Abstract:
:Gallstones can now be treated nonsurgically as well as surgically. The current view is that only symptomatic gallstones should be treated; of these, only cholesterol gallstones can be treated nonsurgically. Cholesterol gallstones in a functioning gallbladder will dissolve slowly when the secretion of unsaturated bile is induced by the ingestion of ursodiol or chenodiol, which are naturally occurring bile acids. Stone dissolution can be accelerated by increasing the surface area via extracorporeal shock wave lithotripsy, which fragments stones rapidly and safely, enhancing their dissolution rate. A technique is being developed in which a catheter is inserted into the gallbladder via either a percutaneous transhepatic or endoscopic route and an organic solvent such as methyl tert-butyl ether is instilled, dissolving the stones rapidly without major side effects. Gallstones will eventually recur in about half of the patients treated by these nonsurgical approaches, because the gallbladder is left in place and the fundamental pathogenic abnormalities associated with this common disease are not corrected. However, the rate of recurrence of symptomatic gallstone disease is lower.
journal_name
Annu Rev Medjournal_title
Annual review of medicineauthors
Hofmann AFdoi
10.1146/annurev.me.41.020190.002153subject
Has Abstractpub_date
1990-01-01 00:00:00pages
401-15eissn
0066-4219issn
1545-326Xjournal_volume
41pub_type
杂志文章,评审abstract::Recent advances in our understanding of and ability to treat panic disorders and various types of phobia have been reviewed. A case of agoraphobia was presented in detail to illustrate clinical issues and serve as a basis for discussing differential diagnosis. The presence or absence of spontaneous panic attacks has c...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.32.020181.003055
更新日期:1981-01-01 00:00:00
abstract::Monoclonal antibodies of defined specificity can be produced using hybridoma technology. New attempts are being made to explore the potential of antibody therapy for cancer. Preliminary studies show that problems such as antigenic modulation, circulating free antigen, effector cell shortage, and host anti-mouse immuno...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.34.020183.000543
更新日期:1983-01-01 00:00:00
abstract::Eccrine sweat is produced by millions of miniscule glands buried in the skin. Eccrine sweating from the general body surface is an extremely important function in human thermoregulation; disturbances either in the control of sweating activity or in the glands themselves can result in problems ranging from minor social...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.34.020183.002241
更新日期:1983-01-01 00:00:00
abstract::The eosinophil is characterized by specific cytoplasmic granules that contain a series of cationic toxins able to kill many targets, including helminths, protozoa, bacteria, and other cells. In bronchial asthma, considerable evidence exists that the eosinophil releases granule proteins, especially the major basic prot...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.44.020193.000505
更新日期:1993-01-01 00:00:00
abstract::Antisense technology exploits oligonucleotide analogs to bind to target RNAs via Watson-Crick hybridization. Once bound, the antisense agent either disables or induces the degradation of the target RNA. Antisense agents can also alter splicing. During the past decade, much has been learned about the basic mechanisms o...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.55.091902.104408
更新日期:2004-01-01 00:00:00
abstract::Most ventricular tachycardias encountered in clinical practice occur in patients who have structural heart disease. Idiopathic ventricular tachycardia refers to those arrhythmias that occur in patients without structural heart disease, metabolic/electrolyte abnormalities, or the long QT syndrome. Three commonly recogn...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.50.1.159
更新日期:1999-01-01 00:00:00
abstract::In vitro coculture studies of normal T lymphocytes, natural killer (NK) cells, or monocytes with human hematopoietic progenitor cells (HPC) suggest a potential role for immune cells in the regulation of hematopoiesis. In some patients with severe aplastic anemia or selective pure red cell, white cell, or megakaryocyte...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.38.020187.000425
更新日期:1987-01-01 00:00:00
abstract::Acute myocardial infarction is caused by coronary thrombosis on an ulcerated atheroma. We now believe that the predominant cause of this intimal disruption is the rupture of the atheroma through the intimal surface, caused by enzymes released by activated macrophages. The subsequent clinical course following atheroma ...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.42.020191.000343
