abstract：:Many effective treatments for scleroderma have emerged in recent years, including bosentan, an endothelin receptor antagonist, and epoprostenol, a prostacyclin, both of which target vasoconstriction. Cyclophosphamide may soon be proven effective against interstitial lung disease. ...

journal_title：Cleveland Clinic journal of medicine

authors： Korn JH

更新日期：2003-11-01 00:00:00

abstract：:Complications of chronic gastroesophageal reflux disease (GERD) run the gamut from erosive esophagitis to esophageal cancer, but all are linked to repeated exposure of the esophagus to caustic gastric and duodenal acid. Progression from one complication to another is not clearly established across the GERD continuum, ...

journal_title：Cleveland Clinic journal of medicine

authors： Fennerty MB

更新日期：2003-11-01 00:00:00

abstract：:Obsessive-compulsive disorder (OCD) is the fourth most common psychiatric disorder. Yet patients often avoid seeking help because they are ashamed. Diagnosis is difficult, but familiarity with the nature of OCD and its current management helps primary care physicians identify patients with OCD and make informed judgme...

journal_title：Cleveland Clinic journal of medicine

authors： El-Sayegh S,Bea S,Agelopoulos A

更新日期：2003-10-01 00:00:00

abstract：:Evidence is mounting that depression is a risk factor for the development of cardiovascular disease and portends a worse outcome in cardiac patients. Depression can be easily diagnosed and safely treated in cardiac patients, but it is undertreated. ...

journal_title：Cleveland Clinic journal of medicine

authors： Kemp DE,Malhotra S,Franco KN,Tesar G,Bronson DL

更新日期：2003-09-01 00:00:00

abstract：:The threshold for testing for hepatitis C virus (HCV) should be low for persons with any risk factor for HCV infection. Current practice calls for first screening for antibodies to HCV and then testing for HCV RNA in those in whom antibodies are detected. Viral testing can distinguish between active and resolved HCV i...

journal_title：Cleveland Clinic journal of medicine

authors： Carey W

更新日期：2003-09-01 00:00:00

abstract：:Arthroscopy for degenerative conditions of the knee is among the most commonly employed orthopedic procedures, but its effectiveness (like the effectiveness of many surgical operations) has never been proven in prospective trials. Moreover, the precise mechanism by which arthroscopy improves the course of degenerative...

journal_title：Cleveland Clinic journal of medicine

authors： Bernstein J,Quach T

更新日期：2003-05-01 00:00:00

abstract：:Patients with pulmonary arterial hypertension (PAH) may present to internists, rheumatologists, cardiologists, or pulmonologists. This breadth of clinicians who encounter PAH patients, together with the complicated nature of PAH as a disease entity, argues for a shared-care approach to the management of these patients...

journal_title：Cleveland Clinic journal of medicine

authors： Mughal MM,Mandell B,James K,Stelmach K,Minai OA

更新日期：2003-04-01 00:00:00

abstract：:Epidemiologic and experimental data suggest that isoflavones have benefits for preventing and treating some prostate disease. Isoflavone supplements may therefore be an important tool for men concerned about prostate disease, such as those with benign prostatic hypertrophy undergoing watchful waiting or those concerne...

journal_title：Cleveland Clinic journal of medicine

authors： Gaynor ML

更新日期：2003-03-01 00:00:00

abstract：:This paper reviews the clinical presentation of gallstone disease, acalculous cholecystitis, biliary dyskinesia, and gallbladder cancer, as well as how to make best use of current diagnostic and treatment methods, particularly ultrasonography, cholescintigraphy, laparoscopic cholecystectomy, and endoscopic retrograde ...

journal_title：Cleveland Clinic journal of medicine

authors： Vogt DP

更新日期：2002-12-01 00:00:00

abstract：:Much scientific and anecdotal data demonstrate favorable metabolic responses to very-low-carbohydrate diets. We believe that very-low-carbohydrate diets merit further study for weight loss, and that criticisms of these diets lack scientific evidence. ...

