Role Of Medical Therapy Research Articles

Medical therapy for male infertility.

To provide up-to-date evidence and clinical guidance on the role of medical therapy in the context of hormonal imbalances affecting human spermatogenesis. Compelling evidence has accumulated over the years regarding the role of gonadotropins, selective estrogen modulators, and aromatase inhibitors to either improve or restore spermatogenesis in men with hormonal abnormalities (e.g. hypogonadotropic/hypergonadotropic hypogonadism, hyperprolactinemia) or supraphysiologic levels (e.g. exogenous testosterone/anabolic steroid use). Despite the increasing number of studies being performed, most of the available evidence relies on small nonrandomized studies, mainly in men with hypergonadotropic hypogonadism or with history of exogenous testosterone/anabolic steroid use. As such, the efficacy of medical therapy is highly variable emphasizing the necessity of randomized clinical trials and individualized approaches. This narrative review provides clinical guidance on medical therapies for male factor infertility based on the most up-to-date evidence, focusing on treatments for hormonal abnormalities (either hypogonadotropic or hypergonadotropic hypogonadism and hyperprolactinemia) and supraphysiologic levels (and exogenous testosterone/anabolic steroid use) to improve spermatogenesis.

How to manage Cushing's disease after failed primary pituitary surgery.

The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy has expanded in the last decade, and options include pituitary-targeting drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. Bilateral adrenalectomy is a more aggressive approach, which may be necessary in cases of persistent hypercortisolism despite surgery, medical treatment, or radiation or when rapid normalization of cortisol is needed. We review the available treatment options for Cushing's disease, focusing on the second-line treatment options to consider after failed primary pituitary surgery.

An Overview of Biopolymers for Drug Delivery Applications

Nowadays, drug delivery has an important role in medical therapy. The use of biopolymers in developing drug delivery systems (DDSs) is increasingly attracting attention due to their remarkable and numerous advantages, in contrast to conventional polymers. Biopolymers have many advantages (biodegradability, biocompatibility, renewability, affordability, and availability), which are extremely important for developing materials with applications in the biomedical field. Additionally, biopolymers are appropriate when they improve functioning and have a number of positive effects on human life. Therefore, this review presents the most used biopolymers for biomedical applications, especially in drug delivery. In addition, by combining different biopolymers DDSs with tailored functional properties (e.g., physical properties, biodegradability) can be developed. This review summarizes and provides data on the progress of research on biopolymers (chitosan, alginate, starch, cellulose, albumin, silk fibroin, collagen, and gelatin) used in DDSs, their preparation, and mechanism of action.

The Role of Medical therapy and Radiotherapy in the management of Pituitary Macroprolactinomas

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Impact of improving severity of secondary mitral regurgitation on survival.

Secondary mitral regurgitation (SMR) is frequent in patients with heart failure with reduced ejection fraction (HFrEF) and portends detrimental prognosis. Despite interventions addressing the mitral valve (MV) have been proven effective to improve survival, an important knowledge gap exists regarding the role of medical therapy (MT) in this context. Thus, we aimed at investigating the role of MT optimization in patients with SMR and HFrEF. A total of 435 patients with SMR and HFrEF were retrospectively evaluated. Of those, 158 with severe SMR were finally included, with 63 (40%) managed with MT alone and 96 (60%) with MV intervention plus MT. Echocardiography was performed after 30days of MT optimization or MV intervention. Responders were patients with a final mitral regurgitation (MR) grade of ≤2+. Survival data were gathered through the National Database Index and patient chart review. MR severity improved in 131 patients (100% MV intervention; 57% MT) but stayed the same or worsened in 27 patients. Responders and non-responders were similar for baseline characteristics. Overall, long-term survival of responders was significantly higher than non-responders [hazard ratio (HR) 0.55, 95% confidence interval (CI) (0.32-0.96), P=0.032]. No difference in survival was observed when evaluated by intervention type in the overall population (MT alone, n=63; MV intervention plus MT, n=95) [HR 0.77, 95% CI (0.48-1.26), P=0.3], nor within responder group (MT alone, n=36; MV intervention plus MT, n=95) [HR 1.03, 95% CI (0.56-1.89), P=0.94]. MT reduces SMR severity in 57% of the patients with severe SMR. A final SMR grade of ≤2+ is linked to improved survival, independently of the type of treatment they receive.

