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Latest thinking in Barrett's esophagus: Heading off esophageal cancer
In some patients, persistent GERD also stimulates immature progenitor cells in the distal esophagus to differentiate into intestinal cell types that constitute the specialized intestinal metaplasia characteristic of Barrett's esophagus. The metaplasia that occurs in Barrett's esophagus may thus represent an adaptive substitution of cells that are highly sensitive to peptic acid injury to cells that are better able to withstand it. Unfortunately, the metaplastic cells are predisposed to malignancy.
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Destroyed toenail with ill-defined crusted plaque
A 72-year-old man presents with a four-month history of a sore on his right great toe. It is intermittently painful, particularly when he is in bed at night. The patient has a history of diabetes mellitus, coronary artery disease, and mild hypertension.
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Treatment of heart failure with reduced left ventricular ejection fraction
Heart failure (HF) affects approximately 5 million persons in the United States each year. HF is predominantly a disease of the elderly: Approximately 80% of patients hospitalized with HF are older than age 65. Approximately one-half of older adult patients with CHF have a decreased ejection fraction. Elderly patients with HF and a reduced LVEF have a higher mortality than elderly patients with HF with a normal LVEF. Despite numerous excellent studies showing the efficacy of appropriate drugs in reducing mortality in patients with HF and a reduced LVEF, these medications are underutilized in the treatment of HF. This article discusses the latest guidelines from the American College of Cardiology/American Heart Association for the treatment of patients with HF and a reduced LVEF.
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Erythema, edema, and fissuring around mouth
A 61-year-old man has a 3-month history of a persistent irritation at the corners of his mouth. He has type 2 diabetes mellitus and is being treated with insulin. Otherwise, he is in good health.
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