{"title":"Pulmonary hypertension: evaluation and management.","authors":"Gustavo A Heresi, Raed A Dweik","doi":"10.1007/s12019-007-0014-0","DOIUrl":"https://doi.org/10.1007/s12019-007-0014-0","url":null,"abstract":"<p><p>Pulmonary hypertension (PH) is a hemodynamic state characterized by elevation in the mean pulmonary arterial pressure and pulmonary vascular resistance leading to right ventricular failure and premature death. PH can be the result of a variety of diseases of different etiologies. Pulmonary arterial hypertension (PAH) should be distinctly differentiated from pulmonary venous hypertension (PVH) as a result of left heart disease. PAH is commonly caused by or associated with an underlying pulmonary, cardiac, or systemic disease (APAH). In the absence of an identifiable etiology or associated underlying disease, PAH is referred to as idiopathic (IPAH). IPAH, formerly known as primary pulmonary hypertension (PPH), is a rare disease most commonly seen in women of childbearing age. Presenting symptoms and signs are nonspecific and include dyspnea on exertion, fatigue, and a loud pulmonary component of the second heart sound. Transthoracic Doppler echocardiography is an excellent noninvasive test to detect the presence of pulmonary hypertension, although every patient should receive a right heart catheterization to confirm the diagnosis. A detailed work up, including laboratory tests and imaging studies, is also indicated to rule out known causes of pulmonary hypertension. Several targeted treatment options have become available in recent years and include parenteral and inhaled prostanoids, oral endothelin receptor antagonists, and oral phosphodiesterase type-5 inhibitors. As a result of their complex care, patients should be referred to centers with expertise in pulmonary hypertension.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 3","pages":"150-61"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0014-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27079686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment after myocardial infarction.","authors":"Wilbert S Aronow","doi":"10.1007/s12019-007-0002-4","DOIUrl":"https://doi.org/10.1007/s12019-007-0002-4","url":null,"abstract":"<p><p>Persons after myocardial infarction (MI) should have their modifiable coronary artery risk factors intensively treated. Hypertension should be treated with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. The blood pressure should be reduced to <140/90 mmHg and to <130/80 mmHg in persons with diabetes or renal insufficiency. The serum low-density lipoprotein cholesterol should be reduced to <70 mg/dl with statins if necessary. Diabetics should have their hemoglobin A1c reduced to <7.0%. Aspirin or clopidogrel, beta blockers, and ACE inhibitors should be given indefinitely unless contraindications exist to the use of these drugs. Long-acting nitrates are effective antianginal and antiischemic drugs. Postinfarction patients at very high risk for sudden cardiac death should have an implantable cardioverter-defibrillator. The two indications for coronary revascularization are prolongation of life and relief of unacceptable symptoms despite optimal medical management.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 1","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0002-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40741485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Warangkhana Wongba, Muhamad Jaffer Ansari, Obiefuna Okoli, Sreesusmitha Garapati, Nkemaolam Iroegbu, Joel B Spear
{"title":"A man with tropical travel history, fever, and pulmonary infiltrates.","authors":"Warangkhana Wongba, Muhamad Jaffer Ansari, Obiefuna Okoli, Sreesusmitha Garapati, Nkemaolam Iroegbu, Joel B Spear","doi":"10.1007/s12019-007-0003-3","DOIUrl":"https://doi.org/10.1007/s12019-007-0003-3","url":null,"abstract":"<p><p>Acute Respiratory Distress Syndrome (ARDS) are one of the most serious complications of falciparum malaria. Pathogenesis of ARDS along with factors contributing towards the development and treatment of ARDS is discussed.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 1","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0003-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41016582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J Swartz, Kristin Janson, Theodore L Deweese, Danny Y Song