Segmental Versus Total Colectomy for Crohn’s Disease in the Biologic Era: Results From The SCOTCH International, Multicentric Study

The extent of resection in colonic Crohn's disease [cCD] is still a topic of debate, depending on the number of locations, the risk of recurrence and permanent stoma, and the role of medical therapy. The Segmental COlecTomy for CroHn's disease [SCOTCH] international study is a retrospective analysis on six tertiary centre prospective databases, comprising all consecutive, unselected patients operated on between 2000 and 2019 with segmental colectomy [SC] or total colectomy [TC] for cCD. The primary aim was long-term surgical recurrence. Secondary aims were perioperative complications, stoma formation and predictors of recurrence. Among 687 patients, SC was performed in 285 [41.5%] and TC in 402 [58.5%]. Mean age at diagnosis and surgery, disease duration, and follow-up were 30 ± 15.8, 40.4 ± 15.4, 10.4 ± 8.6 and 7.1 ± 5.2 years respectively. Isolated cCD, inflammatory pattern, perianal CD, younger age, longer disease duration and preoperative maximal therapy were more frequent in TC, while SC presented more small bowel locations and perforating disease, required fewer 90-day re-admissions, and fewer temporary and definitive stomas. Morbidity and mortality were similar. The 15-year surgical recurrence was 44% in TC and 27% in SC [p = 0.006]. In patients with one to three diseased segments, recurrence risk was related to the omission of biological therapy (hazard ratio [HR] 5.6), the number of segments [HR 2.5], perianal disease [HR 1.9] and paediatric diagnosis [HR 2.8]. When technically feasible, SC is safe and reduces temporary and permanent stoma. Young age, number of locations and perianal disease adversely affect, but postoperative biological therapy significantly reduces, the long-term surgical recurrence.

Influence of Fluconazole Administration on Gut Microbiome, Intestinal Barrier, and Immune Response in Mice.

Antibiotics that can treat or prevent infectious diseases play an important role in medical therapy. However, the use of antibiotics has potentially negative effects on the health of the host. For example, antibiotics use may affect the host's immune system by altering the gut microbiota. Therefore, the aim of the study was to investigate the influence of antifungal (fluconazole) treatment on the gut microbiota and immune system of mice. Results showed that the gut microbial composition of mice receiving fluconazole treatment was significantly changed after the trial. Fluconazole did not affect the relative abundance of bacteria but significantly reduced the diversity of bacterial flora. In the bacteriome, Firmicutes and Proteobacteria significantly increased, while Bacteroidetes, Deferribacteres, Patescibacteria, and Tenericutes showed a remarkable reduction in the fluconazole-treated group compared with the control group. In the mycobiome, the relative abundance of Ascomycota was significantly decreased and Mucoromycota was significantly increased in the intestine of mice treated with fluconazole compared to the control group. Reverse transcription-quantitative PCR (RT-qPCR) results showed that the relative gene expression of ZO-1, occludin, MyD88, interleukin-1β (IL-1β), and IL-6 was decreased in the fluconazole-treated group compared to the control. Serum levels of IL-2, LZM, and IgM were significantly increased, while the IgG level was considerably downregulated in the fluconazole-treated compared to the control group. These results suggest that the administration of fluconazole can influence the gut microbiota and that a healthy gut microbiome is important for the regulation of the host immune responses.

Journey Exploring the Evasive Cause of Cardiomyopathy in a 27 Year Old

Introduction The differential for cardiomyopathy in a young patient is challenging. While there has been published research into genetic cardiomyopathy and lymphocytic myocarditis, there is still much to be studied. Case Report A 27 year old male with significant family history of heart disease and no drug/steroid use, initially presented following cardiac arrest while exercising. Patient was found to be apneic and pulseless upon arrival of EMS. ACLS was performed. In the ED, he was found to have an EF of 10% and global hypokinesis. Lab work showed an elevated troponin which peaked at 20. Angiogram showed no significant obstructions. Patient developed evidence of cardiogenic shock, ultimately requiring pressors, IABP, and VA ECMO. Genetic testing was obtained which showed variance in FLNC and RBM40. Cardiac MRI demonstrated no late gadolinium enhancement. Right heart catherization and myocardial biopsy demonstrated evidence of high output heart failure and borderline lymphocytic myocarditis. Repeat ECHO demonstrated an improved ejection fraction of 43%. Patient was later decannulated and IABP was removed. Patient ultimately underwent AICD placement, and later interrogation noted episodes of VTach of unclear etiology. Patient was optimized on beta blockers, ARNI, and antiarrhythmics. Ejection fraction one year after admission remained 43%. Summary This case highlights the differential for cardiomyopathy in a 27 year old. While the diagnosis at this time is unclear, two main diagnoses become prominent: lymphocytic myocarditis versus underlying genetic disorder. Lymphocytic myocarditis accounts for 54% of all myocarditis, with viral illness the most common identified cause. Workup includes exclusion of other etiologies, as well as endomyocardial biopsy. While the role of medical therapy, such as immunosuppression or antivirals is unclear, the most effective treatment is supportive care. Genetic cardiomyopathies, however are more insidious. While there is still much to know about genetic cardiomyopathies, there have been advances in the recognition of genetic mutations that lead to earlier recognition and treatment. Also, patients with underlying genetic cardiomyopathies can be predisposed to lymphocytic myocarditis. This case is interesting in that it allows us to explore the differential for cardiomyopathy in a young healthy patient, and how the field of cardiomyopathy is evolving.

Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy.

BackgroundLibman-Sacks endocarditis in patients with systemic lupus erythematosus (SLE) is commonly complicated with embolic cerebrovascular disease (CVD) or valve dysfunction for which high-risk valve surgery is frequently performed. However, the role of medical therapy alone for Libman-Sacks endocarditis and associated acute CVD remains undefined.ObjectiveTo determine in this cross-sectional and longitudinal study if conventional anti-inflammatory and anti-thrombotic therapy may be an effective therapy in SLE patients with Libman-Sacks endocarditis and associated acute CVD.Methods and materials17 SLE patients with Libman-Sacks endocarditis detected by two-and-three-dimensional transesophageal echocardiography (TEE) and complicated with acute CVD [stroke/TIA, focal brain injury on MRI, or cognitive dysfunction] were treated with conventional anti-inflammatory and anti-thrombotic therapy for a median of 6 months and then underwent repeat TEE, transcranial Doppler, brain MRI, and neurocognitive testing for re-assessment of Libman-Sacks endocarditis and CVD.ResultsValve vegetations decreased in number, diameter, and area (all p ≤0.01); associated valve regurgitation significantly improved (p = 0.04), and valve thickening did not progress (p = 0.56). In 13 (76%) patients, valve vegetations or valve regurgitation resolved or improved in number and size or by ≥1 degree, respectively, as compared to 4 (24%) patients in whom vegetations or valve regurgitation persisted unchanged or increased in size or by ≥1 degree (p = 0.03). Also, cerebromicroembolism, lobar and global gray and white matter cerebral perfusion, ischemic brain lesion load, and neurocognitive dysfunction resolved or significantly improved (all p ≤0.04).ConclusionThese preliminary data suggest that combined conventional anti-inflammatory and antithrombotic therapy may be an effective treatment for Libman-Sacks endocarditis and its associated CVD and may obviate the need for high-risk valve surgery.

Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus–Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development

Acute liver failure caused by the ingestion of yellow phosphorus-containing rodenticide has been increasing in incidence over the last decade and is a common indication for emergency liver transplantation in Southern and Western India and other countries. Clear guidelines for its management are necessary, given its unpredictable course, potential for rapid deterioration and variation in clinical practice. A modified Delphi approach was used for developing consensus guidelines under the aegis of the Liver Transplantation Society of India. A detailed review of the published literature was performed. Recommendations for three areas of clinical practice, assessment and initial management, intensive care unit (ICU) management and liver transplantation, were developed. The expert panel consisted of 16 clinicians, 3 nonclinical specialists and 5 senior advisory members from 11 centres. Thirty-one recommendations with regard to criteria for hospital admission and discharge, role of medical therapies, ICU management, evidence for extracorporeal therapies such as renal replacement therapy and therapeutic plasma exchange, early predictors of need for liver transplantation and perioperative care were developed based on published evidence and combined clinical experience. Development of these guidelines should help standardise care for patients with yellow phosphorus poisoning and identify areas for collaborative research.

Management of Common Bile Duct Stones: A Comprehensive Review

Bile duct stones (BDS) are usually secondary to gallstones but may be found primarily in biliary system, although the percentage is minimal. They are usually suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis, the latter can be life-threatening in some patients. Abnormalities in the liver function tests especially the elevated direct bilirubin and alkaline phosphatase indirectly raise the suspicion. The majority of BDS can be diagnosed by Transabdominal Ultrasound, but in some cases further imaging such as, Computed Tomography, Endoscopic Ultrasound or Magnetic Resonance Cholangiography are employed prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following Endoscopic Retrograde Cholangiography (ERC) + sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC + pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. Despite all the minimally invasive procedures the role of open surgery for the removal of difficult or impacted stones cannot be completely forgotten. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS.