journal_title：Cleveland Clinic journal of medicine

authors： Volek JS,Westman EC

更新日期：2002-11-01 00:00:00

abstract：:Preliminary clinical trials suggest that therapeutic hypothermia might improve the outcomes of patients with acute stroke. Definitive trials are under way. ...

journal_title：Cleveland Clinic journal of medicine

authors： Hammer MD,Krieger DW

更新日期：2002-10-01 00:00:00

abstract：:The Women's Health Initiative found that the risks of hormone replacement therapy (HRT) exceeded its benefits in a large group of older postmenopausal women, but did not consider the efficacy of HRT in relieving vasomotor symptoms. Another recent study found that low-dose HRT was as effective as standard-dose HRT whil...

journal_title：Cleveland Clinic journal of medicine

authors： Thacker HL

更新日期：2002-09-01 00:00:00

abstract：:An increasing array of treatments such as immunosuppressive drugs and tumor necrosis factor inhibitors can offer patients with ulcerative colitis and Crohn disease improved relief from symptoms with fewer adverse effects. Several additional drugs have shown promise, including nicotine, antimicrobials, and heparin. ...

journal_title：Cleveland Clinic journal of medicine

authors： Wolf JM,Lashner BA

更新日期：2002-08-01 00:00:00

abstract：:The aromatase inhibitors are established first-line drugs for treating metastatic breast cancer in postmenopausal women, and are gaining acceptance as adjuvant treatment as well. ...

journal_title：Cleveland Clinic journal of medicine

authors： Hill J,Moore H

更新日期：2002-07-01 00:00:00

abstract：:Cancer patients and their families often ask their primary care physicians if a new treatment reported in the news can help them. Physicians familiar with the long and complicated process of oncologic clinical trials are in the best position to assess the potential for clinical benefit from a new antineoplastic therap...

journal_title：Cleveland Clinic journal of medicine

authors： Markman M

更新日期：2002-05-01 00:00:00

abstract：:Many drugs can injure the kidneys, but they cause renal injury via only a few common mechanisms. Many patients who develop renal injury after drug exposure have identifiable risk factors that could be modified or that should preclude the use of these drugs in the first place. ...

journal_title：Cleveland Clinic journal of medicine

authors： Guo X,Nzerue C

更新日期：2002-04-01 00:00:00

abstract：:Finding the optimal combination of drugs in the correct dosages, which requires careful monitoring over time, is key to slowing the disease process and prolonging life. For most patients, treating heart failure involves correcting underlying left ventricular dysfunction, thereby slowing the remodeling process. ...

journal_title：Cleveland Clinic journal of medicine

authors： Basile JN

更新日期：2002-02-01 00:00:00

abstract：:Special problems of Asian patients have considerable impact on diagnosis and treatment, and the number of persons of Asian ancestry seen in primary care in the United States is increasing. Knowledge of how to provide optimal care despite language barriers, low socioeconomic status, different health beliefs and practic...

journal_title：Cleveland Clinic journal of medicine

authors： Jin XW,Slomka J,Blixen CE

更新日期：2002-01-01 00:00:00

abstract：:Therapy with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) has long been the cornerstone of pharmacologic management of patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Many patients with OA or RA, however, are at increased risk of developing clinically significant adverse events associate...

journal_title：Cleveland Clinic journal of medicine

authors： Schnitzer TJ,Hochberg MC

更新日期：2002-01-01 00:00:00

abstract：:Most patients find some relief with current agents, even though a poor understanding of the causes of chronic primary headache limits prophylaxis and treatment. The author reviews current preventive and treatment strategies for migraine, chronic tension headache, cluster headache, and substance withdrawal headache. ...

