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Internal Medicine (internal + medicine)
Kinds of Internal Medicine Terms modified by Internal Medicine Selected AbstractsCapturing the power of academic medicine to enhance health and health care of the elderly in the USAGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2004William R Hazzard As in Japan, the US population is aging progressively, a trend that will challenge the health-care system to provide for the chronic, multiple and complex needs of its elderly citizens. and as in Japan, the US academic health enterprise has only belatedly mounted a response to that challenge. Herein is reviewed a quarter of a century of the author's personal experience in developing new programs in gerontology and geriatric medicine from a base in the Department of Internal Medicine at three US academic health centers (AHC): The University of Washington (as Division Head), Johns Hopkins University (as Vice-Chair), and Wake Forest University (as Chair). Rather than to build a program from a new department of geriatrics, this strategy was chosen to capture the power and resources of the department of internal medicine, the largest university department, to ,gerontologize' the institution, beginning with general internal medicine and all of the medical subspecialties (the approach also chosen to date at all but a handful of US AHC). The keystone of success at each institution has been careful faculty development through fellowship training in clinical geriatrics, education and research. Over the same interval major national progress has occurred, including expanded research and training at the National Institute on Aging and the Department of Veterans Affairs, and accreditation of more than 100 fellowship programs for training and certification of geriatricians. However, less than 1% of US medical graduates elect to pursue such training. Hence such geriatricians will remain concentrated at AHC, and most future geriatric care in the USA will be provided by a broad array of specialists, who will be educated and trained in geriatrics by these academic geriatricians. [source] Destructive arthritis in Behçet's disease: a report of eight cases and literature reviewINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2009F. FRIKHA Abstract Behçet's disease (BD) is a multisystemic disease with typically non-erosive and non-deforming joint manifestations. The occurrence of destructive arthritis in Behçet's disease has rarely been reported. Here we attempt to define the epidemiological, clinical and radiological features of this unusual type of osteoarticular manifestation of BD. We retrospectively reviewed the medical records of 553 patients with Behçet's disease seen over 25-year period in our department of Internal Medicine (Sfax-Tunisia). All the patients fulfilled The International Study Group of Behçet's Disease criteria. Patients with destructive arthritis (defined by radiological changes: erosions and/or geodes and/or global narrowing of the joint space and/or ankylosis) were included in this study. Rheumatologic manifestations were observed in 71.1% patients. Eight patients (1.4% overall, 2% among patients with rheumatologic manifestations) had presented with destructive arthritis. The joint symptoms involved the knee in two cases, the wrist in one case, the elbow (one case), the sternoclavicular joint in two cases, the foot in one case and the tarsal scaphoïd in one case. There was recurrent arthritis at the same joint in the majority of cases. X-ray examinations revealed radiological changes: global narrowing of the joint in one case (knee), narrowing of the joint with geodes in three cases (knee, sternoclavicular), isolated geodes in two cases (tarsal scaphoid, foot) and severe lesions with ankylosis in two cases (two elbows, right wrist). Joint manifestations are common in patients with BD, but destructive arthritis is rare. [source] A true impact factor: N. Scott McNutt, MDJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2008Bruce R. Smoller N. Scott McNutt has recently retired from his long-standing position as a Professor in Pathology and Internal Medicine (Dermatology) at Weill Medical College at Cornell University. He leaves behind a legacy that includes trainees throughout the world, many of whom continue to contribute to the world of academic dermatopathology. His obvious love for true scholarship is reflected as much by his indirect influence on hundreds of trainees as by his already impressive personal bibliography. [source] Effect of hospitalist attending physicians on trainee educational experiences: A systematic review,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Pradeep