Coronary heart disease is the most common cause of death in the general population and in patients with ESRD. The principles of cardiovascular risk assessment and management apply to both populations. Advances in noninvasive coronary artery imaging have improved early detection of subclinical disease. The goals of medical management of coronary disease are to modify the natural history of disease and to improve the symptoms of angina. Coronary revascularization poses a different risk and benefit equation in the ESRD population. In stable ESRD with multivessel coronary artery disease, coronary bypass surgery, despite the upfront risks of stroke, myocardial infarction, and chest wound infection, seems to be a favored approach. In patients with ESRD and acute coronary syndromes, percutaneous coronary intervention on the target vessel has been associated with the most favorable outcomes. This article explores the clinical issues with respect to coronary artery disease in patients with ESRD.
http://cjasn.asnjournals.org/content/2/3/611.abstract
Colonic Mass, A 14-year-old girl, with a history of stage 3 Wilms tumor was treated at 1 year of age with chemotherapy and flank radiation. Ten years later, she developed radiation-induced chest-wall osteosarcoma. Recent computer tomography surveillance found multiple hypodense hepatic lesions. Subsequent excision biopsy of a liver nodule demonstrated adenocarcinoma without clear origin. This finding prompted referral for endoscopy. Colonoscopy revealed 2 friable broad-based, polypoid masses partially obstructing the rectal sigmoid junction ( Fig. 1 A). The pathology was consistent with invasive adenocarcinoma arising in tubular adenomas (Fig. 1B, 1B, low power; C, high power). In addition, the patient had a 2-cm flat adenoma in the ascending colon, and histology confirmed tubular adenoma with high-grade dysplasia. Patient responded to chemotherapy with leucovorin, fluorouracil, oxaliplatin, and bevacizumab and awaits surgical resection.
Figure 1 Image Tools
This case once again alerts pediatric gastroenterologists that colorectal cancer can occur in children under unique circumstances circumstances(1). Currently, the etiology of the multiple malignancies is unclear. The literature demonstrates that there is an association between Wilms tumor and subsequent colonic adenocarcinomas (2 4). It is conceivable that previous chemoradiotherapy could also contribute to the development of her colorectal cancer. Microsatellite instability testing is planned to test other genetic susceptibilities (5,6). –
http://journals.lww.com/jpgn/Fulltext/2011/03000/Colonic_Mass,_Colorectal_Adenocarcinoma.1.as px
Contemporary Reviews in Cardiovascular Medicine The Progression of Hypertensive Heart Disease
Hypertension remains a major public health problem associated with considerable morbidity and mortality. Hypertensive heart disease is a constellation of abnormalities that includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical manifestations including arrhythmias and symptomatic heart failure. The classic paradigm of hypertensive heart disease is that the left ventricular (LV) wall thickens in response to elevated blood pressure as a compensatory mechanism to minimize wall stress. Subsequently, after a series of poorly characterized events (“transition to failure”), the left ventricle dilates, and the LV ejection fraction (EF) declines (defined herein as “dilated cardiac failure”). Conclusion
Hypertensive heart disease encompasses a broad spectrum including asymptomatic LVH (either a concentric or an eccentric pattern) and clinical heart failure (with either a preserved or a reduced LVEF). There is considerable interindividual variability in the progression from hypertension to LVH in both the magnitude of the increase in LV mass and its geometric pattern (ventricular dilation or wall thickening). Some of these differences are likely attributable to differences in the pressure load (which may not be discernable by office measurements of blood pressure), concomitant medical conditions, and the underlying neurohormonal milieu. However, these differences in LV geometry also suggest the likelihood of operative genetic influences that are only beginning to be uncovered. The classic paradigm of the progression from hypertension to concentric hypertrophy and then dilated cardiac failure has been established in animal models, but recent data have challenged several of its components. First, in animal models of pressure overload, concentric hypertrophy, which normalizes wall stress, is not obligatory to prevent dilated cardiac failure, raising the possibility that targeted therapy of the hypertrophic pathway may be a potential means to prevent hypertensive heart disease. Second, the progression from concentric hypertrophy to dilated cardiac failure in the absence of interval myocardial infarction may not be a common pathway. Third, patients with hypertension may progress directly to dilated cardiac failure in the absence of myocardial infarction or antecedent concentric hypertrophy. The frequency of this occurrence and its triggers remain to be defined but are important to uncover in order to determine why some hypertensive subjects develop LV dilation and others concentric LVH. Finally, the mechanisms for the progression from asymptomatic concentric LVH to clinical heart failure with a preserved LVEF are just now being unraveled. Presently, this transition appears to be associated with progressive
adverse remodeling of the extracellular matrix and increase in LV filling pressures. Further advances in our understanding of the risk factors for progression along each of these pathways will undoubtedly help to accomplish the goal of reducing the burden of heart failure.