{"title":"Radiation therapy for prostate cancer: the role for dose escalation.","authors":"Michael J Swartz, Kristin Janson, Theodore L Deweese, Danny Y Song","doi":"10.1007/s12019-007-8014-7","DOIUrl":"https://doi.org/10.1007/s12019-007-8014-7","url":null,"abstract":"<p><p>Recent technological advances in radiation treatment delivery have allowed relatively higher doses of radiation to be delivered safely to the prostate. Emerging data suggest improvements in disease control with higher doses of radiation in subsets of patients with prostate cancer.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 4","pages":"216-22"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-8014-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27099651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Late life psychosis: assessment and general treatment strategies.","authors":"Hani Raoul Khouzam, Robert Emes","doi":"10.1007/s12019-007-0016-y","DOIUrl":"https://doi.org/10.1007/s12019-007-0016-y","url":null,"abstract":"<p><p>With the increased number of elderly patients suffering from mental illness, an increased incidence of psychiatric conditions including psychotic disorders is also expected. When psychosis occurs in the elderly, its assessment and treatment may pose a challenge for primary care clinicians and caregivers. This article will review the assessment and treatment of late life psychosis.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 3","pages":"127-43"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0016-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27079684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H David Pettigrew, Suzanne S Teuber, M Eric Gershwin
{"title":"Polyarteritis nodosa.","authors":"H David Pettigrew, Suzanne S Teuber, M Eric Gershwin","doi":"10.1007/s12019-007-0012-2","DOIUrl":"https://doi.org/10.1007/s12019-007-0012-2","url":null,"abstract":"<p><p>Polyarteritis nodosa, as a diagnosis, has been progressively narrowed from a collection of ill-defined vasculitides to its current definition as a systemic transmural necrotizing vasculitis that usually affects medium-sized muscular arteries and sometimes small muscular arteries, commonly within the kidneys, gastrointestinal tract, skin, nerves, joints, and muscles. In this review, we will highlight the clinical features and classification of this disease and emphasize that more accurate diagnosis of subtypes leads to more effective treatment.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 3","pages":"144-9"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0012-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27079685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evidence-based treatment of chronic heart failure.","authors":"David Rosen, Matthew V Decaro, Mark G Graham","doi":"10.1007/s12019-007-0006-0","DOIUrl":"https://doi.org/10.1007/s12019-007-0006-0","url":null,"abstract":"<p><p>The past two decades have seen a knowledge explosion in the field of cardiovascular diseases, in general, and in the understanding of chronic heart failure (HF) as a complex neurohumoral syndrome in particular. A new staging system for chronic HF has been developed within the last decade to facilitate the evidence-based prescription of medications and medical devices for each of its four stages. The burden of care for patients with chronic HF is substantially provided in primary care settings. Primary care physicians need to understand the underlying pathophysiology of chronic HF, the elements of its evaluation and treatment by stage, and when referral is necessary.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 1","pages":"2-17"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-0006-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41016580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of heart failure with normal left ventricular ejection fraction.","authors":"Wilbert S Aronow","doi":"10.1007/s12019-007-8019-2","DOIUrl":"https://doi.org/10.1007/s12019-007-8019-2","url":null,"abstract":"<p><p>Underlying causes and precipitating causes of heart failure (HF) should be treated when possible. Persons with HF and normal left ventricular ejection fraction (LVEF) should have maintenance of sinus rhythm, treatment of hypertension, myocardial ischemia, dyslipidemia, and anemia, slowing of the ventricular rate below 90 bpm, and reduction of salt overload. First-line drug treatment in the management of these persons is the use of loop diuretics combined with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. If persons are unable to tolerate ACE inhibitors because of cough, angioneurotic edema, rash, or altered taste sensation, angiotensin II type I receptor antagonists (ARBs) should be given. If HF persists despite diuretics, beta blockers, and ACE inhibitors or ARBs, isosorbide dinitrate plus hydralazine should be administered. Beta blockers, verapamil, diltiazem, and digoxin may be used to slow a rapid ventricular rate in persons with supraventricular tachyarrhythmias. Digoxin should not be used in persons with HF in sinus rhythm with normal LVEF. Exercise training should be encouraged in persons with mild to moderate HF to improve functional status and to decrease symptoms.</p>","PeriodicalId":75729,"journal":{"name":"Comprehensive therapy","volume":"33 4","pages":"223-30"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12019-007-8019-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27098432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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