Obesity

In her response to a reader’s question about clot prevention in a patient with systemiclupus erythematosus (SLE) and anticardiolipin antibody syndrome,Dr Bonnie Bermas recommends warfarin (CONSULTANT, September 15, 2003,page 1329).

A 21-year-old man presents to the emergency department with abdominal painof 6 hours’ duration. When the pain began, it was diffuse and periumbilical; now,it is worse and localized to the right lower quadrant. It has been accompanied byanorexia but not by diarrhea or emesis. Lying down, consuming liquids, andshowering have not provided relief.

Q:How frequently does hypertension occur in association withobstructive sleep apnea (OSA), and how is OSA best treated?

A 38-year-old woman presents with a pruritic, tender rash on the trunk and extremitiesthat has not changed over the past few days. She has taken fluvastatinand sertraline for 1 year and a popular, over-the-counter weight-loss product for1 or 2 weeks. The patient denies using any other medications. She has had norecent illnesses.

A 41-year-old woman presents as a new patient, with complaintsof chest pain and palpitations that occur intermittentlyand are not associated with activity, meals, or position.She says these symptoms have been present forsome time, and she expresses frustration that her previousphysician was unable to find their cause or to amelioratethem.

A 60-year-old man has had anterior neck discomfort for the pastseveral weeks. He also has right-sided cephalalgia and occasional jaw discomfortwhile eating but no dysphagia or odynophagia. The cephalalgia, which hasbeen present for the past week, is moderately severe and is associated withblurred vision.

For about 3 to 4 months, a 53-year-old man has had gradually worsening footdiscomfort. He describes the discomfort as a burning sensation accompaniedby numbness and tingling. Initially, these symptoms were present only in hisfeet, but for several weeks they have involved both ankles as well. Althoughthe discomfort is always present, it is occasionally aggravated by the bed coversor by heavy woollen socks. The patient has no skin lesions, motor symptoms,or other abnormalities of his legs or feet.

For 3 weeks, a 52-year-old woman has had right-sided, intermittent, dullabdominal pain and jaundice; these symptoms have worsened in the past fewdays. The pain radiates to the back, worsens with movement, is somewhatrelieved in certain positions, and is unrelated to eating or defecation. Duringthe past 3 weeks, she has also noticed darkening of her urine, a profound decreasein appetite, and an increase in fatigue; she has lost considerable weightbut is unsure of the exact amount. She has had no nausea, vomiting, or melenaor other change in her bowel movements.

A 64-year-old woman presentsto the emergency department withworsening crampy abdominal painthat began the night before. Afterthe pain started, she had a bowelmovement containing a significantamount of blood; since then she hashad episodes of diarrhea. She hadbeen previously healthy, denies traumaand fever, and knows no one withsimilar symptoms. She reports norecent enema, endoscopy, or otherabdominal procedure.

An 84-year-old woman with hypertension and type 2 diabetes mellitus isbrought to the emergency department (ED) after an episode of nearsyncope.When emergency medical service personnel initially assessed her,blood pressure was 96/60 mm Hg and heart rate was “slow”; however, shehad no symptoms.

A 74-year-old man with a history ofatrial fibrillation presents to hisprimary care physician with dyspneaof 4 days’ duration. The dyspnea developedwhile he was walking as partof his recovery from back surgery forspinal stenosis 1 month earlier. Hebecame progressively short of breathand was unable to carry out his exerciseprogram.

A 56-year-old woman complainsof right hip pain that has been presentfor several weeks but has recentlyworsened. She denies recent trauma,fever, and increased physicalactivity. She has no history of arthritis,but she does have systemiclupus erythematosus, which a dailyregimen of prednisone, 20 mg PO,has kept in remission. Her medicalhistory is otherwise unremarkable.

A 56-year-old man with insulin-dependent type 2 diabetes is hospitalized foroperative debridement of an ulcer on his left heel. During the preoperativeevaluation, atrial fibrillation (AF)-with a ventricular rate of 130 beats perminute-is detected.

An 84-year-old woman presents with a 3-year history of slowly progressivememory impairment accompanied by functional decline. Thepatient lives alone but has been receiving an increasing amount of support from her 2 daughters,who accompany her to the appointment. The daughters first noticed that their mother was havingtrouble driving. About a year ago, she started forgetting family recipes. She also left food cookingon the stove unattended and burned several pans. Currently, the daughters are providing mealsand transportation, assisting with housework, and doing their mother’s laundry. They have becomeincreasingly alarmed because she takes her medications only sporadically, despite the factthat they fill her pillboxes and call her regularly with reminders. Their chief concern is whether itis safe for their mother to continue to live alone.