Natarajan MD Abstract BACKGROUND: Trainees receive much of their inpatient education from hospitalists. PURPOSE: To characterize the effects of hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490,498. © 2009 Society of Hospital Medicine. [source] Development of a test to evaluate residents' knowledge of medical procedures,,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009Shilpa Grover MD Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source] Contemporary management of pulmonary embolism: the answers to ten questionsJOURNAL OF INTERNAL MEDICINE, Issue 3 2010H. Bounameaux Abstract., Bounameaux H (Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland). Contemporary management of pulmonary embolism: the answers to ten questions (Review). J Intern Med 2010; 268: 218,231. Pulmonary embolism (PE) cannot be diagnosed solely on a clinical basis, because of the lack of sensitivity and specificity of clinical signs and symptoms. Pulmonary angiography is invasive and resource demanding. Because the prevalence of PE is relatively low (20% or less) amongst individuals who are clinically suspected of having the disease, submitting all of them to imaging (multi-detector CT angiography or ventilation/perfusion lung scintigraphy) would not be cost-effective. Therefore, diagnostic algorithms have been developed that include clinical probability assessment and D-dimer measurement to select the patients who require noninvasive imaging. Once the diagnosis is suspected or confirmed, therapy must be started to avoid potentially fatal recurrence. Treatment starts for an initial 3-month period with a 5-day course of parenteral unfractionated or low-molecular-weight heparin or fondaparinux overlapping with and followed by oral vitamin K antagonists monitored to maintain an international normalized ratio of 2,3. This initial period of 3 months may then be followed by a long-term secondary prevention period in patients who experience an idiopathic thromboembolic event and are at low risk of bleeding. New oral anticoagulants that do require patient monitoring and might exhibit a more favourable benefit,risk balance are currently under extensive clinical testing and might change the situation in the near future. A critical appraisal of the contemporary management of suspected PE is given in this overview with the discussion of 10 practical questions. [source] Journal of Internal Medicine: a journal for the futureJOURNAL OF INTERNAL MEDICINE, Issue 1 2006Ulf de Faire Editor-in-Chief No abstract is available for this article. [source] Journal of Internal Medicine launches its own website!JOURNAL OF INTERNAL MEDICINE, Issue 2 2005Article first published online: 14 JUL 200 No abstract is available for this article. [source] The inflammatory reflex , IntroductionJOURNAL OF INTERNAL MEDICINE, Issue 2 2005J. ANDERSSON Abstract. Sepsis is the third leading cause of death in the developed world. Despite recent advances in intensive care treatment and the discovery of antibiotics, sepsis remains associated with a high mortality rate. The pathogenesis of sepsis is characterized by an overwhelming systemic inflammatory response that is central to the development of lethal multiple organ failure. This volume of the Journal of Internal Medicine contains three reviews addressing novel aspects of a system we are only beginning to understand , the interactions between the immune and the nervous systems, the ,neuro-immune axis'. Tracey (Nature 2002; 420: 853) recently discovered that the nervous system, through the vagus nerve, can modulate circulating TNF- , levels induced by microbial invasion or tissue injury. This cholinergic anti-inflammatory pathway is mediated primarily by nicotinic acetylcholine receptors on tissue macrophages , the pathway leads to decreased production of proinflammatory cytokines. The author reports that treatment with the acetylcholine receptor agonist, nicotine, modulates this system and reduces mortality in ,established' sepsis. Watkins and Maier (J Intern Med 2005; 257: 139) illustrate that pathological pain (induced by inflammation) is not simply a strict neuronal phenomenon, but is a component of the immune response, and is modulated by peripheral immune cells and spinal cord glia cells. This may be of importance for future development of novel drugs for neuropathic pain as well as our understanding of increased risks for infections in anaesthetic skin areas. Blalock (J Immunol 1984; 132: 1067) elucidates the possibility that the immune system actually functions as the sixth sense, sensing microbes and microbial toxins that we cannot see, hear, taste, touch or smell. Activation of the sympathetic