and osteomalacia can occur as heritable disorders. The major clinical features of rickets and osteomalacia include bone pain and tenderness, skeletal deformity, muscle weakness and occasionally tetany due to hypocal...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Michael P. Whyte, Rajesh V. Thakker Tags: Bone disorders Source Type: journals

Paget's diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Paget's disease is the result of local increase in bone turnover, leading to pain and deformity. It is particularly common in the UK, North America and Australasia, where its prevalence increases with age. The abnormal bone is weak, leading to fracture, and can also cause pressure symptoms because of expansion. Diagnosis is usually on the basis of typical radiological appearance. Treatment with potent bisphosphonates is primarily given for pain but there remains disagreement as to whether or not it also arrests the development of disease complications. (Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Peter Selby Tags: Bone disorders Source Type: journals

OsteoporosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The fractures that result from osteoporosis are a major public health problem. The physician needs to be aware of the major risk factors for osteoporosis and refer appropriately for bone densitometry. These risk factors include prior fracture, a family history of fracture, slender habitus, early menopause, treatment with drugs known to affect bone (glucocorticoids) and diseases known to affect bone (rheumatoid arthritis). The diagnosis of osteoporosis can be made if the bone density T-score is −2.5 or below. This information can be used with other risk factors to estimate the 10-year risk of fractures. Patients...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Richard Eastell Tags: Bone disorders Source Type: journals

Bone structure and metabolismEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The bones of the skeleton provide mechanical support for joints, tendons and ligaments, protect vital organs from damage and act as a reservoir for calcium and phosphate in the preservation of normal mineral homeostasis. Bone is a complex and dynamic tissue which undergoes renewal and repair throughout life as the result of bone remodelling. Most diseases of bone occur as the result of abnormalities in bone remodelling which compromise the architecture, structure and mechanical strength of bone, leading to clinical symptoms such as pain, deformity, fracture and abnormalities of calcium and phosphate homeostasis. ...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Stuart H. Ralston Tags: Calcium and bone Source Type: journals

HypocalcaemiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Hypocalcaemia is a frequent condition resulting from inappropriate loss of calcium from the kidneys or gastrointestinal tract. The condition is most commonly a consequence of hypoparathyroidism or vitamin D deficiency. Hypoparathyroidism most commonly occurs following surgical removal of the parathyroid glands, but may result from auto-immune disease, rare inherited disorders of parathyroid hormone synthesis or action, or from infiltrative diseases that compromise parathyroid gland function. Alternatively, metabolic disturbances can result in hypocalcaemia because of disturbance to the normal homeostatic regulati...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Elaine Murphy, Graham R. Williams Tags: Calcium and bone Source Type: journals

Hypercalcaemia and primary hyperparathyroidismEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Hypercalcaemia is most commonly caused by primary hyperparathyroidism (PHPT) or malignancy. PHPT is common, affects more females than males, and is usually due to a solitary parathyroid adenoma. The usual presentation now is asymptomatic and incidentally picked up on blood testing. The only curative treatment is parathyroidectomy. In 2009 the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism updated their guidance on management of asymptomatic PHPT. They recommend surgery in: all symptomatic patients; asymptomatic patients with hypercalcaemia greater than 0.25 mmol/litre a...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Jeremy Turner Tags: Calcium and bone Source Type: journals

Endocrine manifestations of malignancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Endocrine manifestations of cancer are primarily observed as paraneoplastic syndromes. These are rare systemic manifestations of malignancy due to non-size-related effects of the underlying cancer. The pathobiology of these syndromes is due to underlying production of hormones and related substances that act in an endocrine or paracrine manner on effector cells distributed through the body, thereby resulting in systemic manifestations. Two major mechanisms are observed: ectopic hormone production by tumours not involving endocrine organs, and malignancy of endocrine glands resulting in direct secretion of hormone...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Saoirse O. Dolly, Sanjay Popat Tags: Endocrine cancer Source Type: journals

