Clinical medicine (London, England)
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Acute myeloid leukaemia is a heterogeneous disease that occurs in all age groups but peaks in older age at around a median of 69-70 years where it has a frequency of 13-15/100,00/annum. With the changing demographics, the number of cases will increase in line with the older population. As the only treatment with curative intent is intensive chemotherapy, this presents an immediate therapeutic challenge for the majority of the disease.
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Eosinophilic oesophagitis is a clinico-pathologic diagnosis that describes patients with dysphagia (intermittent or continuous), food bolus obstruction or regurgitation, where endoscopy and biopsy reveals high concentrations of eosinophils in the lining of the oesophagus. At endoscopy, the presence of rings (trachealisation), furrows, micro-abscesses and strictures may be noted, but sometimes the appearance is normal. ⋯ It is important for all general physicians to recognise this and make an accurate diagnosis in order to give specific treatment. This may involve topical steroids, leukotreine D4 antagonists, dietary exclusions and dilatations.
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After 60 years in which warfarin has been the only practical oral anticoagulant, a number of new oral anticoagulants are entering practice. These drugs differ in a several important respects from warfarin; most notably they have a reliable dose-response effect which means they can be given without the need for monitoring. ⋯ Large trials have established their non-inferiority to warfarin in a number of indications and in some cases their superiority. To date they have been licensed for prophylaxis following high risk orthopaedic procedures, non-valvular atrial fibrillation and treatment of venous thromboembolism, but is not clear that they will supplant warfarin in all areas.
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The mechanisms that drive non-alcoholic fatty liver disease (NAFLD) progression from simple steatosis to non-alcoholic steatohepatitis (NASH) and NASH-fibrosis and/or cirrhosis are complex. Recent studies suggest that the liver progenitor cell (ie liver stem cell) population expands during chronic liver injury, and is an essential component of the repair process. Hedgehog (Hh) is a developmental morphogen that has an important role in the adult tissue repair (and progenitor) response. ⋯ Finally, the administration of Hh inhibitors led to reduced fibrosis in a model of NASH. Future studies are needed to evaluate the utility of these inhibitors in other models of chronic liver disease. If successful, this could pave the way for the development of new therapy for patients with NASH, because Hh pathway inhibitors have now been licensed for use in patients with advanced basal cell carcinoma.