nervous system also has predominantly anti-inflammatory effects that are mediated through direct nerve to immune cell interaction or through the adrenal neuro-endocrine axis. [source] The Journal of Internal Medicine launches an electronic submission and peer-review systemJOURNAL OF INTERNAL MEDICINE, Issue 5 2003Göran Holm Editor-in-Chief No abstract is available for this article. [source] Cerebrotendinous xanthomatosis: molecular characterization of two Scandinavian sistersJOURNAL OF INTERNAL MEDICINE, Issue 3 2002E. Rystedt Abstract.,Rystedt E, Olin M, Seyama Y, Buchmann M, Berstad A, Eggertsen G, Björkhem I (Karolinska Institutet, Stockholm, Sweden; OchanomizuUniversity, Tokyo, Japan; Medisinsk avdeling, Haukeland sykehus, Bergen). Cerebrotendinous xanthomatosis: molecular characterization of two Scandinavian sisters (Case report). Journal of Internal Medicine 2002; 252: 259,264. Cerebrotendinous xanthomatosis (CTX) is a hereditary disorder, which is inherited as an autosomally recessive disease, causing production of cholesterol and cholestanol xanthomas and mental retardation. The disease is caused by mutations in the gene for sterol 27-hydroxylase (CYP27A1). The only CTX patients diagnosed in Scandinavia are two Norwegian sisters from a consanguineous marriage. Here we have characterized the mutation and its functional consequences for the enzyme. Analysis of genomic DNA from cultured fibroblasts identified a base exchange C > T in position 1441, causing arginine at amino acid position 441 to be replaced by tryptophan. The same mutation was introduced by mutagenesis in the complimentary DNA (cDNA) for CYP27, ligated into the expression vector pcDNA4/HisMax and transfected into HEK293 cells. The mutated enzyme had less than 5% of the enzyme activity compared with the native enzyme. No abnormal catalytic products could be identified in the cell culture medium. Probably the mutation affects the haem binding within the holoenzyme. The mutation has also previously been reported in a Japanese family. This is the second example of a CTX-causing mutation that has been recognized in more than one population. [source] Prevalence of undiagnosed coeliac syndrome in osteoporotic womenJOURNAL OF INTERNAL MEDICINE, Issue 4 2001R. Nuti Abstract.,Nuti R, Martini G, Valenti R, Giovani S, Salvadori S, Avanzati A (Institute of Internal Medicine, Metabolic Disease Unit, University of Siena, Siena, Italy). Prevalence of undiagnosed coeliac syndrome in osteoporotic women. J Intern Med 2001; 250: 361,366. Objectives.,The aims of the study were to quantify the prevalence of asymptomatic coeliac disease (CD) in a cohort of osteoporotic females, and to investigate the features of bone loss. Design and subjects.,We studied 255 women (mean age 66.6 ± 8.5 SD) with primary osteoporosis (WHO diagnostic criteria). After the first CD screening with the measure of serum IgG antigliadin antibodies (IgG-AGA), 53 women showed a positive test: antibodies to tissue transglutaminase (TG-ab) were subsequently determined to confirm the diagnosis of CD. Bone metabolism was evaluated by: serum and urinary calcium, serum and urinary phosphate, serum alkaline phosphatase, urinary crosslaps, serum 25(OH)D and serum parathyroid hormone. Results.,High levels of IgG-AGA and TG-ab were observed in 24 patients with a prevalence of serological disease of 9.4%. These women were characterized, in comparison with the other patients, by a statistically significant reduction in serum 25(OH)D (17.8 ± 7.2 vs. 55.1 ± 20.3 nmol L,1, P < 0.01) together with a significant increase of iPTH (65.1 ± 29.7 vs. 35.1 ± 20.0 pg mL,1; P < 0.01). Patients with high TG-ab levels showed also slightly raised values of urinary crosslaps (288 ± 88 vs. 270 ± 90 ,m mol,1 Cr). In IgG-AG positive patients a statistically significant inverse correlation was found between 25(OH)D serum levels and log-transformed TG-ab values (r: ,0.95, P < 0.001). Intestinal biopsies were obtained in 10 TG-ab positive women and verified CD in six patients. Conclusions.,These data support the hypothesis that patients with undiagnosed celiac disease develop high remodelling processes related to calcium malabsorption, secondary hyperparathyroidism and unavailability of vitamin D with a consequent more marked bone loss. [source] A case of POEMS syndrome with high concentrations of interleukin-6 in pericardial fluidJOURNAL OF INTERNAL MEDICINE, Issue 2 2001N. Shikama Abstract. Shikama N, Isono A, Otsuka Y, Terano T, Hirai A (Department of Internal Medicine, Chiba Municipal Hospital; and Second Department of Internal Medicine, Chiba University School of Medicine, Chiba, Japan). A case of POEMS syndrome with high