The Role of Medical Therapy in Idiopathic Ventricular Fibrillation

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Diseases of the Aorta

This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes. This review contains 9 figures, 6 tables, and 132 references.

Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

In the first section, the panel summarizes background information relevant to the topic. In the second section, the panel poses questions regarding the diagnosis and treatment of NCC, evaluates applicable clinical trial and observational data, and makes recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.1 The following 27 clinical questions were answered: I. How should NCC be diagnosed? II. What imaging studies should be used to classify disease? III. What additional tests should be performed before initiation of therapy? IV. How should antiparasitic and anti-inflammatory therapy be monitored? V. What is the role of antiparasitic drugs in VPN? VI. What is the role of anti-inflammatory therapy in management of VPN? VII. What is the role of antiepileptic drugs in VPN? VIII. What follow-up is recommended after initial antiparasitic therapy for patients with VPN? IX. What should be the initial approach to the patient with multiple enhancing lesions from NCC? X. What is the role of antiepileptic medications in patients with SEL from cysticercosis with seizures? XI. What is the role of antiparasitic drugs in patients with SEL? XII. What is the role of anti-inflammatory therapy in SEL? XIII. How should patients with SEL be followed? XIV. What should the initial approach be to patients with calcified lesions suggestive of CPN? XV. What is the role of antiparasitic drugs, antiepileptic drugs, and anti-inflammatory medications in the management of patients with CPN? XVI. Is there a role for surgical therapy in refractory cases? XVII. How are extra parenchymal cysts best identified? XVIII. What is the optimal approach to management of IVN in the lateral and third ventricles? XIX. What is the optimal surgical approach to management of IVN in the fourth ventricles? XX. What is the optimal approach to adherent IVN? XXI. Does medical therapy as an adjunct to procedures or as primary therapy have an impact on outcome in treating patients with IVN? XXII. What is the role of medical therapy in SAN in the basilar cisterns or Sylvian fissures? XXIII. What is the role of neurosurgery in SAN? XXIV. How is SN best treated? XXV. What is the optimal management of OC? XXVI. Should children be managed differently from adults? XXVII. Should management be different in pregnant women?

Diagnosis and Treatment of Neurocysticercosis: 2017 Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).