Carcinoid syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Carcinoid tumours are the most common type of neuroendocrine tumour. However, fewer than 10% actually lead to carcinoid syndrome. Carcinoid tumours arise from enterochromaffin and enterochromaffin-like cells, which originate from the primitive gut. Classic symptoms of carcinoid syndrome, such as flushing and diarrhoea, occur as a consequence of the release of hormones, including serotonin, tachykinins and peptide hormones. In the majority of cases, liver metastasis has already occurred at the time of diagnosis. The diagnosis of carcinoid syndrome is made biochemically. Raised levels of a serotonin metabolite, 5-h...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Channa N. Jayasena, Waljit S. Dhillo Tags: Endocrine cancer Source Type: journals

Multiple endocrine neoplasiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Multiple endocrine neoplasia (MEN) is characterized by tumours involving two or more endocrine glands within a single patient. There are two major forms of MEN: type 1 (MEN1, Wermer's syndrome) and type 2 (MEN2, Sipple's syndrome). MEN1 is characterized by the combined occurrence of tumours in the parathyroids, pancreatic islet cells and anterior pituitary; MEN2 is characterized by the association of medullary thyroid carcinoma, phaeochromocytoma and parathyroid tumours. Non-endocrine tumours may also arise, for example lipomas, collagenomas and angiofibromas occur in MEN1, and mucosal neuromas in MEN2b. The MEN1...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Rajesh V. Thakker Tags: Endocrine cancer Source Type: journals

Testosterone replacement therapyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Testosterone replacement therapy is a well-tolerated and established treatment for hypogonadism, providing excellent clinical and biochemical relief from the effects of sex steroid deficiency. This review gives a practical clinical guide to managing testosterone replacement therapy. It outlines the indications for testosterone replacement, including the relevant testosterone threshold levels for treatment. There is also discussion of its use in non-gonadal illness such as HIV. Recent studies looking at the use of testosterone in cardiometabolic disease are discussed. The routes of administrating testosterone repl...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Leighton J. Seal Tags: Sex hormones Source Type: journals

Polycystic ovary syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women. It typically presents with symptoms of anovulation, associated with clinical and/or biochemical evidence of androgen excess. The spectrum of presentation, however, includes women with hyperandrogenism who have regular periods. As well as being the most common cause of anovulatory infertility it is now recognized as a major risk factor for development of type 2 diabetes. The aetiology of PCOS remains unclear, but both genetic and environmental factors are involved. Typical biochemical features are raised serum concentrations of testoste...
Source: Medicine - August 31, 2009 Category: Internal Medicine Authors: Stephen Franks Tags: Sex hormones Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - August 31, 2009 Category: Internal Medicine Source Type: journals

Self-assessment/CPDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medicine)
Source: Medicine - July 31, 2009 Category: Internal Medicine Tags: Self assessment Source Type: journals

Goitre and thyroid cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Thyroid enlargement is common and thyroid malignancy rare, but the clinical presentation of benign and malignant disease are similar. The aim of clinical assessment and investigations is to identify the small number of cancers amongst the non-malignant thyroid enlargements. Investigations include thyroid function tests and fine-needle aspiration cytology. Benign thyroid disease needs treatment only in the presence of dysfunction or local compressive symptoms. The treatment of thyroid cancer is multidisciplinary and includes surgery, radioiodine therapy and lifelong thyroid-stimulating hormone suppression. The dia...
Source: Medicine - July 31, 2009 Category: Internal Medicine Authors: Fausto Palazzo Tags: Thyroid Source Type: journals

ThyrotoxicosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Thyrotoxicosis is the syndrome that arises from excessive circulating thyroid hormone levels and is usually caused by Graves' disease or toxic nodular thyroid disease, both of which are forms of hyperthyroidism. Other causes of thyrotoxicosis (but not hyperthyroidism) include destructive thyroiditis in which the thyroid is damaged, resulting in leaking of stored thyroid hormone into the circulation. Distinguishing the cause of thyrotoxicosis is an essential initial step in management, once the diagnosis has been confirmed biochemically. In particular, antithyroid drug treatment can cure around 50% of patients wit...
Source: Medicine - July 31, 2009 Category: Internal Medicine Authors: Anthony P. Weetman Tags: Thyroid Source Type: journals