Obesity

Clinical Images to Help You Hone Your Diagnoses

CHICAGO -- Painful neuropathy is more common with type 2 diabetes than with type 1, possibly, researchers suggest, because of a link with the metabolic syndrome.

CHICAGO -- Elevated glucose levels during pregnancy appear to increase risks to mother and baby even at levels below current criteria for gestational diabetes, researchers reported here.

CHICAGO -- Weight gain in type 1 diabetes is associated with coronary artery calcification, but, paradoxically, that may be a sign of better cardiovascular health, investigators here reported.

DENVER -- Type 2 diabetes is no longer the "adult-onset" disease it once was. More and more children with diabetes are type 2 these days, researchers found.

NEW HAVEN, Conn. -- Childhood obesity can be overcome by an intensive family-based program that includes supervised exercise and nutrition education, found researchers here. But dieting wasn't the answer.

CHICAGO -- When the spotlight here focused on rosiglitazone (Avandia) and its harshest critic, Steven E. Nissen, M.D., of the Cleveland Clinic, the cardiologist offered a mild apology to a room full of diabetologists for complicating their lives.

CHICAGO -- Fructose in sodas and other beverages -- but not glucose -- can set patients on the fast track to atherosclerosis, investigators here reported.

CALGARY, Alberta -- A plate and a cereal bowl marked for a portion size designed to limit calorie intake helped obese diabetic patients know when enough is enough, researchers reported.

CHICAGO -- The prevalence of diabetes of all types in the United States has risen by about 5% annually since 1990, keeping pace with the fattening of America, reported CDC investigators.

CAULFIELD, Australia -- The risk of cardiovascular mortality increases at the earliest sign of impaired glucose metabolism, researchers reported here.

INDIANAPOLIS -- Each person metabolizes food differently, so the diet that works for one person won't work for another.

KROZINGEN, Germany -- Obese patients given early revascularization after acute myocardial ischemia are less than half as likely to die within three years than normal-weight patients, researchers here reported.

CLEVELAND -- Neither age nor Medicare status should be determinants for gastric bypass surgery, researchers here found.

SAN DIEGO -- Gastric bypass surgery alters alcohol metabolism -- as many surgeons and patients suspected -- leading to faster peaks and prolonged effects without an increase in symptoms, researchers found.

CHICAGO -- A child who has a body mass index in the range of the 85th to 95th percentile for age and sex should be considered overweight, not "at risk of overweight".

PORTLAND, Ore. -- As a group, white men who served in the U.S. armed forces are twice as likely to die by their own hands as non-veterans, researchers here found.

SAN DIEGO -- Breast cancer survivors who eat properly and exercise may halve their mortality risk regardless of obesity, researchers here found.

UNIVERSITY PARK, Pa. -- Eating more water-rich foods, especially fruits and vegetables, helped women drop more pounds than simply moderating fat intake.

PORTO, Portugal -- As metabolic syndrome becomes more severe, symptomatic heart failure and several cardiac structural and functional abnormalities may increase progressively, researchers here reported.

BOSTON -- In a discovery that may explain the successes of the Atkins diet, investigators have found that a single hormone may switch on the use of stored fat for fuel when all else fails.

SAN DIEGO -- Men older than 50 with androgen deficiency are at a greater risk for all-cause mortality than their peers with age-appropriate testosterone, reported investigators here.

BOSTON -- Folate and B vitamins from food, but not from supplements, may be of modest help in fending off cancer of the pancreas.

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.

* The role of inflammation is well established in theories describing atherosclerotic disease. Virtually every step in atherogenesis is believed to involve cytokines and other bioactive molecules and cells that are characteristic of inflammation. Studies have shown that an elevated level of CRP, which is a serum marker of inflammation, in the high-normal range (0.2 to 1.0 mg/dL) in apparently healthy adults increases the relative risk of cardiovascular disease by 1.5.1

ABSTRACT: Undiagnosed or persistent Helicobacter pylori infection and surreptitious or unrecognized NSAID use are the most common causes of refractory peptic ulcers. The use of antibiotics, bismuth, or proton pump inhibitors (PPIs) suppresses the H pylori bacterial load and may obscure the diagnosis. H pylori infections have also become more difficult to cure because of increased antibiotic resistance. For refractory infection, select an antibiotic based on in vitro susceptibility testing. When this is not available, combination therapy with a PPI, tetracycline, metronidazole, and bismuth is often effective. To detect surreptitious or inadvertent NSAID use, review the drug history in detail. When there is any doubt about such use, check platelet cyclooxygenase function.

For several months, a 60-year-old woman has had weakness, lower extremity edema, and dysphagia. She denies fever, chest discomfort, and rash.

This infection is usually caused by Candida albicans, whichis often present in body folds. Candidiasis is common in persons with diabetes and in obese persons. Other predisposing factors are the use of antibiotics, topical corticosteroids, or immunosuppressive drugs; poor nutrition; and immunosuppression.

A 49-year-old woman was referred for evaluation of cardiac valvular dysfunction. Years earlier, she had taken phentermine and fenfluramine for 3 to 6 months for weight loss. She had lost 6.75 kg (15 lb) during that interval without any cardiac symptoms or side effects. She stopped taking the drug on her own.

PHILADELPHIA -- Teens suffering from sleep apnea will doze off in class and teachers will label them lazy, but younger children with the condition usually don't act sleepy. They become hyperactive and tantrum-prone.