Colon Cancer, Adenocarcinoma

Invasive colorectal cancer is a preventable disease. Early detection through widely applied screening programs is the most important factor in the recent decline of colorectal cancer in developed countries. Full implementation of the screening guidelines can cut mortality rate from colorectal cancer in the United States by an estimated additional 50%; even greater reductions are estimated for countries where screening tests may not be widely available at present. New and more comprehensive screening strategies are also needed.

Fundamental advances in understanding the biology and genetics of colorectal cancer are taking place. This knowledge is slowly making its way into the clinic and being employed to better stratify individual risks of developing colorectal cancer, discover better screening methodologies, allow for better prognostication, and improve one’s ability to predict benefit from new anticancer therapies.

In the past 10 years, an unprecedented advance in systemic therapy for colorectal cancer has dramatically improved outcome for patients with metastatic disease. Until the mid 1990s, the only approved agent for colorectal cancer was 5-fluorouracil. New agents that became available in the past 10 years include cytotoxic agents such as irinotecan and oxaliplatin, oral fluoropyrimidines (capecitabine and tegafur), and biologic agents such as bevacizumab, cetuximab, and panitumumab.

Though surgery remains the definitive treatment modality, these new agents will likely translate into improved cure rates for patients with early stage disease (stage II and III) and prolonged survival for those with stage IV disease. Further advances are likely to come from the development of new targeted agents and integration of those agents with other modalities such as surgery, radiation therapy, and liver-directed therapies.

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Cholelithiasis

Gallstones are concretions that form in the biliary tract, usually in the gallbladder.

Their development is insidious, and they may remain asymptomatic for decades. Migration of gallstones may lead to occlusion of the biliary and pancreatic ducts, causing pain (biliary colic) and producing acute complications, such as acute cholecystitis, ascending cholangitis, or acute pancreatitis. Chronic gallstone disease may lead to fibrosis and loss of function of the gallbladder and predisposes to gallbladder cancer. Excision of the gallbladder (cholecystectomy) to cure gallstone disease is among the most frequently performed abdominal surgical procedures.

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Case Review in Adolescent Acne: Multifactorial Considerations to Optimizing Management

The management of pediatric and adolescent acne requires multifaceted considerations revolving around the patient, parents, and appropriate treatment. The following case report represents a typical scenario exemplifying the key role of the dermatology nurse practitioner in optimizing successful acne management outcomes.

Acne vulgaris is common among adolescents; most, if not all, personally experience its impact or are directly involved with individuals who have the condition. Effects of acne may extend beyond the physical lesions; psychological and social implications associated with the condition can be equally severe. The management of acne is multifactorial and, fortunately, a number of therapeutic options are available. Nevertheless, careful consideration must be made, particularly among adolescents, to properly align appropriate treatment to optimize outcomes.

The role of nurse practitioners (NP) is particularly important, as the need for continual patient education, motivation, and followup can sometimes lapse in a typically busy clinical practice. Addressing patient concerns, evaluating treatment efficacy and tolerability, and monitoring adherence to treatment are critical components of acne management. The following case study represents a characteristic scenario where all of the aforementioned components play a considerable role in the NP's contributions to successful management.

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Benign Childhood Epilepsy

Epilepsy is defined as 2 or more unprovoked seizures. The various types of epilepsy differ in many aspects, including (1) age of onset, (2) semiology, (3) EEG findings, and (4) outcome. In 1987, Freeman et al reported that most children with generalized tonic-clonic seizures have a benign developmental disorder that reduces their seizure threshold and will be outgrown. This disorder has been termed benign childhood epilepsy and is thought to be secondary to CNS immaturity.

In this article the term benign epilepsy is used to refer to a group of pediatric epileptic disorders in which remission and lack of significant neurologic sequelae are expected in the vast majority of patients. These disorders are idiopathic, occur in otherwise healthy children, and have (with rare exceptions) a strong genetic component. They include both generalized epilepsies and partial epilepsies. These epilepsies are presented according to the age of onset, starting from the neonatal period.

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Autoimmune Hepatitis

During the past 30 years, remarkable advances have occurred in the understanding of the epidemiology, natural history, and pathogenesis of chronic hepatitis. The development of viral serologic tests has permitted hepatologists to differentiate chronic viral hepatitis from other types of chronic liver disease, including autoimmune hepatitis. Autoimmune hepatitis is now accepted as a chronic disease of unknown cause, characterized by continuing hepatocellular inflammation and necrosis, which tends to progress to cirrhosis. Immune serum markers frequently are present, and the disease often is associated with other autoimmune diseases. Autoimmune hepatitis cannot be explained on the basis of chronic viral infection, alcohol consumption, or exposure to hepatotoxic medications or chemicals.

In 1950, Waldenstrom first described a form of chronic hepatitis in young women. This condition was characterized by cirrhosis, plasma cell infiltration of the liver, and marked hypergammaglobulinemia. Kunkel, in 1950, and Bearn, in 1956, described other features of the disease, including hepatosplenomegaly, jaundice, acne, hirsutism, cushingoid facies, pigmented abdominal striae, obesity, arthritis, and amenorrhea. In 1955, Joske first reported the association of the lupus erythematosus (LE) cell phenomenon in active chronic viral hepatitis. This association led to the introduction of the term lupoid hepatitis by Mackay and associates in 1956. Researchers currently know that no direct link exists between systemic lupus erythematosus (SLE) syndrome and autoimmune hepatitis; thus, lupoid hepatitis is not associated with SLE.