concentrations of interleukin-6 in pericardial fluid. J Intern Med 2001; 250: 170,173. The POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy of various forms, monoclonal gammopathy, skin changes) is a rare multisystem disorder of unknown pathogenesis. Overexpression of proinflammatory cytokines has been implicated in the pathogenesis of POEMS syndrome, however, it is not known whether there is an association between abnormalities in cytokines and pericardial fluid. We present a case of POEMS syndrome with high concentrations of interleukin-6 (IL-6) in pericardial fluid. In our patient, pericarditis developed into cardiac tamponade, and the concentration of IL-6 in pericardial fluid was remarkably elevated compared with that in serum (1760 vs. 6.57 pg mL,1). We suggest that IL-6 is associated with the progression or maintenance of pericarditis as a result of POEMS syndrome. [source] Journal of Internal Medicine and the new centuryJOURNAL OF INTERNAL MEDICINE, Issue S741 2001G. Holm No abstract is available for this article. [source] Telemedicine: barriers and opportunities in the 21st centuryJOURNAL OF INTERNAL MEDICINE, Issue S741 2001B. Stanberry Abstract. Stanberry B (Centre for Law Ethics and Risk in Telemedicine, Cardiff, Wales, UK). Telemedicine: barriers and opportunities in the 21st century (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 615,628. This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into ,info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician,patient relationships and against complacency regarding the risks and responsibilities , many of which are as yet unknown , that distant medical intervention, consultation and diagnosis carry. [source] Consulting the source code: prospects for gene-based medical diagnosticsJOURNAL OF INTERNAL MEDICINE, Issue S741 2001U. Landegren Abstract. Landegren U (Rudbeck Laboratory, Uppsala, Sweden) Gene-based diagnostics (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 271,276. Gene-based diagnostics has been slow to enter medical routine practice in a grand way, but it is now spurred on by three important developments: the total genetic informational content of humans and most of our pathogens is rapidly becoming available; a very large number of genetic factors of diagnostic value in disease are being identified; and such factors include the identity of genes frequently targeted by mutations in specific diseases, common DNA sequence variants associated with disease or responses to therapy, and copy number alterations at the level of DNA or RNA that are characteristic of specific diseases. Finally, improved methodology for genetic analysis now brings all of these genetic factors within reach in clinical practice. The increasing opportunities for genetic diagnostics may gradually influence views on health and normality, and on the genetic plasticity of human beings, provoking discussions about some of the central attributes of genetics. [source] Controlled drug delivery: therapeutic and pharmacological aspectsJOURNAL OF INTERNAL MEDICINE, Issue 5 2000J. Urquhart Abstract. Urquhart J (Department of Epidemiology, Pharmaco-epidemiology Group, Maastricht University, Maastricht, the Netherlands). Controlled drug delivery: therapeutic and pharmacological aspects (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 357,376. Concerted work to develop human pharmaceuticals based on rate-controlled drug delivery systems began in 1970. Today there are over three dozen such products, plus a few for veterinary use. In addition, osmotic minipumps have been extensively used since 1978, resulting in over 6000 publications in the pharmacological, endocrinological and physiological literature. Rate-controlled delivery provides for drug entry into the bloodstream continuously at either a constant or a modulated rate. By this means, one avoids the usual peak and trough pattern of drug concentrations in plasma, with its echoing peak and trough pattern of drug actions, during the interval between successive doses. In contrast to the happenstance release kinetics of rapid-release dosage forms, rate-controlled delivery systems can be designed to provide specific temporal patterns of drug concentration in plasma, for the purpose of optimizing the selectivity of drug action, the interval between successive administerings of drug and the likelihood that the next administering will occur at the proper time. [source] Medical education in the new millenniumJOURNAL OF INTERNAL MEDICINE, Issue 2 2000L. H. Rees Abstract. Rees LH (Royal College of Physicians, London, UK). Medical education in the new millennium (Internal Medicine in the 21st Century). J Intern Med 2000; 248: 