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What's New in Medicine

New and Updated Recommendations from Medscape's Clinical Reference

October 2008

advertisementHerpes zoster (shingles) is 1 of 2 distinctive manifestations of human infection with the varicella-zoster virus (VZV). Read more about the pathophysiology and frequency of herpes zoster.

From Sinusitis, Chronic, Infectious DiseasesChoosing the right antimicrobials for chronic sinusitisAntibiotic selection depends on several

factors, including history of drug allergies, cost of therapy, and the likelihood of involvement by beta-lactamase–producing organisms and MRSA.

From Smallpox, Infectious DiseasesSmallpox in the age of bioterrorism: A new vaccine for outbreak controlThe vaccine contains live vaccinia virus and works by causing a mild infection that stimulates an immune response that effectively protects against smallpox without actually causing the disease.

From Head and Neck Cancer: Squamous Cell Carcinoma, Plastic SurgeryMolecular markers under investigation to individualize treatment of squamous cell carcinomaMolecular markers such as epidermal growth factor receptors (EGFR) and human papillomavirus (HPV) may help individualize treatment options for squamous cell carcinoma.

Rising Star

, MBBCh, PhDDr. is a resident physician in the department of pediatrics at SUNY Upstate Medical University and is one of the rising stars at eMedicine. He has developed software that helps scientific investigators analyze raw data and developed and teaches a novel communication skills curriculum in pediatrics. At eMedicine, Dr. is an author in our Infectious Diseases and Pediatrics: General Medicine sections. Energetic, thorough, and always dependable, he recently worked with one of our senior coauthors to submit a comprehensive topic that will be the core of our new HIV section. Our thanks to Dr. for his enthusiastic dedication to eMedicine.Dr. recently

coauthored the Infectious Diseases article Avian Influenza.

From Transfusion Reactions, HematologyProposed mechanisms for transfusion-related acute lung injury (TRALI)Two pathophysiologic mechanisms have

been proposed for transfusion-related acute lung injury (TRALI).

From Mycobacterium Avium-Intracellulare, Infectious DiseasesA potential new diagnostic tool for MAC pulmonary infectionAn enzyme immunoassay (EIA) kit used in Japan has been used to detect serum IgA antibody to MAC-specific glycopeptidolipid core antigen. This could be useful for serodiagnosis of MAC pulmonary infection. Sensitivity and specificity of this EIA kit were reported as 84% and 100%, respectively.

From Hepatocellular Carcinoma, General Surgery The fastest growing cause of cancer mortality overallHepatocellular carcinoma, with its link to the hepatitis C epidemic, represents the fastest growing cause of cancer mortality overall and the second fastest growing cause of cancer deaths. Over the past 20 years, the incidence of hepatocellular carcinoma has more than doubled.

From Cardiac MRI - Technical Aspects Primer, RadiologyOptimizing MRI technique for the diagnosis and management of cardiac pathologyWith an understanding of the technical aspects specific to cardiac MRI, the imager should be able to optimize image quality to aid in the diagnosis and management of these and other cardiovascular diseases.

From Epididymitis, Emergency MedicineNew ways to differentiate epididymitis from testicular torsionBedside ultrasonography and C-reactive

protein and erythrocyte sedimentation rate are explored as ways to differentiate epididymitis from testicular torsion, a true emergency.

From Immunotherapeutic Targeting, PediatricsToll-like receptor–targeted therapies for pediatric tumorsAnimal models have suggested that

toll-like receptor (TLR)-targeted therapies may potentially have a role in pediatric tumor regression.

From Mycosis Fungoides, HematologyEvaluation of mycosis fungoides and Sezary syndromeFine-needle aspiration biopsy, immunophenotyping, and T-cell receptor gamma chain polymerase chain biopsy may have a role in the evaluation of mycosis fungoides and Sezary syndrome.

From Goiter, Toxic Nodular, EndocrinologyHyperactivity of toxic adenomas often results from mutations of the thyrotropin receptorIn 20-80% of toxic adenomas, autonomous nodular hyperactivity is conferred by somatic mutations of the thyrotropin, or thyroid-stimulating hormone (TSH), receptor.

From CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy), Neurology – New ArticleAspirin may increase intracerebral hemorrhage risk in patients with CADASILThe benefit of antiplatelet agents in the treatment of CADASIL has not been established, and in fact potentially increases the risk of intracerebral hemorrhage.

From Massage, Traction, and Manipulation, Physical Medicine and RehabilitationNew evidence for an old treatmentA recent Hungarian study

indicates that vertical suspension of patients in a warm-water bath, with weight applied to their lower limbs, may, in combination with physical therapy, be an effective treatment for lumbar and cervical diskopathy.

From Penetrating Neck Trauma, TraumaOptimal management of wartime penetrating neck injuriesFor the military injury, arteriography remains the criterion standard in the optimal management of penetrating neck injuries, particularly in delayed evaluations.

