Anemia

STANFORD, Calif. -- Treating inborn urea-cycle disorders with intravenous phenylacetate and benzoate, an alternative way to remove toxic ammonia, has saved more than 80% of patients, mainly children, researchers here reported.

BALTIMORE -- Medicare has reacted to an FDA black box on erythropiesis stimulating agents by drawing a red line on the coverage of treatment for cancer patients.

SILVER SPRING, Md. -- Although the FDA advised physicians in March to use erythropoiesis-stimulating agents at the lowest possible dose to preclude a transfusion, an advisory committee has urged the agency to develop still stricter standards.

SEATTLE -- Few geriatricians appear willing to try newer medications to treat chronic constipation in older adults, an informal survey here showed.

SEATTLE -- Gastric acid suppression with proton pump inhibitors appears to hold no excess risk of pneumonia in hospitalized older adults, researchers reported here.

Benzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of "scope" procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.

Generalized muscle weakness, ataxic gait, and numbness and tingling in her hands and feet prompted a 45-year-old woman with a history of heavy alcohol abuse to seek medical attention. Atrophic glossitis and decreased sensation to light, touch, and vibration of the distal extremities were noted.

WINSTON-SALEM, N.C. -- Vitamin D deficiency in older patients has been associated with poor performance on simple physical tasks, according to investigators here.

ANCONA, Italy -- A five-drug postoperative chemotherapy regimen for gastric cancer that appeared promising in preliminary studies did not improve survival, researchers here reported.

TORONTO -- Anemia after kidney transplantation nearly doubles mortality and graft failure risk over four years, according to international researchers here.

BETHESDA, Md. -- Chains of for-profit dialysis centers use considerably more erythropoiesis-stimulating agents per patient than do non-profit or hospital-affiliated centers, regardless of anemia status, found investigators here.

LOS ANGELES -- Darbepoetin alfa (Aranesp) should not be used for treatment of anemia caused by cancer, researchers here reported. Compared with placebo, darbepoetin hastened death despite significantly reducing the need for transfusion.

BARCELONA, SPAIN -- The ability of the investigative protease inhibitor telaprevir to rapidly reduce levels of hepatitis C virus hints that shorter treatment regimens may be possible, researchers reported here.

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

Oral Contraceptives: Five Vignettes Illustrate Dx and Rx Problems-- and Solutions

ROCKVILLE, Md. -- The FDA has approved eculizumab (Soliris), tbe first of a new class of natural immune system blockers, for paroxysmal nocturnal hemoglobinuria, a rare blood disorder that can lead to disability and death.

ROCKVILLE, Md. -- The FDA warned today that aggressive use of erythropoiesis-stimulating agents to raise hemoglobin to a target of 12 g/dL or higher was associated with "serious and life-threatening side-effects and or/death."

Research Focus: Recent Developments in HIV Therapeutics

The authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

GLASGOW, Scotland, Feb. 19 -- There's more evidence women can benefit from moderate exercise during early treatment for breast cancer, researchers here said.

MELBOURNE, Australia -- Trying to achieve normal hemoglobin levels in patients with anemia caused by chronic kidney disease increases their risk of dying, according to researchers here.

A 26-year-old woman presented with a1-week history of pleuritic chest painand abdominal pain, which was associatedwith nausea but unrelated tofood intake or bowel movements. Shehad also had gross hematuria for thepast 10 days and swelling around hereyes and ankles as well as fatigue andarthralgias for 2 weeks.

In his recent editorial Putting Guidelines for Chronic Kidney Disease IntoPractice (CONSULTANT, October 2006, page 1295), Dr Gregory Ruteckidiscussed the results of a study that shows many clinicians fail to follow evidence-based guidelines for the management of chronic kidney disease(CKD), such as when to consult a nephrologist.1 A sampling of the feedbackwe received appears below, along with Dr Rutecki's responses.

A 59-year-old woman was evaluated for epigastric discomfort and iron deficiency anemia of 2 months' duration. Two years earlier, she had undergone left upper lung lobectomy and adjuvant radiation for T2 N0 M0 poorly differentiated adenocarcinoma of the lung.

DALLAS -- Serious symptoms of sickle cell disease in childhood don't imply a greater risk of premature stroke or death for patients as they grow up, according to researchers here.

ROCKVILLE, Md. -- For cancer patients with anemia not caused by chemotherapy, the off-label use of Aranesp (darbepoetin alfa) is ineffective and also boosts mortality, the FDA reported.

MINNEAPOLIS -- Older women with moderately impaired renal function are at increased risk for hip fractures, particularly trochanter breaks, researchers here reported.

DELHI, India -- Prenatal vitamin and mineral supplements may benefit babies born to undernourished pregnant women, researchers here have found.

The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.