更新日期:1991-01-01 00:00:00
abstract::Both genetic and environmental factors contribute to the etiology of non-insulin-dependent diabetes. The genetic component is heterogeneous and in some patients is probably complex, involving multiple genes. Specific genetic defects have been identified for rate monogenic forms of NIDDM: maturity-onset diabetes of the...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.47.1.509
更新日期:1996-01-01 00:00:00
abstract::Chronic myelogenous leukemia (CML) is a clonal hematopoetic stem cell disorder characterized by the Philadelphia chromosome and resultant production of the constitutively activated Bcr-Abl tyrosine kinase. Characterized clinically by marked myeloid proliferation, it invariably terminates in an acute leukemia. Conventi...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.53.082901.103853
更新日期:2002-01-01 00:00:00
abstract::The endothelium is a physical barrier between the blood and vascular smooth muscle, a source of enzymes activating and deactivating cardiovascular hormones and a site of production of relaxing and contracting factors. In addition, the endothelium is a source of growth inhibitors and promoters of vascular smooth muscle...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.44.020193.002143
更新日期:1993-01-01 00:00:00
abstract::Clostridium difficile infection is associated with broad-spectrum antibiotic therapy and is the most common cause of infectious diarrhea in hospital patients. Pathogenic strains of C. difficile produce two protein exotoxins, toxin A and toxin B, which cause colonic mucosal injury and inflammation. Infection may be asy...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.49.1.375
更新日期:1998-01-01 00:00:00
abstract::The number of patients with end-stage heart failure (HF) continues to increase over time, but there has been little change in the availability of organs for cardiac transplantation, intensifying the demand for left ventricular assist devices (LVADs) as a bridge to transplantation. There is also a growing number of pat...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev-med-041217-011015
更新日期:2019-01-27 00:00:00
abstract::The most significant complication of elevated parathyroid hormone (PTH) levels in uremia is the development of osteitis fibrosa cystica. The hormone also appears to play a role in soft-tissue and organ calcification, metabolic abnormalities (glucose, lipids), and electroencephalographic changes seen in uremic patients...
journal_title:Annual review of medicine
pub_type: 杂志文章
doi:10.1146/annurev.me.37.020186.000443
更新日期:1986-01-01 00:00:00
abstract::The International HapMap Project produced a genome-wide database of human genetic variation for use in genetic association studies of common diseases. The initial output of these studies has been overwhelming, with over 150 risk loci identified in studies of more than 60 common diseases and traits. These associations ...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.60.061907.093117
更新日期:2009-01-01 00:00:00
abstract::It is now well recognized that the atherosclerotic plaques responsible for thrombus formation are not necessarily those that impinge most on the lumen of the vessel. Nevertheless, clinical investigations for atherosclerosis still focus on quantifying the degree of stenosis caused by plaques. Many of the features assoc...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev-med-041709-133809
更新日期:2011-01-01 00:00:00
abstract::A viral reservoir is a cell type or anatomical site in association with which a replication-competent form of the virus accumulates and persists with more stable kinetic properties than the main pool of actively replicating virus. This article reviews several cell types and anatomical sites proposed as potential reser...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.53.082901.104024
更新日期:2002-01-01 00:00:00
abstract::Diastolic dysfunction is an important cause of the clinical syndrome of congestive heart failure. Traditionally, the syndrome of pulmonary congestion due to the elevation of left heart filling pressure has been attributed to the depressed ability of the heart to eject blood during systole, with a secondary increase in...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.42.020191.002211
更新日期:1991-01-01 00:00:00
abstract::It is clear from the preceding material that bacterial infection is a significant threat to the newborn infant. The most common gram-negative organism causing meningitis in the neonate is E. coli, and the invasive capacity of this organism is correlated with its polysaccharide antigen, K1. Careful studies of supportiv...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.29.020178.001021