95,101. This article reviews current trends in undergraduate and postgraduate medical education and speculates on the future in the new millennium. [source] Telemedicine: barriers and opportunities in the 21st centuryJOURNAL OF INTERNAL MEDICINE, Issue 6 2000B. Stanberry Abstract. Stanberry B (Centre for Law Ethics and Risk in Telemedicine, Cardiff, Wales, UK). Telemedicine: barriers and opportunities in the 21st century (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 615,628. This paper aims to examine how health telematics will develop in the first 10 years of the new millennium and, in particular, to assess what operational, ethical and legal barriers may lie in the way of this development. A description of the key principles and concepts involved in telemedicine and a short historical overview of telemedicine's evolution over the past century are followed by consideration of why empirical research into ,info-ethics' and other deontological and legal issues relating to telemedicine is being necessarily catalysed by, amongst others, the European Commission. Four evolving health telematics applications are examined in some detail: electronic health records; the transmission of visual media in disciplines such as teleradiology, teledermatology, telepathology and teleophthalmology; telesurgery and robotics and the use of call centres and decision-support software. These are discussed in the light of their moral, ethical and cultural implications for clinicians, patients and society at large. The author argues that telemedicine presents unique opportunities for both patients and clinicians where it is implemented in direct response to clear clinical needs, but warns against excessive reliance upon technology to the detriment of traditional clinician,patient relationships and against complacency regarding the risks and responsibilities , many of which are as yet unknown , that distant medical intervention, consultation and diagnosis carry. [source] Multidrug resistance in haematological malignanciesJOURNAL OF INTERNAL MEDICINE, Issue 5 2000P. Sonneveld Abstract. Sonneveld P (University Hospital Rotterdam , Dijkzigt, The Netherlands). Multidrug resistance in haematological malignancies (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 521,534. The development of refractory disease in acute myeloid or lymphoblastic leukaemias (AML, ALL) and multiple myeloma (MM) is frequently associated with the expression of one or several multidrug resistance (MDR) genes. MDR1, MRP1 and LRP have been identified as important adverse prognostic factors in AML, T-ALL and MM. Recently, it has become possible to reverse clinical multidrug resistance by blocking P-glycoprotein-mediated drug efflux. The potential relevance of these reversal agents of MDR and potential new approaches to treat refractory disease are discussed. [source] Prospects for progress in diagnostic imagingJOURNAL OF INTERNAL MEDICINE, Issue 4 2000E. J. Potchen Abstract. Potchen EJ (Michigan State University, Michigan, USA). Prospects for progress in diagnostic imaging (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 411,424. New fast-imaging MRI systems designed specifically for cardiac magnetic resonance enable new applications of noninvasive vascular imaging. The use of functional MRI and diffusion tensor imaging to map brain function and structure offers a new dimension to an understanding of the human condition. Clinical applications of functional MRI will influence many specialties including surgery, education, and rehabilitation. Functional imaging has the potential to visualize the regional concentration of specific proteins. This imaging at the level of molecules may be possible by use of a contrast material whose signal is changed by local enzymatic activity. The three-dimensional digital data collected in modern imaging techniques allow for virtual endoscopy in the respiratory, alimentary, and cardiovascular systems. Virtual endoscopy may replace many of the more invasive diagnostic methods in the near future. The measurement of clinical decision-making through observer performance studies better informs both the physician and the patient on how to improve upon the quality of clinical practice. These prospects for progress reinforce diagnostic imaging as a cornerstone in medical informatics. The history of creating images used in medicine reveals the invention of diagnostic tools which may provide new information but premature use can result in improper application of a poorly understood technology. Research into the use of new technology may be as important as the technology itself in improving the human condition. [source] Advanced glycation end