In the first section, the panel summarizes background information relevant to the topic. In the second section, the panel poses questions regarding the diagnosis and treatment of neurocysticercosis (NCC), evaluates applicable clinical trial and observational data, and makes recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework [1]. The following 27 clinical questions were answered: How should neurocysticercosis be diagnosed? What imaging studies should be used to classify disease? What additional tests should be performed prior to initiation of therapy? How should antiparasitic and anti-inflammatory therapy be monitored? What is the role of antiparasitic drugs in viable parenchymal neurocysticercosis? What is the role of anti-inflammatory therapy in management of viable parenchymal neurocysticercosis? What is the role of antiepileptic drugs in viable parenchymal neurocysticercosis? What follow-up is recommended after initial antiparasitic therapy for patients with viable parenchymal neurocysticercosis? What should be the initial approach to the patient with multiple enhancing lesions from neurocysticercosis? What is the role of antiepileptic medications in patients with single enhancing lesions from cysticercosis with seizures? What is the role of antiparasitic drugs in patients with single enhancing lesions? What is the role of anti-inflammatory therapy in single enhancing lesions? How should patients with single enhancing lesions be followed? What should the initial approach be to patients with calcified lesions suggestive of calcified parenchymal neurocysticercosis? What is the role of antiparasitic drugs, antiepileptic drugs, and anti-inflammatory medications in the management of patients with calcified parenchymal neurocysticercosis? Is there a role for surgical therapy in refractory cases? How are extraparenchymal cysts best identified? What is the optimal approach to management of ventricular neurocysticercosis in the lateral and third ventricles? What is the optimal surgical approach to management of ventricular neurocysticercosis in the fourth ventricles? What is the optimal approach to adherent ventricular neurocysticercosis? Does medical therapy as an adjunct to procedures or as primary therapy have an impact on outcome in treating patients with ventricular neurocysticercosis? What is the role of medical therapy in subarachnoid neurocysticercosis in the basilar cisterns or Sylvian fissures? What is the role of neurosurgery in subarachnoid neurocysticercosis? How is spinal neurocysticercosis best treated? What is the optimal management of ocular cysticercosis? Should children be managed differently than adults? Should management be different in pregnant women? BACKGROUND Neurocysticercosis, caused by the larval form of the cestode parasite Taenia solium, is a major cause of seizure and neurologic disease worldwide and is common among immigrant populations in the United States. Highly endemic regions include Latin America, sub-Saharan Africa, and parts of Asia [2, 3]. In endemic areas, it is linked to approximately 29% of cases of seizures [4]. Estimates suggest that there are >2000 cases per year in the United States, with hospital charges of nearly $100 million per year [5, 6]. Humans can be hosts to both the tapeworm form and larval forms of the parasite. Taeniasis (also termed taeniosis) refers to infestation of the human intestines with the tapeworm form. The tapeworm is acquired by ingestion of undercooked pork. The scolex evaginates and attaches to the intestinal wall, and segments termed proglottids form a long ribbon-like chain referred to as the strobili. The gravid proglottids and eggs are passed in stool. Humans can also develop cysticercosis after ingestion of ova. Cysticercosis refers to infection of the tissues with the larval cyst (or metacestode). Normally, pigs host the cysts, which are acquired by ingestion of ova or proglottids from human feces. However, humans can be infected by ingestion of ova and develop cysticercosis. Neurocysticercosis refers to cysticercosis involving the central nervous system, including the brain parenchyma, ventricles, basilar cisterns, sulci, gyri, spine, and retina. The pathogenesis, natural history, clinical manifestations, and management vary with the location of the cysticerci [3]. For example, the main clinical manifestations vary between different forms of disease (Table 1). Parenchymal NCC typically presents with seizures or headache. Ventricular NCC most often presents with obstructive hydrocephalus. Subarachnoid NCC can present with communicating hydrocephalus, meningitis, stroke, or focal neurologic findings. Mixed forms are also common. Due to the complexity of diagnosis and management, the American Society for Tropical Medicine and Hygiene (ASTMH) and the Infectious Diseases Society of America (IDSA) agreed to jointly develop guidelines for the diagnosis and management of NCC.

Laryngomalacia: is there an evidence base for management?

The advent of supraglottoplasty clearly has transformed the surgical management of severe laryngomalacia. The condition, however, generally runs a milder course, with spontaneous resolution the norm. To identify gaps in the knowledge and identify topics for future study. Systematic review of the literature. The literature suggests that there is a range of abnormalities leading to the typical collapsing upper airway, and that neurological disease, other airway abnormalities, syndromes and gastroesophageal reflux all contribute to disease severity and influence outcomes. The procedures involved in supraglottoplasty are rarely specified, the indications for surgery are vaguely defined and the role of medical therapy is unclear. Every review article or survey of opinion suggests that there is still a marked variation in individual practice and a lack of consensus.

Surgical Management of Ulcerative Colitis

Inflammatory bowel disease is a chronic inflammatory disease of the intestine that can be divided into two main categories: Crohn disease and chronic ulcerative colitis (CUC). Although the role of medical therapy in CUC is directed at symptom control or the underlying inflammatory process, fortunately, the intestinal manifestations of CUC can be effectively cured by surgery. The operation of choice is an ileal pouch-anal anastomosis (IPAA), which can be performed open or laparoscopically, with a hand-sewn or stapled anastomosis, or in a one-, two-, or three-stage fashion. Although pouch function and quality of life remain good following IPAA, common complications include pouchitis, anal stricture, pouch fistulas, and small bowel obstructions. The most dreaded complication is an anastomotic leak resulting in pelvic sepsis and, often, eventual pouch excision. Less common complications include pouch dysplasia or cancer and de novo Crohn disease of the pouch. Overall, regardless of age, patient satisfaction following IPAA remains high, and more than 90% of patients retain their pouches for more than 20 years. This review contains 11 highly rendered figures, and 83 references.

Diseases of the Aorta

This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes. This review contains 9 figures, 6 tables, and 132 references.

Diseases of the Aorta

This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes. This review contains 9 figures, 6 tables, and 132 references.

Is there a role for medical therapy for non- functioning pituitary adenomas? - FOR

Is there a role for medical therapy for non- functioning pituitary adenomas? - FOR