Autoimmune hepatitis now is recognized as a multisystem disorder that can occur in males and females of all ages. This condition can coexist with other liver diseases (eg, chronic viral hepatitis) and also may be triggered by certain viral infections (eg, hepatitis A) and chemicals (eg, minocycline).

The histopathologic description of autoimmune hepatitis has undergone several revisions over the years. In 1992, an international panel codified the diagnostic criteria. The term autoimmune hepatitis was selected to replace terms such as autoimmune liver disease and autoimmune chronic active hepatitis. The panel waived the requirement of 6 months of disease activity to establish chronicity, expanded the histologic spectrum to include lobular hepatitis, and reaffirmed the nonviral nature of the disease. The panel also designated incompatible histologic features, such as cholestatic histology, the presence of bile duct injury, and ductopenia.

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Atherosclerosis

Atherosclerosis is a disease of large and medium-sized muscular arteries and is characterized by endothelial dysfunction, vascular inflammation, and the buildup of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall. This buildup results in plaque formation, vascular remodeling, acute and chronic luminal obstruction, abnormalities of blood flow, and diminished oxygen supply to target organs.

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Assessment of Adolescents for Depression in the Pediatric Primary Care Setting

Lifetime depression rates rise to 14% for adolescents ages 15 to 18 from an average of less than 3% in childhood (Lewinsohn, Rohde, & Seeley, 1998). At any given point in time, 3% to 8% of adolescents face major depressive disorder (MDD), making it more common than asthma and most other chronic medical problems of this age group (Jackson, & Lurie, 2006). In addition, depressed youth are at risk for many co-morbidities, including conduct problems, personality disorders, substance abuse, obesity, interpersonal conflict, unfulfilling social relationships, and educational and occupational underachievement (Zalsman, Brent, & Weersing, 2006).

Adolescents visit their primary care provider an average of once to twice a year, and youth who have mental health issues are more likely than their peers to be high users of primary care services (Stein, Zitner, & Jensen, 2006). It is common for depressed adolescents to experience unexplained physical symptoms, such as headaches, stomachaches, and fatigue, and present to their primary care provider with recurrent somatic complaints that cannot be explained medically (Jackson & Lurie, 2006). This makes the primary care setting an appropriate venue for screening and identifying depression, initial management of depression, and a referral source for other mental health and psychiatric services. This article will review the current research regarding the screening, assessment, diagnosis, and treatment of adolescent depression in the primary care setting, early treatment options, and referral criteria.

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Ascites

The word ascites is of Greek origin (askos) and means bag or sac. Ascites describes the condition of pathologic fluid collection within the abdominal cavity. Healthy men have little or no intraperitoneal fluid, but women may normally have as much as 20 mL, depending on the phase of their menstrual cycle. This article focuses only on ascites associated with cirrhosis.

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Ascariasis

Ascariasis is the most common helminthic infection, with an estimated worldwide prevalence of 25% (0.8-1.22 billion people). Usually asymptomatic, ascariasis is most prevalent in children of tropical and developing countries, where they are perpetuated by contamination of soil by human feces or use of untreated feces as fertilizer. (For more information on ascariasis in children. Symptomatic ascariasis may manifest as growth retardation, pneumonitis, intestinal obstruction, or hepatobiliary and pancreatic injury. In developing countries, ascariasis may exist as a zoonotic infection in pigs, but little evidence has shown transmission of porcine ascariasis to humans.

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Angina Pectoris

ANGINA PECTORIS is a clinical syndrome due to transient myocardial ischemia caused by an imbalance between myocardial blood supply and oxygen demand. Myocardial oxygen demand actually exceeds oxygen supply. It comes from the latin words: "Angere" meaning "to choke" and "Pectus" meaning "chest".

Angina Pectoris has a wide range of clinical symptoms but the most common complaint described by patients is a squeezing, central, substernal chest pressure or tightening most often radiating to the arms, shoulders or jaws.

The most common clinical sign observed in patients is the clutching of the patient's chest or what we call as Levine Sign.

Amebiasis

Amebiasis is caused by Entamoeba histolytica, a protozoan found worldwide. Although most cases of amebiasis are asymptomatic, dysentery and invasive extraintestinal disease can occur. Amebic liver abscess is the most common manifestation of invasive amebiasis, but other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, and cutaneous sites. In developed countries, amebiasis primarily affects migrants from and travelers to endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals.

E histolytica is transmitted via ingestion of the cystic form (infective stage) of the protozoa. Viable in the environment for weeks to months, cysts can be found in fecally contaminated soil, fertilizer, or water or on the contaminated hands of food handlers. Fecal-oral transmission can also occur in the setting of anal sexual practices or direct rectal inoculation through colonic irrigation devices. Excystation then occurs in the terminal ileum or colon, resulting in trophozoites (invasive form). The trophozoites can penetrate and invade the colonic mucosal barrier, leading to tissue destruction, secretory bloody diarrhea, and colitis resembling inflammatory bowel disease. In addition, the trophozoites can spread hematogenously via the portal circulation to the liver or even to more distant organs.

Amebic infection was first described by Fedor Losch in 1875 in St. Petersburg, Russia. In 1890, Sir William Osler reported the first North American case of amebiasis, when he observed amebae in stool and abscess fluid from a physician who previously resided in Panama. The species name E histolytica was first coined by Fritz Schaudin in 1903. In 1913, in the Philippines, Walker and Sellards documented the cyst as the infective form of E histolytica. The life cycle was then established by Dobell in 1925.

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Acne Vulgaris

 


Acne vulgaris is a common skin disease that affects 60-70% of Americans at some time during their lives. Twenty percent will have severe acne, which results in permanent physical and mental scarring. Acne vulgaris is American's most common diseas and is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back.

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