product in familial amyloidotic polyneuropathy (FAP)JOURNAL OF INTERNAL MEDICINE, Issue 4 2000N. Nyhlin Abstract. Nyhlin N, Ando Y, Nagai R, Suhr O, El Sahly M, Terazaki H, Yamashita T, Ando M, Horiuchi S (Umeå University Hospital, Umeå, Sweden and Kumamoto University School of Medicine, Kumamoto, Japan). Advanced glycation end product in familial amyloidotic polyneuropathy (FAP). J Intern Med 2000; 247: 485,492. Objectives. Advanced glycation end products (AGE) are present in amyloid deposits in ,2 -microglobulin amyloidosis, and it has been postulated that glycation of ,2 -microglobulin may be involved in fibril formation. The aim of this paper was to ascertain whether AGE occur in amyloid deposits in familial amyloidotic polyneuropathy (FAP). Setting. Department of Medicine, Umeå University Hospital and First Department of Internal Medicine, Kumamoto University School of Medicine. Design. The presence of AGE was sought immunohistochemically and biochemically in amyloid-rich tissues from patients with FAP. Subjects. Biopsy specimens from nine patients and 10 controls were used for the immunohistochemical analysis. For amyloid preparation, vitreous samples from three FAP patients were used. Results. Immunohistochemical studies using a polyclonal anti-AGE antibody revealed positive immunoreactivity in intestinal materials, but the pattern of reactivity was unevenly distributed; it was often present in the border of amyloid deposits, or surrounding them. Non-amyloid associated immunoreactivity was also observed in a few regions of the specimens, although the AGE-positive structures were situated in areas containing amyloid deposits. Western blotting of purified amyloid from the vitreous body of FAP patients revealed a significant association of AGE with amyloid fibrils. Conclusion. The immunoreactivity for the AGE antibody suggests that AGE may be involved in fibril formation in FAP. [source] PAINFUL NEUROPATHY, MONOCLONAL GAMMOPATHY AND AMYLOID DEPOSITS: RESPONSE TO THERAPY IN 3 CASESJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2002Article first published online: 11 MAR 200 Siciliano G.1, D'Avino C.1, Panichi V.2, Azzarà A.3, Del Corona A.1, Pollina L.3, Murri L.1 1Department of Neuroscience, 2Department of Internal Medicine and 3Department of Oncology,University of Pisa-Italy Amyloidosis is a systemic disease with a wide organic involvement. Amyloidotic polyneuropathies may be genetic in their origin or present in association with a number of chronic inflammatory dysimmune disorders. We report on three patients affected by predominantly sensitive polyneuropathy, monoclonal gammopathy and amyloidosis. Patient 1. Woman, 72 years old, with a one year history of painful paraesthesias, ataxic gait and demyelinating predominantly sensitive polyneuropathy at 4 limbs also with involvement of sympathetic fibres. Blood protein electrophoresis showed a monoclonal gammopahty (IgG-k) with normal bone marrow biopsy and positivity for amyloid at fat biopsy. The patient has been treated with melphalan 0.2 mg/Kg/day+prednisone 100 mg/day for 7 days each month for 6 months with good efficacy and only a transient reduction in platelet and white blood cells count. Patient 2. Man, 60 years old, new diagnosis of diabetes with a 9 month history of painful paraesthesias and hyposthenia, a demyelinating sensory-motor polyneuropathy at 4 limbs. The patient presented an IgG-, monoclonal gammopathy with normal bone marrow biopsy, fat biopsy but not sural nerve biopsy positive for amyloid. The patient underwent melphalan+prednisone therapy, with insulinic control of glycemia. He presented a clear-cut improvement in sensitive-motor symptomatology. Patient 3. Man, 72 years old, with a 15 year history of ulcerous rectocolites. Since 1998 started complaining of paraesthesias and disaesthesias at four limbs associated with gait disturbances. The patient presented an IgG-, monoclonal gammopathy with normal bone marrow aspiration and elevated serum Interleukin-6 levels, fat biopsy positive for amyloid, and high anti-MAG antibodies titer (1:100000). Because of RCU, melphalan therapy was excluded and the patient is at the moment under fludarabine (25 mg/m2/day) ev for 5 days each 6 weeks for 6 bouts. [source] ANTI-SULFATIDE IgM ANTIBODIES DETECTED IN A PATIENT DIAGNOSIS OF MOTOR NEURON DISEASEJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2002Article first published online: 11 MAR 200 D'Avino C., Del Corona A., Bacci A., Calabrese R., Siciliano G. Department of Neuroscience-Clinical Neurology-University of Pisa-Italy Case report. The patient, a 66-year-old man with a 5-year diagnosis of diabetes mellitus, in Sep. 2000 started complaining of