journal_title：Cleveland Clinic journal of medicine

authors： Solomon GD

更新日期：2001-11-01 00:00:00

abstract：:Newer theories suggest that patients with fibromyalgia have a biologic predisposition to perceiving pain with more sensitivity than people without fibromyalgia. Several biologic triggers are implicated as possibly initiating or worsening the symptoms of fibromyalgia. Treatments to manage pain, help with sleep, and, wh...

journal_title：Cleveland Clinic journal of medicine

authors： Clauw DJ

更新日期：2001-10-01 00:00:00

abstract：:Cholesterol is a fat-like substance that is in our blood. Our bodies naturally produce some cholesterol. The other portion comes from animal products such as meat, eggs, butter, cheese, and whole milk. Foods from plants do no contain cholesterol. When you have a high level of cholesterol in your blood, it builds up in...

journal_title：Cleveland Clinic journal of medicine

authors：

更新日期：2001-07-01 00:00:00

abstract：:Observational studies indicate that aspirin may counteract the beneficial effect of angiotensin-converting enzyme (ACE) inhibitors, but the data are not yet sufficient for making firm recommendations. We review the available data and offer tentative conclusions. ...

journal_title：Cleveland Clinic journal of medicine

authors： Peterson JG,Lauer MS

更新日期：2001-06-01 00:00:00

abstract：:You can find evidence-based answers to clinical questions quickly by searching online medical databases. The key is to be selective, on the basis of the type of information you need. Online textbooks, consensus guidelines systematic reviews, and MEDLINE are all available. ...

journal_title：Cleveland Clinic journal of medicine

authors： Mehta N,Jain A

更新日期：2001-04-01 00:00:00

abstract：:The most important component of the treatment of irritable bowel syndrome (IBS) is to establish a therapeutic physician-patient relationship, coupled with patient education. We describe a stepwise approach to management, including judicious use of invasive tests, and setting realistic treatment goals that address the ...

journal_title：Cleveland Clinic journal of medicine

authors： Shen B,Soffer E

更新日期：2001-03-01 00:00:00

abstract：:Both diabetic and prediabetic patients have abnormal vascular reactivity and should be considered to have occult cardiovascular disease. Angiotensin-converting-enzyme (ACE) inhibitors are particularly beneficial in diabetes because they reduce the incidence of both cardiovascular events and diabetes-related complicati...

journal_title：Cleveland Clinic journal of medicine

authors： Hsueh WA

更新日期：2000-11-01 00:00:00

abstract：:Obesity is epidemic and dangerous. Weight loss is difficult but worth the effort. Although new weight-loss drugs are available, there are no magic bullets: to lose weight and keep it off, people must eat less and exercise more. This article presents a practical approach on how physicians can help their patients lose w...

journal_title：Cleveland Clinic journal of medicine

authors： Weiss D

更新日期：2000-10-01 00:00:00

abstract：:Antibiotics can be effective against acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease, but with bacterial resistance to multiple antibiotics increasing worldwide, appropriate antibiotic selection is critical. Categorizing patients with acute exacerbations according to age, number of ...

journal_title：Cleveland Clinic journal of medicine

authors： Adams SG,Anzueto A

更新日期：2000-09-01 00:00:00

abstract：:Too often, physicians, patients, and families make end-of-life care decisions despite poor physician-patient communication and misunderstanding by the patient and family about the effectiveness of cardiopulmonary resuscitation. We describe an approach to resolving conflict and reaching consensus on end-of-life care. T...

journal_title：Cleveland Clinic journal of medicine

authors： Agich GJ,Arroliga AC

更新日期：2000-06-01 00:00:00

abstract：:Early restoration of patency of the infarct-related artery is a universally accepted goal in the treatment of acute myocardial infarction. However, even with the most successful fibrinolytic regimen only approximately 50% of patients achieve restoration of normal flow at 90 minutes. "Rescue" angioplasty, the mechanica...