更新日期:1978-01-01 00:00:00
abstract::Infantile autism probably has many etiologies. Several specific genetic disorders appear to be associated with the syndrome much more often than would be expected by chance, but these account for only a minority of cases. In the majority of cases, where etiology is still unknown, genetic factors probably also play a r...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.36.020185.002215
更新日期:1985-01-01 00:00:00
abstract::In 2012, a zoonotic coronavirus was identified as the causative agent of Middle East respiratory syndrome and was named MERS coronavirus (MERS-CoV). As of August 11, 2016, the virus has infected 1,791 patients, with a mortality rate of 35.6%. Although MERS-CoV generally causes subclinical or mild disease, infection ca...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev-med-051215-031152
更新日期:2017-01-14 00:00:00
abstract::Clonal populations of cells can be identified by a number of different independent approaches, including analyses of karyotype, gene rearrangements, deletions or point mutations, X-linked polymorphisms, and integration of virus into the genome. Assessment of clonality has yielded valuable and surprising clues to the p...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.42.020191.002423
更新日期:1991-01-01 00:00:00
abstract::Cyclosporine-A is primary therapy for organ transplantation. Its immunosuppressive effect might suggest a therapeutic role in autoimmune diseases, including several idiopathic and secondary glomerular conditions. Various forms of idiopathic nephrotic syndrome, including focal segmental glomerulosclerosis (FSGS), minim...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.50.1.1
更新日期:1999-01-01 00:00:00
abstract::All potent CNS depressant drugs can depress cardiac function in man in a dose-dependent manner. The dose-effect curve is considerably flatter with several drugs (diethyl ether, cyclopropane, fluroxene, isoflurane, and ketamine), presumably from sympathetic nervous-system activation. Potent analgesics and tranquilizers...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.28.020177.000451
更新日期:1977-01-01 00:00:00
abstract::Significant progress has been made in identifying changes in cholinergic, monoaminergic, and peptidergic neurotransmitter systems in the brains of individuals with Alzheimer's disease. Moreover, neurobiological approaches are beginning to reveal the relationships between these neurotransmitter abnormalities and histol...
journal_title:Annual review of medicine
pub_type: 杂志文章
doi:10.1146/annurev.me.36.020185.002025
更新日期:1985-01-01 00:00:00
abstract::Acquired immunodeficiency syndrome indicates opportunistic infection or unusual malignancy associated with a marked deficiency of cell mediated immunity in the absence of any other cause of the immune defect. This review examines epidemiology, virology, and immunology associated with this disorder. The syndrome appear...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.36.020185.002553
更新日期:1985-01-01 00:00:00
abstract::Proteinuric chronic kidney disease (CKD), once a rare affliction believed to be mainly caused by genetic mutations, has become a global pandemic that severely diminishes the quality of life for millions. Despite the changing face of CKD, treatment options and resources remain woefully antiquated and have failed to arr...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev-med-050311-163340
更新日期:2013-01-01 00:00:00
abstract::MicroRNAs (miRNAs) are small, noncoding RNAs with important functions in development, cell differentiation, and regulation of cell cycle and apoptosis. MiRNA expression is deregulated in cancer by a variety of mechanisms including amplification, deletion, mutation, and epigenetic silencing. Several studies have now sh...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.med.59.053006.104707
更新日期:2009-01-01 00:00:00
abstract::1. Patients should be divided preoperatively into low- or high-risk categories, depending on their probability of developing postoperative pulmonary complications. The evaluation should include spirometry as well as an assessment of the previously defined risk factors. 2. Patients in a low-risk category need only inst...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.28.020177.001235
更新日期:1977-01-01 00:00:00
abstract::Brain imaging is increasingly applied in psychiatry, both for clinical evaluation and as a research tool. Computerized tomography (CT) and magnetic resonance imaging (MRI) have documented that structural brain abnormalities occur in some types of psychiatric patients, particularly those who suffer from schizophrenia. ...
journal_title:Annual review of medicine
pub_type: 杂志文章,评审
doi:10.1146/annurev.me.39.020188.002003
更新日期:1988-01-01 00:00:00