Ulcerative colitis is fascinating as one of the emerging immunological areas with profound clinical manifestations, an area that is both well and poorly understood, and one that is ripe for a field of biological agents.
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It’s doesn’t get more bread and butter than this – the diagnosis and management of stable COPD. Every physician needs to know this through and through, and where better than a freshly updated guidelines. Here’s a brief summary of the updates:
A couple of points from skimming through the article:
Check out the tables with the diagnostic criteria and scoring systems. The article also provides a nice overview of treatment, with an algorithm presented to simplify matters.
Last year, we gave you an overview article from Gastroenterology about haemochromatosis. This year, the official AASLD guidelines have been released.
It’s an excellent article, with a great initial description of iron control, and goes on to provide some great step by step diagrams.
Check it out, for free and in full, here.
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Of all the gynaecological cancers, this is the one you will be most commonly faced with – so it’s important to know what to look out for, how to work it up, and what needs to be done. For the answers, look to this month’s BMJ.
The article has a lovely collection of summary points to stimulate your interest, including the hallmark symptom, a brief list of investigations, and treatment options. It’s a fantastic summary and definitely worth a read.
Over at the BMJ here.
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Breaking down the tumour is usually a good thing – except when there’s a massive load of tumour cells and it all becomes a bit overwhelming. So what exactly happens – and how do you stop it?
Basically, when the cancer cells break down, they release a few nasties – potassium and phosphorus, as well as a few nucleic acids that end up as uric acid. This leads to a multitude of problems, including cardiac arrhythmias, seizures, and renal failure, which all doesn’t help when you’ve just started chemotherapy (although it can happen spontaneously too).
Look at the bloods, for the following:
– high potassium
– high phosphate
– high uric acid
– high creatinine
– low calcium
The key approaches to management are to prevent the complications, and to choose therapy wisely if someone is at high risk. This article from the New England Journal of Medicine carefully describes the laboratory and clinical diagnosis of tumour lysis syndrome and provides some great algorithms on management.
Read it here.
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I’d say there’s a proportion of you out there who’ve heard this term thrown around, hovering around in the back of your mind in regards to causes of cirrhosis, but if it came to actually explaining the pathophysiology and management, things may be a bit more difficult. Good time for a Lancet review then…
In fact, even after flipping through Harrison’s you may not have a complete idea to the processes that lead to this. A couple of important points:
So you get an FBE in a well patient, with platelets that are noted to be 24, and the GP refers to you suspecting ITP. What other bloods do you need to order? What other major disorders do you need to exclude? Do you need to do a bone marrow? What’s the best way to treat?
A diagnosis of exclusion, and yet surprisingly common, ITP is one of those conditions you will definitely deal with at some point. Since 1950, we’ve known about the immune pathogenesis, but it’s still very complex. Beyond the standard steroid therapy, there are a multitude of other options out there, including IVIg and anti-D, as well as brand new agents like thrombopoietin receptor antagonists (including one with possibly the best drug name ever, eltrombopag).
The American Society of Haematology has released guidelines for the management in Blood – with a fantastic summary table that gets straight to the point.
The guidelines are here.
Surprisingly common in the elderly, but often goes unsuspected – multiple myeloma is a classic haematological malignancy that needs to be well known. What’s more, there have been some significant advances in both diagnosis and treatment that are well deserving of your attention.
This nice article from NEJM steps you through the management of multiple myeloma, as well as dealing with the adverse effects of treatment.
Check it out over here.
IMAGE: Patrick Hoesly
It’s not all just pan systolic this and grade 2 that – murmurs have a lot of subtle nuances, and it’s an area where old school clinical skills come to the fore. We’re not going to deny that echo has revolutionised the diagnosis of valvular heart disease, but picking up a Cabot Locke at the bedside is a damn impressive way to diagnose anaemia.
What is a Cabot Locke murmur I hear you ask? Well that and a collection of other eponymous murmurs are listed for you with a brief review at NEJM, along with some audio for your listening pleasure.
Check it out here. Oh, and the dude in the picture? Austin Flint. I know – awesome mutton chops.
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