Jeannette Y. Wick, RPh, MBA, FASCP

Thymoma is rare and most known for its presence in 15% of patients who have myasthenia gravis. Thymoma tumors can be quite large. Surgery is the mainstay of treatment for thymoma, but when thymoma recurs (as it does in 10% to 30% of patients), the best course of action is often unclear.

Cardiologists have discussed the pros and cons of drug-eluting stents (DES) for several years. Some evidence seems to indicate that DES reduce risk of restenosis or ischemia-driven target vessel revascularization. They may, however, be more prone than bare metal stents to late (beyond 1 year) and sudden coronary artery occlusion.

Diabetes, particularly poorly controlled diabetes, seems to be associated with late-life dementia. Study results show that African Americans with longstanding diabetes are at risk for accelerated cognitive decline.

Clinicians are most likely to prescribe amiodarone when they see patients who have recurrent ventricular dysrhythmias; paroxysmal supraventricular dysrhythmias including atrial fibrillation and flutter; and or need sinus rhythm maintenance after electrical cardioversion for atrial fibrillation.

Also known as alternate day fasting, "zigzag" caloric cycling calls for the dieter to eat the number of calories required to maintain weight one day, and then 25% of his or her energy needs on the fast day. Studies have shown that individuals who are compliant with this pattern can lose 4% to 8% of their body weight over 8 to 12 weeks.

Patients who have HCV infection are at high risk for arthralgia, myalgias, pruritus, neuropathy, and decompensated livers. Until recently the sole available treatment was interferon. After the US Food and Drug Administration (FDA) approved ribavirin, patients who took ribavirin plus interferon responded better. Now, the FDA has approved a small selection of oral antivirals to treat hepatitis C.

Benign paroxysmal positional vertigo (BPPV), an idiopathic condition for patients, occurs when otoconia of the utricular macula become dislodged and floating debris moves into semicircular canals. Recently, researchers have noted patients with BPPV tend to have low serum vitamin D levels compared with controls.

Patients who have hypertension may be at increased risk for cognitive decline and dementia. According to a study published in the October 2014 issue of JAMA Neurology, researchers have been trying to elucidate the timing and mechanism by which elevated blood pressure robs patients' thinking abilities.

Frontal lobe lesions can cause personality and social cognition impairment. Some data suggested that 2 types of patients – those with prefrontal lesions and those with the behavioral variant of frontotemporal dementia – experience similar distractibility, personality changes, and social inappropriateness. Patients with either diagnosis also experienced profoundly impaired moral reasoning, yet few studies have compared these patients.

Distal radius fracture-also called a wrist fracture by patients-is common. Its incidence is expected to increase in the next 20 years, since our population is aging and the risk of this specific fracture increases in patients with metabolic disorders, including osteoporosis. However, the health care community has yet to reach a consensus regarding indications for surgery, and there is insufficient data to identify a preferred operative technique.

Team-based feedback has the potential to improve surgeons' relationships with coworkers and patients. The clinical implication: using such feedback to improve less-than-optimal behaviors could increase practice reimbursement under the "pay-for-professionalism" system.

Supporters of a duty-hour limits in the surgical suite to 80 hours/week say that patient safety is improved. Opponents claim that limiting resident duty-hours jeopardizes resident education and preparedness.

Early reports from the Safety and Appropriateness of Growth hormone treatments in Europe (SAGhE) project noted increased cardiac and cerebrovascular mortality in adults who were treated for stature problems as children. In addition, other studies have linked stroke risk to short stature in general, hypothesizing that shorter people have increased metabolic risks.

Endocrinologists generally see middle-aged people who have developed type 2 diabetes mellitus (T2DM) subsequent to overnutrition (or overeating) and weight gain. Most clinicians tend to forget that low caloric intake, or undernutrition, in the prenatal period or during a child's formative years also seems to increase the risk of the T2DM later in life.

