Obesity

A 57-year-old woman presents with swelling of the hands that began several weeks earlier and is now worsening. She denies joint pain, and she has no history of trauma or significant vascular disease. She has had pneumonia several times; each episode was successfully treated with antibiotics. She has smoked 2 packs of cigarettes a day for the past 20 years

VANCOUVER, British Columbia -- An active lifestyle away from work protects against on-the-job upper-body repetitive strain injury, according to researchers here.

KOBE, Japan -- Fish-oil supplements added to statin therapy can further reduce the risk for major coronary events even among patients who already eat a diet heavy in fish, Japanese investigators reported.

Binge eating disorder is more common than anorexia and bulimia combined, according to a national survey, but many physicians are unaware of the problem. The guidance and evidence discussed here highlight the key issues in recognizing and managing the disorder.

DURHAM, N.C. -- Biopsies may underestimate the severity of prostate cancer in obese men, a team of investigators found.

NEW ORLEANS -- A cup of cocoa in the morning may improve endothelial function for overweight patients, a small study found, particularly if the dark chocolate powder is mixed with unsweetened water.

DALLAS -- When diet and exercise fail to lower cholesterol in children with high-risk lipid abnormalities, statins should be first- line drug therapy, declared the American Heart Association.

BOSTON -- For firefighters the odds of death from coronary heart disease within 24 hours of fighting a blaze are far higher than if they were on desk duty, researchers reported.

BRISTOL, England -- Even 15 minutes a day of extra moderate to vigorous running, jumping, or kicking a ball can dramatically cut the risk of childhood obesity, according to researchers here.

PARIS -- Atherosclerotic arterial disease seems to predict relatively high rates of myocardial infarction, stroke, or cardiovascular death within a year, according to a large, international registry study.

SEATTLE -- Obese men diagnosed with prostate cancer in middle age are at a 2.6-fold higher risk of dying from the disease than are patients of normal weight, according to a case-control study.

ATLANTA -- Adults in the U.S. need a major bolus of fruits and vegetable in their diets if they are to achieve the national objectives set by "Healthy People 2010," according to the CDC.

TOKYO -- Obstructive sleep apnea patients have a high rate of silent brain infarctions that can be seen by magnetic resonance imaging, according to researchers here.

BOSTON -- Middle-age volunteers whose parents survived to age 85 or older had significantly better Framingham risk scores than those whose parents died younger, suggesting that cardiovascular longevity may reside in the genes.

WINSTON-SALEM, N.C. -- For a few patients undergoing, weight-loss surgery, a thiamine deficiency may cause memory loss and other neurologic problems, easily correctable when recognized.

LOS ANGELES -- The higher the body mass index, the lower the likelihood that patients hospitalized for ischemic stroke would be discharged directly home, found UCLA researchers.

AARHUS, Denmark -- If would-be parents are fat, pregnancy may be a long time coming, according to a Danish study.

STANFORD, Calif. -- Women who followed the low-carbohydrate, high-protein Atkins diet for a year lost more weight than women assigned to three other diets with a high or higher carbohydrate intake, researchers here reported.

WASHINTON -- Doctors discovered a blood clot in Vice- President Dick Cheney's left calf today and started him on first-line therapy for deep vein thrombosis, his office said.

NEW BRUNSWICK, N.J. -- Bariatric surgery in morbidly obese teenagers more than tripled between 2000 and 2003, researchers here reported.

ORLANDO -- Three-year-olds pack away 46 calories, mostly in sugar-laden snacks and drinks, for every hour they spend watching television, researchers here reported. This can add up.

GENEVA -- Complications after hip replacement are more common for obese patients, particularly women, researchers here found.

NORWICH, England -- The way that toddlers and teens grow may protect them against high cholesterol levels in adulthood, researchers here found.

Case Report: Cytomegalovirus Encephalitis in an HIV-Seropositive Person

The authors describe a previously healthy patient who required surgical resection of a large mucoid tumor lined with atypical columnar epithelium. The diagnosis was mucinous cystadenocarcinoma, a rare type of pulmonary cancer that is difficult to identify.

A 42-year-old woman returned from a 2-month stay in India with a rash and alow-grade fever. She also complained of fatigue, nausea, anorexia, and weightloss. Despite treatment with amoxicillin for a presumed streptococcal rash,her symptoms worsened. The pruritic rash spread over the patient’s body;only the face was spared.

The prevention of symptomaticcoronary heart diseaseand other vascular disordersrepresents a significanthealth care priority, especiallyin a population that is growingolder and more obese. However,a recent survey has shownthat many laypersons-and evensome physicians-do not know allthe target lipid levels that are associatedwith optimal reduction ofcardiovascular risk.

ABSTRACT: A 4-pronged approach that includes patient education, skin and nail care, appropriate footwear, and proactive surgeries can effectively prevent diabetic foot problems. Teach patients with diabetes to examine their feet daily to detect new onset of redness, swelling, breaks in the integrity of the skin, blisters, calluses, and macerated areas. Have them follow a daily foot care regimen that includes warm water soaks and lubrication, and have them keep toenails properly trimmed. Recommend that patients select shoes that fit properly and have sufficient padding and toe box space; have them use inserts, lifts, orthoses, or braces--as recommended-to correct abnormal gait patterns. Finally, if deformities develop, simple proactive surgical procedures can correct these problems before they result in the development of wounds.

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.

BOSTON -- Daily use of over-the-counter analgesics -- including aspirin -- significantly increased the risk that men will develop new-onset hypertension, researchers here reported.