Obesity

ROCKVILLE, Md. -- The demand for obesity surgery has swelled by nearly 2,000% from 1998 to 2004, according to the federal Agency for Healthcare Research and Quality.

LOS ANGELES -- For heart failure patients, the "obesity paradox" of better survival rates with increasing heft appears to hold true during acute hospitalization as well, according to a large registry study.

BETHESDA, Md. -- For men who have prostate cancer, extra poundage may increase the risk of dying from an aggressive form of it, according to investigators here.

BOSTON -- When soft-drink companies fund nutritional research, the result is quite likely to be a favorable outcome, according to sour researchers here.

VILLEJUIF, France -- Risk factors for new-onset diabetes following liver transplantation include hepatitis C status, weight, and impaired fasting glucose status, French investigators reported.

BALTIMORE -- The most vulnerable age for girls to initially put on too much weight is from nine to 12, and that may lead to high blood pressure and other cardiovascular risk factors, according to investigators here.

NEW YORK -- Pre-hypertension appears to increase the risk of developing an enlarged heart among teens and young adults, according to a study of American Indians.

BOSTON -- The interplay of genetic predisposition and modifiable risk factors, such as obesity and smoking, increases the risk for age-related macular degeneration, researchers reported.

MILAN, Italy -- An hour a week devoted by office workers to on-the-job stress management achieved small but significant improvements in both heart rate variability and arterial blood pressure after a year, researchers here reported.

ROCKVILLE, Md. -- Clinical and regulatory developments in psychiatry during the year included extended black box warnings about suicide for antidepressants, new insights for treating schizophrenia gleaned from an old trial, and the possibility of a "taste test" for selecting the best medicine.

SAN ANTONIO -- The thiazolidinedione Actos (pioglitazone) produced metabolic and histologic improvements in patients with nonalcoholic steatohepatitis, the most severe form of fatty liver disease, researchers here found.

ATLANTA -- Despite fortification of the food supply with folic acid, serum folate levels have fallen en masse among women in recent years, researchers said.

ROCKVILLE, Md. -- The FDA approved a diet drug today that it wants no one to even consider taking. Slentrol (dirlotapide), is an obesity agent for dogs, with nasty side effects if humans try it.

WASHINGTON -- The Federal Trade Commission announced today that it fined four makers of over-the-counter weight-loss products more than million for false advertising, including a .2 million civil penalty against Bayer for claims made for One-A-Day Weight Smart.

ANN ARBOR, Mich. -- African Americans with chronic hepatitis C (HCV) are significantly less likely than Caucasians to have a fatty liver, according to researchers here.

TOKYO -- Tremors and other symptoms associated with Parkinson's disease can be reduced significantly by the antiepileptic drug Zonegran (zonisamide) without an increase in dyskinesias, according to Japanese researchers.

PITTSBURGH -- Poor sleep is a frequent companion of depression in children, according to researchers here.

abstract: Pulmonary disease caused by nontuberculous mycobacteria (NTM) can be challenging to diagnose and manage. Patients typically present with nonspecific symptoms, such as cough and fever, and they often have underlying lung disease, which further complicates both diagnosis and treatment. To avoid treating pseudoinfection, the diagnosis should be based on a combination of the history and results of physical examination, radiographic imaging, and smears and cultures of at least 3 sputum samples. Occasionally, it is necessary to perform bronchoalveolar lavage or obtain tissue via transbronchial or open lung biopsy for histopathology and to assess for tissue invasion. Treatment involves a long course of often costly multiple antimycobacterial drugs. However, treatment with the second-generation macrolides, clarithromycin and azithromycin, has significantly improved cure rates for specific NTM infections. (J Respir Dis. 2007;28(1):7-18)

The authors report a case of idiopathic eosinophilic pneumonia in a man with sclerosing cholangitis and ulcerative colitis associated with features of sarcoidosis.

Asked to evaluate bilateral unexplained upper-thigh bruises on a profoundly impaired woman newly admitted to our rehabilitation unit 2 weeks after an intracerebral hemorrhage. Patient received high-dose dexamethasone to reduce perihemorrhage edema.

ABSTRACT: Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort, bloating, and constipation or diarrhea; the pain is typically relieved by defecation. The diagnosis is not one of exclusion; it can be made based on the answers to a few key questions and the absence of "alarm" symptoms. Fiber therapy, the elimination of particular foods, and regulation of bowel function can help relieve symptoms. Tegaserod or polyethylene glycol can be used to treat IBS with constipation. Loperamide and alosetron are of benefit in IBS with diarrhea (although the latter carries a small risk of ischemic colitis). Low-dose tricyclic antidepressants may be used to treat the abdominal pain associated with IBS. Probiotic therapy or rifaximin may help reduce bloating. Psychological therapies seem to improve well-being in patients with IBS.

A 40-year-old Hispanic homemaker is admitted with a 3-week history of high fever, chest pain, and a dry, irritating cough. Her illness began insidiously with increasing right upper chest pain that is sharp, pleuritic, and rates a 6 on a pain scale of 1 to 10. The pain is associated with temperatures of up to 38.8°C (102°F) and chills, rigors, and profuse sweating that increase in the evening. Worsening dyspnea has been accompanied by a drop in effort tolerance.

Television ads promote a quick pharmaceutical "fix" for erectile dysfunction (ED). The afferent limb is greater recognition of the problem by health care providers and the lay public. The efferent limb is a prescription for a phosphodiesterase inhibitor. The downside of this reflex action may be a lack of insight into the clinical significance of ED.

An 80-year-old woman has a 3-month history of increasing dysphagia (withboth solids and liquids), fatigue, and dyspnea on exertion. She has also involuntarilylost 50 lb during the same period. She reports no abdominal pain orchange in bowel function.

A 58-year-old man presents with exertionaldyspnea of 6 weeks’ duration, adry cough for 2 weeks, and decreasedappetite. He denies fever, chills, sputumproduction, hemoptysis, cigarette smoking,and significant weight loss. Thepatient, a retired electrician, was exposedto asbestos 20 years earlier.

For 3 months, a 66-year-old retired man has had increasingweakness of the lower legs with stiffness,tingling, and numbness; worsening ataxia; anergia; andexertional dyspnea of insidious onset. He has lost 8 lb,and his appetite is poor. He denies fever, cough, chest orabdominal pain, paroxysmal nocturnal dyspnea, orthopnea,ankle swelling, bleeding disorders, hematemesis,melena, headache, vision problems, sciatica, joint pain,bladder or bowel dysfunction, and GI symptoms. He hasnocturia attributable to benign prostatic hypertrophy.

For the past week, a 16-year-old boy has had a progressively worsening dry, irritating cough; dyspnea on exertion; and intermittent fever and chills. During the past 24 hours, he has had no appetite and has vomited greenish material 3 or 4 times.

Q:How can I accurately determine when a patient’s hypertension isresistant to treatment-and what is the best approach to theevaluation?

A 32-year-old man complains ofknee pain that resulted when he felland twisted his right knee skiing theday before. He suffered other minorcontusions from the fall, but none ofthese required medical attention. Heis otherwise in good health and hasno relevant medical history.

A 16-year-old boy presents for evaluation of various lesionsthat have appeared on his extremities since he joined thewrestling team 2 months earlier. He is otherwise healthyand takes no medications.