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- Volume 42, 1991
Annual Review of Medicine - Volume 42, 1991
Volume 42, 1991
- Review Articles
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Stunned and Hibernating Myocardium
Vol. 42 (1991), pp. 1–8More LessMyocardium that is not functioning may be dead (infarct or scar), viable but stunned (postischemic ventricular dysfunction), viable but hibernating (chronic low flow state), or acutely ischemic. Stunned myocardium has clearly been documented (a) in experimental studies of brief coronary artery occlusion followed by reperfusion, and (b) in myocardial infarct models in which early reperfusion salvages viable tissue. Recent clinical studies have confirmed the existence of stunned myocardium in humans. Evidence supporting the concept of hibernating myocardium comes from clinical studies in which patients with chronic low flow ischemia exhibit improvement in left ventricular function (sometimes immediately) following revascularization.
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The Diagnosis and Treatment of Prostate Cancer
Vol. 42 (1991), pp. 9–15More LessProstate cancer is the most common cancer among American men and is the third leading cause of cancer death in the United States. Over the past few years, significant advances (e.g. improved prostatic ultrasonography and the discovery of serum prostate-specific antigen) have made it possible to detect prostate cancer at an early stage. In addition, refinements in the treatment both of localized disease (by nerve-sparing radical prostatectomy) and of advanced disease (by novel forms of hormonal therapy) have improved the outlook and quality of life for men with prostate cancer.
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Growth Factors and Cytokines in Bone Cell Metabolism
Vol. 42 (1991), pp. 17–24More LessGrowth factors regulate the growth and differentiated function of cells. Skeletal cells synthesize fibroblast growth factor, platelet-derived growth factor, insulin-like growth factor, transforming growth factor β, and additional cytokines. Some of the growth factors produced by bone cells primarily stimulate bone cell replication, whereas others also affect the differentiated function of the osteoblast. Skeletal growth factors also may play a role in the pathogenesis and therapy of metabolic bone disease.
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Cell-Mediated Immunity in Glomerular Disease
Vol. 42 (1991), pp. 25–33More LessOur understanding of the role of the immune system in modulating glomerular injury continues to evolve. The participation of antibody, complement, and neutrophils alone cannot completely explain many aspects of the pathways of experimental and human glomerulonephritis. The elements of the immune system that mediate cellular immunity, T lymphocytes and monocytes, also appear to be important effectors of glomerulonephritis. An understanding of the role of cell-mediated immunity in renal disease is essential in designing therapies to interrupt immunologically sustained glomerular damage.
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Initiating Events of Acute Coronary Arterial Occlusion
Vol. 42 (1991), pp. 35–45More LessAcute 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 disruption is determined by the rate and size of thrombus formation. Partially occlusive thrombi produce unstable angina; completely occlusive thrombi produce myocardial infarction; clot embolization can produce sudden death. The localized thrombus lyses within days. The healing process, however, is frequently accompanied by rapid local progression of the size of the atheroma at the site ofintimal disruption. With healing of the intimal surface, the patient's clinical status stabilizes. Thus coronary disease is a cyclical phenomenon driven by cellular events within the atheroma and by the interaction of the atheroma with circulating blood elements.
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Latency of the Human Herpesviruses
Vol. 42 (1991), pp. 61–67More LessThe herpesviruses are ubiquitous pathogens that establish latent infections and can reactivate to produce recurrent disease. The fact that clinical recurrences are infrequent in most healthy individuals indicates that potent regulatory mechanisms must exist to ensure viral latency. Rapid progress is being made toward understanding the pathogenesis of latency and reactivation and is the subject of this review.
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Antiviral Therapy of HIV Infection
Vol. 42 (1991), pp. 69–90More LessIn only five years, antiretroviral therapy progressed from promising in vitro results with a newly recognized virus (HIV) to the standard practice of primary care applicable to hundreds of thousands of patients. With AZT (zidovudine) we have learned that we can prolong survival, reduce morbidity, and delay the progression of asymptomatic infection to disease. We have also learned that doses of AZT lower than those used in the original studies are as effective but less toxic. Additional compounds are under evaluation and more are needed to provide regimens, probably as combinations of drugs, that can be administered chronically with more efficacy, less toxicity, and diminished likelihood to select for drug-resistant virus.
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Pathophysiology of Hashimoto's Thyroiditis and Hypothyroidism
Vol. 42 (1991), pp. 91–96More LessAutoimmune Hashimoto's thyroiditis, the most common endocrine disorder, is primarily a subclinical disease. Whether or not subclinical hypothyroidism should be treated remains controversial. Recent advances have been made in understanding the molecular nature of the antigens that are the target of the immune system in Hashimoto's thyroiditis. The “microsomal antigen” is now recognized to be thyroid peroxidase.
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Genetics of Major Psychiatric Disorders
Vol. 42 (1991), pp. 151–158More LessWe review recent studies on the inheritance of affective disorders and schizophrenia. Both groups of diseases have substantial genetic and nongenetic components, and their inheritance does not fit simple Mendelian models. Linkage studies implicate the Xp28 and 11p15 regions as potential disease loci in affective illness, and the 5q11-q13 region in schizophrenia. These conclusions are highly controversial, however, and must be viewed as extremely tentative.
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Epidemiology and Outcome of Child Abuse
Vol. 42 (1991), pp. 217–224More LessMaltreatment in childhood can result in problems that eventually present to the internist. The common somatic, psychosomatic, and psychiatric presentations in adults are reviewed. Mental health referral is often appropriate. When a case of child abuse is reported to the physician by a patient, the physician's legal responsibilities and protections are summarized.