language disturbances as rhinolalia. In Jan. 2001, because of generalized fatigue and difficulties in walking, he was hospitalized in Internal Medicine and a diagnosis of diabetic angiopathy and neuropathy was made. Since discharge patient clinical conditions gradually deteriorated and a neurological evaluation showed tongue atrophy, dysarthria, dysphagia, fasciculations in the four limbs, increased deep tendon reflexes with bilateral foot clonus and paraparetic spastic deambulation. He underwent spinal MRI that showed mild arthrosic abnormalities in cervical spinal cord and limb EMG that showed denervation spontaneous activity with neurogenic MUAP modifications, with normal sensory and motor conduction velocity. MEP showed bilateral pyramidal track involvement. A significantly increased anti-sulphatide IgM antibodies titer (1:32,000) in the serum was detected. The diagnosis at discharge was "probable motor neuron disease" and the patient is under riluzole therapy at the moment. Discussion. Anti-sulfatide IgM antibodies are currently associated with several subtypes of peripheral neuropathy. In most cases it is a chronic dysimmune sensory or sensorimotor neuropathy in which electrophysiological and morphological studies are usually con- sistent with a predominant demyelination frequently associated with prominent axonal loss. Although rare, an association between motor neuron disease and IgM anti-sulfatide has been described in a recent paper by Latov and coworkers that reviewed electrophysiologic, morphologic and laboratory data of 25 patients with elevated antisulfatide antibodies. It seems interesting to follow-up the clinical course of the patient, the response to therapy and its correlation to antibodies titer, while the opportunity of high dose IVIg therapy is under discussion at the moment. [source] A Survey of Evidence in the Journal of Veterinary Internal Medicine Oncology Manuscripts from 1999 to 2007JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010A. Sahora Objectives: To survey and monitor trends in evidence for oncology manuscripts published in the Journal of Veterinary Internal Medicine (JVIM) between 1999 and 2007 based on an evidence-based medicine (EBM) standard. Methods: All veterinary oncology-related articles published in JVIM and 7 other high-impact journals from 1999 to 2007 were collected by database searches. Relevant manuscripts then were characterized including investigator affiliation, subject matter investigated, retrospective or prospective study design, manuscript type, and classifications of manuscripts using an EBM standard. Results: A total of 172 relevant veterinary oncology manuscripts were identified in JVIM between 1999 and 2007. The proportion of oncology manuscripts published each year rose with the total number of manuscripts published in JVIM (mean, 13%; range, 8,15%). The author affiliations and subject matter were similar during this evaluation period. Case series represented the most common manuscript type (40%). With the exception of a progressive increase in prospective manuscripts and a reduction in case reports, no significant changes in the classification of manuscripts using EBM standards were seen. During this same period, veterinary oncology manuscripts published in 7 high-impact journals were associated with higher standards of evidence including prospective studies and randomized trials. Conclusions: The standards of evidence for veterinary oncology manuscripts published in JVIM have remained static between 1999 and 2007. This survey provides an informative benchmark for the state of evidence in previous JVIM oncology manuscripts and may be useful in identifying specific opportunities that may raise the standards of evidence in future publications in JVIM. [source] Publication of the Journal of Veterinary Internal MedicineJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2008K.W. Hinchcliff No abstract is available for this article. [source] Special Editorial,Internal Medicine and Clinical Pathology: Rebuilding the RelationshipJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2004Mary M. Christopher No abstract is available for this article. [source] A systematic review of titles and abstracts of experimental studies in medical education: many informative elements missingMEDICAL EDUCATION, Issue 11 2007David A Cook Context, Informative titles and abstracts facilitate reading and searching the literature. Objective, To evaluate the quality of titles and abstracts of full-length reports of experimental studies in medical education. Methods, We used a random sample of 110 articles (of 185 eligible articles) describing education experiments. Articles were