November 2005

Recent research into the use of markers of inflammation to aid in cardiovascular risk assessment has focused on C-reactive protein, an acute-phase reactant found in atherosclerotic lesions. Serum levels of C-reactive protein are strongly associated with cardiovascular disease risk. Several clinical trials have shown that elevated C-reactive protein concentration predicts increased risk in persons with average or even below-normal levels of low-density lipoprotein cholesterol. When measured with the high-sensitivity assay, C-reactive protein has been shown to add to the predictive power of traditional cardiovascular risk factors and can enhance the 10-year Framingham Risk Score risk prediction. This article reviews the available evidence and addresses the potential for lowering C-reactive protein levels to reduce the risk of cardiovascular disease.

Leprosy was well recognized in antiquity and was often associated with social stigma. In 1873, Dr G. Hansen first identified Mycobacterium leprae as the cause for this condition, which was then named Hansen's disease. Not until the 20th century was specific treatment developed. Leprosy remains endemic to certain areas in the world, especially tropical and subtropical zones. Overall prevalence has decreased, but the reported incidence of leprosy has remained steady, even in the United States. In light of the significant morbidity associated with the disease, physicians must remain vigilant for its signs and symptoms even in developed countries, especially with increasing travel to and from endemic areas.

Tardive dyskinesia is a common problem associated with the long-term use of potent antipsychotic drugs. It has become less common with the increased use of the newer atypical antipsychotic medications. The condition is manifested by abnormal orofacial, extremity, and sometimes trunk movements. Decades after it was first identified, our understanding of the pathophysiology of tardive dyskinesia remains incomplete, and currently no definitive treatment is available. Encouraging advances in recent years point to promising new treatment options. This article discusses factors that may predispose to tardive dyskinesia as well as the latest developments in treatment.

Carcinoids are rare neuroendocrine tumors. More than 75% of patients present with cutaneous flushing and diarrhea. About 8% of these tumors occur in the colon. Carcinoid tumors are recognized by their histologic patterns seen on Masson's stain, Grimelius'stain, and immunohistochemistry and in situ hybridization. Evidence of the elevation of 2 biochemical markers?plasma chromogranin A and urinary 5-hydroxyindoleacetic acid?is usually sufficient for diagnosis. This article discusses the diagnosis, localization, and current and investigational treatment options for carcinoids of the colon.