Rare Undersea Discovery Could Extend Your Life by 10, 20 or 30 Years Humans have made incredible health strides and are living longer lives than ever. Many of the maladies that struck down our ancestors have for the most part been completely eliminated – everything from tuberculosis, to polio to malaria. Today, the biggest killers stem as much from our lifestyles as from microscopic bacteria and viruses. One of the worst of these is heart disease, and specifically high blood pressure. It’s a slow, but efficient killer that robs many people of what should be the last 10, 20 or 30 years of their lives. Part of the reason that heart disease is so prevalent and intractable is that it often requires massive changes to one’s lifestyle— changes that are not easy to make. Everything from radically altering ones diet to implementing serious exercise routines. And while it’s never too late to start, people often realize the true danger only when it’s too late to make the changes and the damage is done. Now, however, there may be a scientific breakthrough that could have an impact on high blood pressure comparable to penicillin’s ability treat infections or quinine’s effect on malaria. Scientists are claiming that they have now isolated unusual ingredients in a rare seaweed discovered by fishermen off the coast of Korea that offer incredible health benefits—including the ability to restore blood pressure to normal levels. Dr. Haengwoo Lee, a renowned biochemist living near Seattle, Washington conducted a massive 15 year, multimillion dollar clinical study on these two ingredients. The first is Seanol, an extremely rare seaweed extract from Ecklonia Cava that's proven to be 100 times more powerful than any land-based antioxidant. That's because it stays working in your body for 12 hours, compared to land-based antioxidants that work for 30 minutes. "Its secret is its make-up of special polyphenol antioxidants that are a whopping 40% lipid (fat) soluble," Dr. Lee explains. "Unlike nearly all land-based antioxidants that are water soluble, Seanol's protective compounds can get into things like the fatty tissues of your brain and
penetrate all three layers of your cells, including the outside, the oil-based cell membranes, and your DNA." Indeed, Seanol is so powerful, it's the only FDA-approved Ecklonia Cava marine-algae extract in existence. The second ingredient is Calamarine, a deep-sea omega-3 discovery that delivers 85% more DHA omega-3s to your heart, brain, joints, and eyes. It's known to combat everything from fatigue and poor memory, to vision problems, joint pain, mood swings and depression. With that research in mind, Dr. Lee combined Seanol and Calamarine with a high dose of vitamin D to form Marine-D3, the newest supplement in the fight against age-related illnesses and high blood pressure. According to the CDC, about 1 in 3 U.S. adults has high blood pressure, which increases the risk for heart disease and stroke, the two leading causes of death in the United States. Increasing your omega-3 intake can reduce high blood pressure, and because it's difficult to get enough omega-3s in foods like fish and nuts, many people turn to supplements. Dr. Lee found that Calamarine delivers some of the greatest concentration of omega-3s known to science, and has been able to formulate it without any fishy burps or aftertaste. Combined with Seanol's ability to reduce body inflammation, as well as help cells get the nutrients they need to thrive, stay healthy and protected, Marine-D3 is able to boost a body's entire well being. The makers of Marine-D3 are so confident that you'll see fast dramatic results from this product, that if you aren't happy after two full months, simply return the unused portion and they'll buy it back. They'll even give you ten dollars extra just for giving it an honest try! That kind of faith, combined with Dr. Lee's exhaustive research, shows that Marine-D3 really is a one-of-a-kind product.
http://www.howlifeworks.com/health_beauty/Rare_Undersea_Discovery_Could_Extend_Your_Life_ by_10_20_or_30_Years_524?ag_id=1358&wid=3201DA99-3654-4DEA-8E6643A5D5CB0349&did=6580&cid=1005&si_id=3039&pubs_source=mpt&pubs_campaign=201403031358