published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine. Titles were categorised as informative, indicative, neither, or both. Abstracts were evaluated for the presence of a rationale, objective, descriptions of study design, setting, participants, study intervention and comparison group, main outcomes, results and conclusions. Results, Of the 105 articles suitable for review, 86 (82%) had an indicative title and 10 (10%) had a title that was both indicative and informative. A rationale was present in 66 abstracts (63%), objectives were present in 84 (80%), descriptions of study design in 20 (19%), setting in 29 (28%), and number and stage of training of participants in 42 (40%). The study intervention was defined in 55 (52%) abstracts. Among the 48 studies with a control or comparison group, this group was defined in 21 abstracts (44%). Study outcomes were defined in 64 abstracts (61%). Data were presented in 48 (46%) abstracts. Conclusions were presented in 97 abstracts (92%). Conclusions, Reports of experimental studies in medical education frequently lack the essential elements of informative titles and abstracts. More informative reporting is needed. [source] Effectiveness of medical school admissions criteria in predicting residency ranking four years laterMEDICAL EDUCATION, Issue 1 2007Christopher Peskun Background, Medical schools across Canada expend great effort in selecting students from a large pool of qualified applicants. Non-cognitive assessments are conducted by most schools in an effort to ensure that medical students have the personal characteristics of importance in the practice of Medicine. We reviewed the ability of University of Toronto academic and non-academic admission assessments to predict ranking by Internal Medicine and Family Medicine residency programmes. Methods, The study sample consisted of students who had entered the University of Toronto between 1994 and 1998 inclusive, and had then applied through the Canadian resident matching programme to positions in Family or Internal Medicine at the University of Toronto in their graduating year. The value of admissions variables in predicting medical school performance and residency ranking was assessed. Results, Ranking in Internal Medicine correlated significantly with undergraduate grade point average (GPA) and the admissions non-cognitive assessment. It also correlated with 2-year objective structured clinical examination (OSCE) score, clerkship grade in Internal Medicine, and final grade in medical school. Ranking in Family Medicine correlated with the admissions interview score. It also correlated with 2nd-year OSCE score, clerkship grade in Family Medicine, clerkship ward evaluation in Internal Medicine and final grade in medical school. Discussion, The results of this study suggest that cognitive as well as non-cognitive factors evaluated during medical school admission are important in predicting future success in Medicine. The non-cognitive assessment provides additional value to standard academic criteria in predicting ranking by 2 residency programmes, and justifies its use as part of the admissions process. [source] Differences in clinical features between influenza A H1N1, A H3N2, and B in adult patientsRESPIROLOGY, Issue 2 2003Masahide KAJI Objective: The differences in clinical features between influenza A H1N1, A H3N2, and B in the past three influenza seasons were examined. Methodology: Patients with respiratory symptoms who consulted Kurume University Medical Center, Department of Internal Medicine, Kurume, Fukuoka, Japan, from January to March in 1999, 2000, and 2001 were included. Based on virological and serological findings, the influenza patients were divided into the above three groups for comparison of symptoms and laboratory data. Results: Patients (n = 196) included 54 with influenza A H1N1, 98 with A H3N2, and 44 with B. Mean ages in the groups were 33 ± 8.4 years, 41 ± 15.2 years, and 29 ± 9.8 years (influenza B patients tended to be younger). Fever was much greater in the A H3N2 group (38.6 ± 0.46°C) than in the A H1N1 or B groups. This was also true for laboratory indices of viral infection. Gastrointestinal symptoms such as nausea, epigastralgia, and diarrhoea were prominent in influenza B. Myalgia was common in all groups. Conclusions: Influenza A H3N2 infection was more severe than A H1N1 or B in terms of fever, leukopenia, and C-reactive protein. Myalgia and other symptoms such as fever, headache, general malaise and sore throat were equally frequent in influenza A H3N2, A H1N1, and B infections. Gastrointestinal symptoms were more common in influenza B. [source] | ||||||||||||||||||||||||||||||||||