From Cardiopulmonary Resuscitation (CPR), Clinical Procedures and Therapeutics – New articleWhy ventilations are no longer part of bystander CPRStudies have concluded that stopping compressions in order to give ventilations may be detrimental to the patient’s outcome.

From Atopic Dermatitis, Dermatology2008 guidelines for atopic eczema in childrenThe incidence of atopic dermatitis continues to increase, and new NICE pediatric treatment guidelines are published for 2008.

From Dry Eye Syndrome, OphthalmologyUpdated therapeutic options for dry eye diseaseThe International Dry Eye WorkShop (DEWS) recently updated

all aspects of dry eye disease, including therapeutic options for dry eye disease treatment.

From Fractionated Stereotactic Radiation for Acoustic Neuroma, Otolaryngology and Facial Plastic SurgeryLong-term results of Gamma Knife radiosurgery studiedA 2008 study by Bush et al analyzes the long-term hearing results of Gamma Knife radiosurgery in treating acoustic neuromas.

From Brain Abscess, Emergency MedicineControlling infection and preventing complicationsEarly administration and selection of appropriate

antibiotic therapy for brain abscess are key in controlling infection and preventing complications.

From Os Odontoideum, Orthopedic SurgeryStabilizing os odontoideumIn patients with os odontoideum, there are 2 types of management: surveillance and operative stabilization. In patients with more severe symptoms of spinal instability, neurologic involvement, or intractable pain, several surgical options are described in detail, such as onlay fusion, wiring and fusion, screw fixation, and resection of the os fragment.

From Neurofibromatosis, PediatricsNew treatments for malignant peripheral nerve sheath tumorsNew chemotherapy treatments targeting relevant neurofibromatosis pathways have shown great promise in the treatment of malignant peripheral nerve sheath tumors.

From Splinting, Posterior, Long Leg, Clinical Procedures and Therapeutics – New articleShould NSAIDs be used

in the treatment of fractures?Controversy exists regarding NSAIDs and bone healing, and further investigation is warranted to fully understand which patients are at highest risk for delayed healing and complications produced by NSAIDs.

From Pulmonary Hypoplasia, Radiology – New articleRadiographic findings for pulmonary hypoplasiaOn radiographs, pulmonary hypoplasia is usually unilateral, volume of the chest is reduced on the affected side, and the affected lung is small. Antenatal ultrasound and MRI are also being increasingly used to detect pulmonary hypoplasia.

From Skin Grafting, DermatologySkin substitutes – How much is too much?Dermal graft substitutes continue to be developed, but cost and other factors limit their usefulness.

From Riedel Thyroiditis, Physical Medicine and RehabilitationA promising diagnostic tool in Riedel thyroiditisAlthough promising, the role of positron emission tomography (PET) scanning in the diagnosis of Riedel thyroiditis (RT) has not yet been established. However, studies indicate that in patients with RT, fluorodeoxyglucose-PET scanning demonstrates increased glucose metabolism in affected thyroids.

From Lysosomal Storage Disease, NeurologyFirst treatment for Hunter syndrome approvedMany recombinant enzyme-replacement regimens have been

developed to treat several lysosomal storage diseases. The latest of these proteins to be produced is idursulfase, the first pharmacologic agent to be approved for the treatment of Hunter syndrome.

From Vocal Fold Paralysis, Bilateral, Otolaryngology and Facial Plastic SurgeryBilateral vocal fold paralysis seen after stent placementA 2008 study by Gellad et al examines bilateral vocal cord paralysis after stent placement for proximal esophageal strictures.

From 3-Beta–Hydroxysteroid Dehydrogenase Deficiency, PediatricsA potential complication in 3-beta–hydroxysteroid dehydrogenase deficiencyRest tumors have been identified as a potential complication in 3-beta–hydroxysteroid dehydrogenase (3BHSD) deficiency that may result in infertility and gonadal dysfunction.

From Paraneoplastic Diseases, DermatologySpecific HLAs for paraneoplastic pemphigusEvidence indicates that patients with alleles HLA-Cw14 and

HLA-DRB103 may be susceptible to developing paraneoplastic pemphigus.

From Thrombocytosis, Essential, HematologyIs deregulation also involved in polycythemia vera, essential thrombocytosis, and myelofibrosis?JAK2 mutations activate the JAK-STAT pathway in polycythemia vera and essential thrombocytosis and are linked to myelofibrosis development. The authors hypothesized that a deregulation of the suppressor of cytokine signaling (SOCS) protein system in these cases could produce this activation.

The Latest eMedicine CME Case PresentationsAn Auricular Mass in a 42-Year-Old ManA 14-Year-Old Boy With Progressive Weakness and DyspneaA Young Athlete in Cardiac ArrestPainful Left Knee in a 7-Year-Old BoyMore eMedicine CME CasesSubmit a Case

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