journal_title：Cleveland Clinic journal of medicine

authors： Mukherjee D,Ellis SG

更新日期：2000-05-01 00:00:00

abstract：:Pancreas transplantation can improve quality of life for patients with type 1 diabetes by eliminating hypoglycemic and hyperglycemic episodes, the need for insulin injections, frequent self-monitoring of blood glucose levels, and dietary restrictions. Increasing evidence suggests that it may slow the progression of lo...

journal_title：Cleveland Clinic journal of medicine

authors： Mayes JT,Dennis VW,Hoogwerf BJ

更新日期：2000-04-01 00:00:00

abstract：:The Internet can be useful for physicians, but beginning users are apt to encounter two problems: too much irrelevant information, and difficulty finding the desired information. This paper offers some practical tips that can prevent frustration and wasted time when searching for medical information on the Internet. ...

journal_title：Cleveland Clinic journal of medicine

authors： Mehta N

更新日期：1999-10-01 00:00:00

abstract：:Although most patients with emphysema are managed medically, a small subset of severely disabled patients may become candidates for surgery. This paper discusses for the internist who works with emphysema patients the risks, benefits, patient selection criteria, and outcome data for three procedures in current use: bu...

journal_title：Cleveland Clinic journal of medicine

authors： Dasgupta A,Maurer J

更新日期：1999-07-01 00:00:00

abstract：:By incorporating additional data, clinicians can transform the exercise stress test from a poor diagnostic test to a good prognostic one. These additional data include indices of how the patient's heart rate and blood pressure respond to exercise. Computerized measures of electrocardiographic ST-segment changes that a...

journal_title：Cleveland Clinic journal of medicine

authors： Lauer MS

更新日期：1999-05-01 00:00:00

abstract：:Anticonvulsant hypersensitivity syndrome, a potentially fatal but rare reaction, manifests as rash, fever, tender lymphadenopathy, hepatitis, and eosinophilia. To manage hypersensitivity syndrome successfully, one must recognize the symptoms early, stop the offending drug immediately, and substitute a safe, alternativ...

journal_title：Cleveland Clinic journal of medicine

authors： Hamer HM,Morris HH

更新日期：1999-04-01 00:00:00

abstract：:When a patient reports constipation, a careful history and physical examination may identify the underlying cause. In many patients, though, no underlying cause is identified. Empiric treatment with exercise, hydration, fiber supplementation, and mild laxatives is often effective. If constipation does not resolve with...

journal_title：Cleveland Clinic journal of medicine

authors： Soffer EE

更新日期：1999-01-01 00:00:00

abstract：:Heart failure is the most important public health problem in cardiovascular medicine, and is increasing in both prevalence and expense. Programs that use an interdisciplinary team to improve outpatient treatment and prevent hospitalizations will help improve care and control costs. But the most important long-term str...

journal_title：Cleveland Clinic journal of medicine

authors： Starling RC

更新日期：1998-07-01 00:00:00

abstract：:Often patients with immune hemolytic anemias present with symptoms that are common in anemia of any cause. In the different types of immune hemolytic anemia, red blood cells are destroyed by processes mediated by antibodies. This article reviews the pathophysiology, diagnosis, and treatment of this group of diseases. ...

journal_title：Cleveland Clinic journal of medicine

authors： Domen RE

更新日期：1998-02-01 00:00:00

abstract：:Although stress-related mucosal damage is common (and potentially serious) in critically ill patients, the risk of clinically significant gastrointestinal bleeding appears to be confined to patients with certain factors: mechanical ventilation, coagulopathy, multiple trauma, increased intracranial pressure, and multio...

journal_title：Cleveland Clinic journal of medicine

authors： Bobek MB,Arroliga AC

更新日期：1997-11-01 00:00:00

abstract：:Patients with panic disorder often believe they are suffering a myocardial infarction or another life-threatening illness. The history and physical examination and a few tests usually suffice to diagnose this disorder, which is treatable with behavioral therapy, antidepressants, and benzodiazepines. ...

journal_title：Cleveland Clinic journal of medicine

authors： Muzina DJ,Malone DA

更新日期：1997-09-01 00:00:00