More tightly defined and controlled studies have found definite benefit associated with adjuvant therapy following surgery for stage III colon cancer. The decision for those with stage II disease is best made on an individual basis.
Investigations linking this disorder to numerous factors, such as neurotransmitters and apolipoprotein E, are leading to future drug therapy. Current patient care must be focused on finding and alleviating the causes of immediate behavioral concerns.
The drugs that are effective in inflammatory bowel disease (IBD) act by inhibiting the chronic unregulated intestinal inflammation in these patients. The mainstays of the drug therapy of IBD are a variety of formulations of 5-aminosalicylic acid (5-ASA), the conventional and newer low bioavailability glucocorticoids, the nitroimidazole antibiotic metronidazole, and certain immunomodulating agents. Increased understanding of the mechanisms of inflammation in IBD has permitted the development of effective designer drugs. These agents are products of the biotechnology industry and include antibodies to tumor necrosis factor (TNF)-alpha, antisense oligonucleotides and recombinant human interleukin (IL)-10. In addition, a number of other agents such as nicotine and n-3 fatty acids are useful in certain patients. This review first focuses on the pharmacology and mechanism of action of these drugs in IBD, followed by an approach to the treatment of patients with ulcerative colitis (UC) and Crohns disease (CD). The recommendations consider type and activity of IBD and are based largely on data from controlled trials and systematic reviews in the IBD literature.
The pointers outlined recommend specific steps for the neurologic examination, assessment instruments for detecting physical and cognitive dysfunction and mood alteration, and relevant laboratory tests. When to use imaging studies is highlighted.
The debate persists on the relative role of beta 2-agonists, corticosteroids, and other antiasthmatic drugs, in part because asthma can be so difficult to control. Exploration of the concerns about therapy is followed by practical recommendations.
Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.
Risk factors for osteoporosis, bone densitometry, and biochemical testing can identify those most in need of preventive measures to optimize calcium metabolism and reduce bone loss. Treatment options for established disease are evaluated.
This systematic approach to low back pain limits the use of imaging studies and surgery. The natural history of this condition and its resolution show that such modalities are best restricted to a minority of patients.
These agents seem beneficial in all HIV-infected patients with CD4 counts under 500 cells/mm3, but the effects are time limited and related to baseline immune status. Active viral replication is now known to occur even during periods of clinical latency.
The diagnosis is made clinically, often independent of special tests, through a series of simple, carefully planned observations and maneuvers. The objective is to separate true Parkinson's disease from other conditions with parkinsonian features.
PREVIEW High blood pressure presents a major threat in patients with either type 1 or type 2 diabetes. It greatly increases the risks for such complications as end-stage renal disease, coronary artery disease, stroke, peripheral vascular disease, and diabetic retinopathy. Drug therapy can help avert these complications but often is underutilized as a treatment option. In this article, the authors discuss pharmacologic interventions and how best to use them in diabetic patients with hypertension. In the February issue, the authors discussed why aggressive treatment is essential, and in March, they examined the perceived and real barriers to effective treatment.
The question of which antimicrobial agents to use is compounded by the imprecision of presenting signs and symptoms and the limitations of diagnostic tests. The use of empiric therapy is explored along with suggested management if treatment fails.
The azole antifungal drugs fluconazole and itraconazole have changed our approach to the treatment of serious fungal infections. Increased use of these drugs has generated information of value for clinical practice.
A clearer understanding of the underlying dynamics of the acute coronary syndromes and of the drugs that are useful in these conditions has modified recommendations on drug selection and regimens. These changes have led to better clinical outcomes.
Risk assessment, known coronary and other atherosclerotic disease, and lipid levels determine the potential need for drug therapy. Specific lifestyle objectives are strongly emphasized. Indications and regimens for newer and older drugs are offered.
