Tag Archives: Medicine

Basal Cell Carcinoma: Diagnosis And Treatment

The skin is The largest organ in the body. It certainly receives the largest amount of ionizing radiation from the sun, the most common cause of genetic mutation of cells of the skin. As you get older, these mutations build up, leading to an increasing number of skin cancers that need removal.

In my younger years, I had red hair and lots of freckles. Between the freckles I had a little pigmentation to protect me from the sun. The only sunscreen then available was a messy white paste called zinc oxide, and I resorted to it infrequently. I was out a lot playing tennis, hiking and camping, and even skied once or twice. I did wear hats a lot, especially as I got older and wiser, but still it is amazing I’m not having more trouble now.

I go to the dermatologist every 3 to 6 months to get my actinic keratoses frozen off. These are the little patchy,rough irregularities in the skin that can grow into basal cell, and sometimes squamous cell cancer. I have had just one skin cancer, a basal cell, which I discovered when there was a patch on my chin that kept bleeding when I shaved. One of my classmates in medical school was a plastic surgeon, and kindly removed this lesion with a minimum of scarring.

Lots of doctors, usually Dermatologists, currently specialize in Mohs surgery, in which the basal cell  cancer is gradually shaved off until its margins, the edge of the shaved biopsy, show no cancer.

The moral of the story is to avoid unnecessary ultraviolet exposure. Don’t go to tanning studios. If you must be in the sun, put on sunscreen, and wear a hat. Some would argue that if you stay out of the sun you will get vitamin D deficiency. It is true that vitamin D Is important, and I would recommend checking your blood vitamin D level every year or so. But would rather take my vitamin D in a capsule than get it from sun exposure.

—Dr. C.

2021 HEART RESEARCH: TOP FINDINGS OF CARDIOLOGISTS

Coronary artery bypass graft (CABG) was supported as superior to fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease (CAD). PCI failed to meet noninferiority criteria at 1-year follow-up in a study comparing outcomes between FFR-guided PCI using contemporary stents and CABG. This adds to existing evidence showing superior outcomes with CABG in patients with the most-complex CAD.

The sodium–glucose transporter-2 (SGLT-2) inhibitor empagliflozin was found to be beneficial in heart failure with preserved ejection fraction. Empagliflozin is the first medication shown to improve outcomes in this population. It’s unknown if this is a class effect of all SGLT-2 inhibitors, but this could be a game changer.

Poor-quality carbohydrates were linked to cardiovascular mortality, around the world. Consumption of higher-glycemic-index carbohydrates was associated with higher rates of cardiovascular disease and mortality in countries all around the world. These data are particularly important because lower-income countries often have diets high in refined carbohydrates, which may worsen cardiovascular disparities.

New guidelines for managing valvular heart disease were released. These new guidelines add or elevate several recommendations for transcatheter therapy, and they lower thresholds for intervention in some conditions.

The editors of Circulation: Cardiovascular Quality and Outcomes addressed racial-ethnic disparities. The editors affirmed that structural racism is a public health crisis and that the scientific publishing community can play a role in addressing it.

Tricuspid annuloplasty for moderate regurgitation during mitral-valve surgery was of unclear benefit. Annuloplasty was associated with less progression of moderate tricuspid regurgitation but more pacemakers at 2 years. Unfortunately, this mixed outcome does not clearly inform the decision on performing annuloplasty at the time of surgery, and longer-term follow-up is needed.

Immediate angiography was not beneficial in out-of-hospital cardiac arrest without ST elevation. Patients with out-of-hospital cardiac arrest who did not have ST elevation on their initial ECG did not benefit from immediate angiography. Although a potential coronary culprit was identified in about 40% of patients, neurologic injury was by far the most frequent cause of death, negating any benefit from coronary revascularization.

Many statin side effects are related to the “nocebo” effect. A creative study enrolled 60 people with statin intolerance and gave them 12 randomly ordered 1-month treatment periods: 4 periods of no medication, 4 of placebo, and 4 of statin. Symptom intensity did not differ between placebo and statin periods and, interestingly, some even had more symptoms on placebo. This demonstrates that some cases of “statin intolerance” may be related to the “nocebo” effect.

Shorter duration of dual antiplatelet therapy following PCI/stent placement was found to be acceptable in patients with high bleeding risk. A large, randomized trial found that 1 month of dual antiplatelet therapy provided similar clinical outcomes and a lower bleeding risk than 3-to-6-month regimens for this challenging patient subset.

De-escalation” of dual antiplatelet therapy for patients undergoing PCI for acute myocardial infarction (MI). This industry-funded study evaluated patients who had received 1 month of aspirin plus ticagrelor after acute MI and stent placement and “de-escalated” half to aspirin plus clopidogrel. At 1 year, there was significantly less bleeding in the de-escalation group and a nonsignificant trend toward fewer ischemic events as well.

CANCERS: DIAGNOSING CARCINOID TUMORS

Cancer is a huge problem, since it is actually a collection of a lot of different diseases in different places, resulting from mutation of the genes and invasiveness as the common characteristic. All cancers are different.

Carcinoid tumor is a good illustration. These are so called neutoendocrine tumors. They are slow growing, and are usually not detected until they are quite advanced. They can be located in different organs such as the gastrointestinal tract and the lung.

In their vicinity they produce symptoms characteristic of the area; trouble swallowing, nausea, vomiting, constipation and abdominal pain for gastrointestinal carcinoid, and cough, wheezing, shortness of breath and chest pain for those located in the lung.

Many advanced cancers can produce weight loss, muscle pain and fatigue In addition to symptoms characteristic of their location. The special characteristic of carcinoid tumors is that they may secrete substances that produce diverse symptoms such as  flushing of the skin, sudden diarrhea and vomiting and, strangest of all, heart valve leakages.

Diagnosis of carcinoid tumors is often made by checking for serotonin or chromogranin-A in the blood, and 5-Hydroxy indolacetic acid ( 5-HIAA) in the urine, and locating the tumor with Imaging such as CT and MRI.

It is usually treated best for surgery, but cell surface somatostatin can be targeted for hormone therapy, and targeted radiotherapy with PRRT. It is very much to the advantage of the patient if she has a tumor with specific hormone or other marker that can be targeted for treatment, such as a breast cancer with estrogen receptors that can be targeted by tamoxifen.

Please check the accompanying mayo clinic article for more information.

—Dr. C.

Read more

Opioids: Postsurgical Pain Management (Mayo Clinic)

Read more