A 13-year-old boy complains ofpain in his right hip. The pain began3 days earlier after he was tackledseveral times while playing footballwith his friends. He was able to walkhome. The pain has increased sincethat time. Although the patient is stillable to walk, he now has a limp andfavors his left leg. The patient isotherwise healthy and has no significantmedical history.

About 30% of American adults are obese, and an additional34% are considered overweight. As the prevalence of obesityincreases, so does the incidence of related medical disordersand mortality. Here a team of experts highlights the clinicalimplications of recent research on obesity.

Tanisha, 12 years old, comes to your office with left knee pain. Her father says she has complainedfor about 10 days, but she insists that the pain began about 3 weeks ago. When askedabout the quality of the pain, she responds by saying, “It just hurts.” She denies any injury ordiscomfort involving the hip or ankle and direct trauma to the knee. She rarely plays sportsor games that involve intense running or other physical activity. There is no recent history offever or respiratory or GI symptoms.

For several months, a 16-year-old girl has had an asymptomatic papulosquamousdescending linear eruption on 1 leg.

An 84-year-old woman presents with a 3-year history of slowly progressivememory impairment accompanied by functional decline. Thepatient lives alone but has been receiving an increasing amount of support from her 2 daughters,who accompany her to the appointment. The daughters first noticed that their mother was havingtrouble driving. About a year ago, she started forgetting family recipes. She also left food cookingon the stove unattended and burned several pans. Currently, the daughters are providing mealsand transportation, assisting with housework, and doing their mother’s laundry. They have becomeincreasingly alarmed because she takes her medications only sporadically, despite the factthat they fill her pillboxes and call her regularly with reminders. Their chief concern is whether itis safe for their mother to continue to live alone.

For 3 months, a 57-year-old woman has had a persistent green nail that is occasionallyslightly sore; the nail plate has lifted. Another physician prescribed a7-day course of levofloxacin for a suspected Pseudomonas infection; the treatmenthad no effect on the nail. A subsequent 7-day course of norfloxacin wasalso unsuccessful. The patient is otherwise healthy.

A 41-year-old woman with a 4-yearhistory of polymyositis with lupus featureshas had constant rectal pain for4 months. She has not noticed any factorsthat either aggravate or relievethe pain. The patient complains of intermittentconstipation (but no dischargeor rectal bleeding), generalizedweakness and malaise for the past 2months, a low-grade fever for the pastmonth, and a 4.1-kg (9-lb) weight lossover the past 6 weeks. She denies nightsweats or chills, anorexia, vision problems,drug allergies, and tobacco oralcohol use.

A 24-year-old woman complains ofa pruritic rash that erupted after shesoaked in a hot tub a few days earlier.The patient is otherwise healthy;her only medication is an oralcontraceptive.

Highlights:➤What to tell your patients about thebenefits-and risks-of mammography.➤A realistic look at cancer screening: Arewe overstating the benefits?➤Which screening strategies you canrecommend with confidence.➤How best to bring the patient into thedecision-making process.

This painful, blistery eruption recentlydeveloped on the hand of ateenage girl. She claims she has hadno other such lesions. What doesthis look like?

A30-year-old man complains of chest pain, dyspnea, fever, and nonproductivecough that began earlier in the day. The pain is constant and does notdiminish with rest; it worsens somewhat with deep inspiration and has localizedto the left chest. The patient has had no nausea, vomiting, or abdominal pain.He has been immobile for several years secondary to spinal cord disease buthas no history of cardiopulmonary disease.

ROCHESTER, N.Y. -- Childhood obesity remained a focus of pediatrics during the year, along with concerns about safety, particularly the safety of psychiatric medications.

MONTREAL -- Early reports about promising investigational compounds and new insights into the effect of diet on the gut were highlights in gastroenterology during the year.

ATLANTA -- The long-running debate about treatment choices for early localized prostate cancer remained the focus of much research into the disease during 2006, a year in which malignancy of the gland was the second leading cause of cancer deaths in American men.

ROCKVILLE, Md. -- Against the background of the growing incidence of type 2 diabetes and obesity in the United States came news this year about the first new insulin delivery system in 80 years, as well as new categories of drugs for type 2 disease.

NEW YORK -- The ban on trans fats in this city was the highest profile event during the year in diet and nutrition, as Americans continued to struggle against ever-expanding waistlines and foods deemed unhealthy.