UpToDate 14, 15, 16.1

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the uptodate 16.1 is not there...sorry

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you can use this id and password to open uptodate on its website... version 16.1
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[vortice]

Uptodate 16.1 for PPC , Palm and SmartPhone:

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Version 16.2 July 2008



What’s new in UpToDate 16.2

For each specialty, UpToDate summarizes the most important new medical findings since the last release. Below are sample
updates thought to be of particular interest by our editors. For the full list of “What’s New” topics, run a search on “what’s new”.

CARDIOLOGY
Gastrointestinal bleeding presents a major challenge in the care of patients with acute coronary syndromes (ACS) who are treated with one or more antithrombotic agents. This subject has
been updated and a new discussion of the potential role of prophylactic proton pump inhibition has been created. (See “Antiplatelet agents in unstable angina and acute non-ST
elevation (non-Q wave) myocardial infarction”, section on Gastrointestinal bleeding and see “Overview of the management of unstable angina and acute non-ST elevation (non-Q wave)
myocardial infarction”, section on Gastrointestinal prophylaxis).

ENDOCRINOLOGY
Two randomized trials found no cardiovascular benefit to more aggressive glycemic control (target A1C <6.0 and 6.5%) in patients with longstanding type 2 diabetes. (See
“Glycemic control and vascular complications in type 2 diabetes mellitus”, section on Intensive therapy).

FAMILY MEDICINE
Methylnaltrexone, a peripherally acting opioid antagonist, was approved by the United States Food and Drug Administration to treat opioid-induced constipation. Methylnaltrexone does not
cross the blood-brain barrier and thus does not induce opiate withdrawal. (See “Pharmacologic therapy of cancer pain”, section on Opioid antagonists).

GASTROENTEROLOGY
The American College of Gastroenterology updated its guidelines on Barrett's esophagus. An important change pertains to the management of high-grade dysplasia. (See “Management
of Barrett’s esophagus”).

GYNECOLOGY
A systematic review of randomized trials found no significant differences in major complications among laparoscopic entry techniques; however, trials were underpowered to
detect rare complications (ie, vascular or visceral injury). Major findings of this review included: direct-entry technique or radially expanding trocar
reduced extraperitoneal insufflation and failed entry; not lifting the abdominal wall prevented failed entry; and radially expanding trocars reduced trocar site bleeding. (See
“Overview of gynecologic laparoscopic surgery”, section on Laparoscopic entry and insufflation).

HEMATOLOGY
In a phase III trial of the thrombopoietic growth factor romiplostim (AMG 531) in patients with chronic immune thrombocytopenic purpura (ITP), a durable platelet response was seen in 16
of 42 splenectomized patients receiving romiplostim (38 percent) and in none of the 21 receiving placebo. Similarly, a durable platelet response was seen in 25
of the 41 non-splenectomized patients receiving romiplostim (56 percent) and in only one of the 21 receiving placebo (5 percent). (See “Treatment and prognosis of immune (idiopathic)
thrombocytopenic purpura in adults”, section on Romiplostim).

INFECTIOUS DISEASES
Two large trials conducted in Africa and South America have evaluated whether HSV-2 suppression with acyclovir maintenance therapy may reduce HIV acquisition, with disappointing results.
(See “Prevention of sexually transmitted diseases”, section on Suppressive therapy for HSV).

INTERNAL MEDICINE
The POISE trial raises substantial questions about the safety and efficacy of perioperative beta blocker administration. Administration of beta blockers appears to decrease the risk of
myocardial infarction but increase the risk of stroke and perhaps mortality. (See “Management of cardiac risk for noncardiac surgery”, section on Beta blockers).

NEPHROLOGY
In multiple myeloma, a retrospective study found that the ability of plasmapheresis to lower free light chains by 50 percent or more was associated with a significant improvement in renal
function. (See “Treatment of renal failure in multiple myeloma”).

OBSTETRICS
The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Trial showed a continuous relationship between the risk of macrosomia and maternal glucose level. (See
“Treatment and course of gestational diabetes mellitus”, section on Risk of macrosomia).

ONCOLOGY
Accumulating data from several trials indicate that benefit from treatments targeting the epidermal growth factor receptor (EGFR) such as cetuximab and
panitumumab is limited to patients whose tumors contain wild-type (WT, nonmutated) K-ras. (See “Systemic chemotherapy for metastatic colorectal
cancer: Completed clinical trials”, section on Molecular determinants of response).

PATIENT INFORMATION
New topics about type 1 and type 2 diabetes and diet are available (see “Patient information: Type 1 diabetes and diet” and see “Patient information: Type 2 diabetes and diet”); this
complements other new topics about diet and health that were also added recently. (See “Patient information: Low sodium diet” and see “Patient information: Low potassium diet”).

PEDIATRICS
In May 2008, the American Academy of Pediatrics and the American Heart Association recommended performing an evaluation comprised of a cardiovascular-focused patient and
family history, and physical examination to detect cardiac disease in patients who need to receive stimulant therapy for their attention deficit hyperactivity
disorder (ADHD). An electrocardiogram is not required before initiating stimulant therapy for patients with ADHD, if the history and examination are not suggestive of cardiac disease.
(See “Cardiac evaluation of children receiving pharmacotherapy for attention deficit hyperactivity disorder”, section on AHA and AAP joint statement).

PULMONARY MEDICINE
A multicenter trial randomly assigned 983 patients with acute respiratory distress syndrome (ARDS) to receive low tidal volume ventilation alone or the combination of high PEEP,
recruitment maneuvers, and low tidal volume ventilation. There was no significant difference in all-cause hospital mortality, although the composite intervention group had less
refractory hypoxemia and needed fewer rescue interventions. (See “Mechanical ventilation in acute respiratory distress syndrome”, section on High PEEP).

RHEUMATOLOGY
There are limited data on the effect of glucosamine when used for patients with OA of the hip. One study randomly assigned 222 patients with OA of the hips to receive either
glucosamine sulfate (1500 mg once daily) or placebo for two years. There were no statistically significant differences between the two groups with respect to changes in pain,
function, or joint space narrowing. (See “Investigational approaches to the pharmacologic therapy of osteoarthritis”, section on Glucosamine).


UpToDate 16.2 PDA: (PALM, PPC and Smartphones)

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UpToDate 16.2 PC:

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