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Resistance of Viruses to Antiviral Drugs
Vol. 42 (1991), pp. 247–259More LessIn recent years, substantial advances in antiviral therapy have been made; however, in the immunocompromised host, antiviral drug resistance is becoming an issue of increasing clinical importance. Understanding the mechanism of action of antiviral agents, especially those used to treat herpesvirus infections, may enable us to design new therapeutic agents and better treatment regimens to deal with antiviral drug resistance.
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Unusual Forms of Insulin Resistance
Vol. 42 (1991), pp. 373–379More LessInsulin resistance is an important feature in the pathogenesis of noninsulin-dependent diabetes mellitus. Some rare patients have syndromes associated with a severe form of insulin resistance, usually involving acanthosis nigricans and, in premenopausal females, hyperandrogenism. This review discusses two of the causes of insulin resistance: mutations in the insulin receptor gene and autoantibodies directed against the insulin receptor.
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Hypothalamic-Pituitary-Adrenal Axis in Psychiatric Disorders
Vol. 42 (1991), pp. 519–531More LessHypothalamic-pituitary-adrenocortical (HPA) physiology is complex, and dysregulation of this neuroendocrine axis cannot be characterized adequately by isolated or unintegrated measures. Repeated assessments over time, involving multiple measures of axis activity (basal and dynamic tests), have furthered our understanding of the character of the HPA abnormalities reported in various psychiatric disorders. We review the nature and clinical significance of these HPA disturbances in the affective disorders and other psychiatric illnesses.
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Pathophysiology and Management of Hypertension in Diabetes
Vol. 42 (1991), pp. 533–548More LessArterial hypertension is more common in diabetes mellitus than in nondiabetic subjects, and many metabolic and hemodynamic features of diabetes mellitus contribute to the etiology of hypertension. Control of hypertension in diabetes mellitus is extremely important as high blood pressure accelerates both macrovascular and microvascular complications of this disease. Most classes of antihypertensive agents are effective in blood pressure control in diabetes mellitus, so the choice of antihypertensive therapy is based on the differences in adverse effects of these agents on metabolic control and other cardiovascular risks.
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Parenteral and Enteral Nutrition
Vol. 42 (1991), pp. 549–565More LessStress and starvation, especially when complicated by sepsis, will give rise to a rapid erosion of the cellular mass, which significantly affects morbidity and mortality. The best clinical evaluation of the nutritional state is obtained from the medical history and the physical examination. In the patient who cannot eat a balanced diet, specialized nutritional support, in the form of either enteral or parenteral nutrition, is required to prevent malnutrition in the normally nourished, or to correct the nutritional state in the malnourished.
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Growth Factors and Wound Healing: Platelet-Derived Growth Factor as a Model Cytokine
Vol. 42 (1991), pp. 567–584More LessCytokines such as the platelet-derived growth factor (PDGF) have the potential to initiate and mediate many if not all of the complex biological responses associated with inflammation and wound healing. PDGF is a potent cytokine that may be used to illustrate the diverse activities initiated by the interactions of PDGF with its receptor relevant to the inflammatory response and subsequent wound repair. Because PDGF can chemotactically attract, activate, and initiate new expression of quiescent genes (e.g. the small inducible gene, SIG, family), it fulfills the predictions anticipated of a candidate wound hormone. PDGF added directly to experimental wounds in animals enhances wound healing, which suggests that cytokines will become increasingly important as therapeutic agents in the treatment of wounds in humans.
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Previous Volumes
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Volume 75 (2024)
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Volume 74 (2023)
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Volume 73 (2022)
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Volume 72 (2021)
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Volume 71 (2020)
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Volume 70 (2019)
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Volume 69 (2018)
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Volume 68 (2017)
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Volume 67 (2016)
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Volume 66 (2015)
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Volume 65 (2014)
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Volume 64 (2013)
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Volume 63 (2012)
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Volume 62 (2011)
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Volume 61 (2010)
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Volume 60 (2009)
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Volume 59 (2008)
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Volume 58 (2007)
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Volume 57 (2006)
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Volume 56 (2005)
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Volume 55 (2004)
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Volume 54 (2003)
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Volume 53 (2002)
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Volume 52 (2001)
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Volume 51 (2000)
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Volume 50 (1999)
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Volume 49 (1998)
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Volume 48 (1997)
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Volume 47 (1996)
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Volume 46 (1995)
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Volume 45 (1994)
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Volume 44 (1993)
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Volume 43 (1992)
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Volume 42 (1991)
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Volume 41 (1990)
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Volume 40 (1989)
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Volume 39 (1988)
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Volume 38 (1987)
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Volume 37 (1986)
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Volume 36 (1985)
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Volume 35 (1984)
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Volume 34 (1983)
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Volume 33 (1982)
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Volume 32 (1981)
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Volume 31 (1980)
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Volume 30 (1979)
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Volume 29 (1978)
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Volume 28 (1977)
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Volume 27 (1976)
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Volume 26 (1975)
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Volume 25 (1974)
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Volume 24 (1973)
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Volume 23 (1972)
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Volume 22 (1971)
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Volume 21 (1970)
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Volume 20 (1969)
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Volume 19 (1968)
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Volume 18 (1967)
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Volume 17 (1966)
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Volume 16 (1965)
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Volume 15 (1964)
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Volume 14 (1963)
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Volume 13 (1962)
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Volume 12 (1961)
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Volume 11 (1960)
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Volume 10 (1959)
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Volume 9 (1958)
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Volume 8 (1957)
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Volume 7 (1956)
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Volume 6 (1955)
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Volume 5 (1954)
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Volume 4 (1953)
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Volume 3 (1952)
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Volume 2 (1951)
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Volume 1 (1950)
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Volume 0 (1932)