Biomedical subjects
Publications and source records attributed to C D Still.
Lactose intolerance affects more than 50 million Americans. It is one of the most common gastrointestinal disorders seen by primary care physicians. When this disorder is properly diagnosed, the patient is easily treated with education and dietary modifications. Lactose intolerance is commonly misdiagnosed because of its overlapping symptoms of diarrhea and abdominal bloating. This article reviews the etiology, diagnosis, and treatment of lactose intolerance.
The use of enteral and parenteral nutrition support may be warranted when patients are unable to ingest adequate calories or protein (or both). This review provides an overview of the indications, access, administration, management, and complications of these modes of therapy.
Diverticular disease is a common medical problem seen in Western society. Outpatient management with close observation is appropriate for the majority of patients. Established criteria for hospitalization and treatment of diverticulitis can help to reduce medical costs and length of stay. Minimally invasive techniques such as computed tomography-guided drainage of diverticular abscess can expedite medical and surgical treatment.
Acute pancreatitis is a relatively common disease with an incidence of 30 per 100,000 persons per year. In the United States, more than 80% of the cases are related to biliary stones or alcohol use. It is a potentially fatal disease with an overall mortality of 5% to 10%. When first seen, patients have an acute abdomen. It is imperative that the diagnosis be established rapidly with a thorough history, physical examination, and appropriate laboratory and imaging studies. Prompt determination of patients who need referral for intensive care or consultation is crucial. There is no specific treatment for most patients with acute pancreatitis. Supportive care includes intravenous administration of fluids, parenterally administered analgesia, nutritional support, and prevention and treatment of complications.
Leptin is a hormone produced primarily by the adipocytes. It works through different receptors and seems to provide information to the hypothalamus about the energy status of the body. Although leptin appears to exert its anti-obesity effect through its central action, the full spectrum of its action is yet to be determined. Most obese subjects in studies have high serum levels of leptin, suggesting that the major problem is leptin resistance rather than leptin deficiency. Consequently, these patients may not respond to exogenous leptin. Recent trials have indicated, however, that leptin may have therapeutic potential in leptin-deficient as well as leptin-resistant states.
Enterocutaneous fistulas (ECFs) are a complex topic in terms of classification. ECF-related morbidity and mortality can be high due to fluid loss and electrolyte imbalance, sepsis, and malnutrition. Most prognostic factors influencing the outcome of ECF are now well-known. ECF treatment is complex; and, based on various situations, it can be surgical or conservative/ medical. Depending on fistula site and nutritional status, clinicians have to decide whether total parenteral or enteral nutrition should be established. In cases where total parenteral nutrition alone for 7 days has failed to influence the high output fistulas, overall data support the use of adjuvant drug, somatostatin, or its synthetic analogue, octreotide. Somatostatin 250 microg/d and octreotide 300-600 microg/d have been tried along with total parenteral nutrition to decrease the healing time of ECFs and to reduce the number of complications.
The epidemic of obesity in the United States has major consequences for society. Healthcare providers need to have an appreciation for obesity's complexity and related multiple comorbid medical problems. This article reviews the epidemiology, definitions, and assessment of obesity with emphasis on its clinical consequences. In addition, current techniques in evaluating and treating the obese patient are also described.
Surgical options for severe obesity are becoming an increasingly common method of treatment, the consequence of the historically high rates of recidivism with conventional medical treatment, the availability of modified, less drastic surgical procedures, and long-term efficacy statistics. This article reviews the indications and contraindications to bariatric surgery and reviews common surgical procedures and their efficacy.
Although advances have been made in the treatment of obese and overweight patients, no "magic bullet" yet exists. Future targets for pharmacotherapy include the OB protein leptin, neuropeptide, beta 3-adrenergic receptors, uncoupling proteins 2 and 3, and protein kinase A. Cholecystokinin, bombesin, and glucogen-like peptide-1, receptors for gastrointestinal hormones, offer potential future pharmacologic agents that enhance energy expenditure, and they have proven promising for the development of appetite-suppressant pharmacotherapy. Receptor agonists for each of these proteins have been shown to be useful as appetite suppressants and reducing meal size. This article discusses various research modalities currently under consideration. Despite rapid strides toward an ideal antiobesity agent, the role of diet, exercise, and behavior modification must be considered the cornerstone for any potential future pharmacotherapy.
Explore the source record for details and available documents.