Obesity in children is a very complex problem. How children eat and what they believe about food and obesity is largely determined in their family units.

Kidney donors may have lower 1,25-dihydroxyvitamin D and phosphate levels. Their parathyroid hormone levels may be elevated, but with minimal effect on calcium levels.

Clinicians who see their own clinical outcomes data (sometimes referred to as surgeon-specific mortality data) can use that information to promote and enhance patient safety. However, critics of this approach argue that places the burden solely on the surgeon and under-appreciates the surgical team's role and dismisses hospital staffing, infrastructure, and process as contributors to patient safety.

When surgical patients have tumors that secrete adrenal hormonal, the anesthesiologist needs to thoroughly address preoperative evaluation, perioperative hemodynamic control, electrolytes, and metabolic abnormalities

Almost everyone has episodes of low back pain (LBP) from time to time. Fortunately, most episodes of LBP are considered acute, and resolve within 6 to 12 weeks. When LBP pain persists and becomes chronic, treatment is considerably more complicated and often leads the patient to the surgical suite.

Thyroid dysfunction causes many well-recognized changes at the level of the brain, and most are reversible with treatment. Patients who have hypothyroidism often have other neuropsychiatric comorbidities, including affective disorders, depression, cognitive function loss, anxiety, or irritability.

Among diabetics, poor adherence or nonadherence results in poorer glycemic control and increased risk of complications and disability, as well as increased healthcare costs.

New evidence indicates that mitochondria are a crucial element in metabolic homeostasis in white adipocytes. They appear to have significant involvement in adipogenesis, fatty acid synthesis and esterification, branched-chain amino acid catabolism, and lipolysis

Vitamin D has a role in the immune system distinct from its regulatory role in calcium homeostasis. Immune cells express the vitamin D receptor and can metabolize circulating 25-hydroxyvitamin D into its active form, 1,25-dihydroxyvitamin D. This finding has researchers looking for new ways to manipulate vitamin D in the innate and adaptive immune systems.

Low testosterone is a common condition among men with diabetes-diabetic men are approximately twice as likely as others to develop low testosterone and hypogonadism. Because its symptoms mimic other conditions, patients often fail to report concerns and clinicians may fail to diagnose "Low T."

Phthalates may be replacing lead as the leading environmental exposure concern. Some studies indicate that there may be a link between phthalates, obesity, endocrine disruption, and metabolic interference.

Homozygous familial hypercholesterolemia (HoFH) is a rare and severe hereditary lipid disorder. Patients with HoFH generally have very high serum levels of low-density lipoprotein cholesterol (LDL-C) that is treatment-resistant. HoFH puts affected patients at extremely high risk of premature onset coronary heart disease, and many patients die before they reach their mid-30s.

As the number of bariatric surgeries increase, clinicians require more and better data about its long-term outcomes. As we know, as more people take a medication or undergo a surgical procedure, the better the quality of the collective data. It's the strength in numbers concept. In the case of bariatric surgery, many clinicians have questions about treatment failure rates and they suspect that reports of sustained weight loss may be overly optimistic.

Patients who have HCV infection are at high risk for arthralgia, myalgias, pruritus, neuropathy, and decompensated livers. Until recently the sole available treatment was interferon. After the US Food and Drug Administration (FDA) approved ribavirin, patients who took ribavirin plus interferon responded better. Now, the FDA has approved a small selection of oral antivirals to treat hepatitis C.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is frequently the go-to procedure for patients with complex or morbid obesity who need or want to reduce their weights. Laparoscopic procedures are attractive to surgeons, insurers and patients because in addition to being as effective as other procedures, they shorten hospital stay and allow patients to heal more quickly compared to other bariatric surgeries.

Laparoscopic interventions for rectal cancer are controversial. Oncologists have concerns about high conversion rates and long operating times associated with laparoscopic total mesorectal excision (TME), and they worry that laparoscopic TME violates the principle of sharp mesorectal dissection.