Obesity

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

To initiate a discussion with a patient about excess weight without causing embarrassment or offense, try reporting the patient's body mass index.

A 44-year-old African American woman presented to the emergency department with constipation of 4 days' duration. She also complained of a sticking sensation in her throat over the past year and dysphagia to solids but not liquids. Over the past 2 years, she had an unintentional 40-lb weight loss, which she attributed to decreased appetite.

BOSTON -- As angry men age, taking a deep breath for an exclamation of rage may grow ever more difficult, according to investigators here.

NASHVILLE, Tenn. -- A glass of fruit or vegetable juice every other day may help fend off Alzheimer's disease, a prospective study of older Japanese-Americans suggested.

WASHINGTON -- Plates groaning with food, a society that discourages walking, and long hours of working and commuting are all conspiring to make Americans obese, according to a report released by a non-profit group.

LOS ANGELES -- In advanced ovarian cancer, excess weight shortens the time to recurrence and increases the risk of death, researchers here say.

IRVINE, Calif. -- Too much work is mirrored in high sphygmometer readings, according to a survey of those who toil in California.

ROCKVILLE, Md. -- Even carrying a few extra pounds in patients who are not frankly obese is enough to increase the risk of death, according to two large studies.

LEIDEN, The Netherlands -- Whether by road, rail, or air, travel for more than four hours caused a two-fold increase in the risk of deep-vein thrombosis, researchers here reported.

TORONTO -- Human growth hormone appears to reverse some elements of HIV-treatment related lipodystrophy, researchers reported here.

CINCINNATI -- Cellulite is forever, or pretty close to it, even in the face of weight loss, according to researchers here.

DALLAS -- Schools are not making the grade when it comes to physical education, according to the American Heart Association.

CHAPEL HILL, N.C. -- Patients can lose weight over the short term by following the dictates of their terminals, with automatically generated computer feedback reinforcing adherence to a healthy diet and activity regimen.

SEATLLE -- Low testosterone may be a signal that a man's body is running down-or maybe out.

LOS ANGELES -- Unmarried life may impinge on life expectancy, according to researchers here.

MINNEAPOLIS -- Teens with a poor body image tend to behave in ways that are self-perpetuating, researchers here said, and may react better to positive encouragement rather than to criticism.

BOSTON -- There are a lot more chubby babies than there used to be, reported investigators here. That goes for chubby preschoolers, too.

WASHINGTON -- The Physicians Committee for Responsible Medicine, a crusading group that has long ranked vegetarianism high on its agenda, has made a compelling case for a low-fat vegan diet to improve glycemic control.

ROYAL OAK, Mich. -- Morbidly obese patients with poor cardiorespiratory fitness are more likely to suffer major complications after bariatric surgery, according to researchers here.

WINSTON-SALEM, N.C. -- The waistline may succumb to a diet, but it takes exercise as well to shrink the size of subcutaneous abdominal fat cells that affect type 2 diabetes, according to researchers here.

STANFORD, Calif. -- Abnormal body-image concerns and the risk of a full-blown eating disorder in high-risk college-age women can be significantly reduced by an Internet-based behavioral intervention, researchers here reported.

LONDON -- For some patients with cardiovascular disease risk factors, the root cause may be the loneliness of childhood, according to a study that followed more than 1,000 adults from birth.

NEW YORK -- The summer is barely half over, and much of the country has had enough-enough of heat-related illness, enough heat-related power outages, and enough heat-related misery from a sweltering wave of extraordinary heat that broke records from coast to coast.

ATLANTA -- Weight gain of 5% or less among underweight tuberculosis patients after two months of induction treatment was associated with an increased risk of relapse, CDC researchers here reported.

The authors present a case that demonstrates the diagnostic challenge of mediastinal tumors. They describe the clinical presentation of a patient who had a central endobronchial tumor that was identified as a primary mediastinal spindle cell neoplasm.

We describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.

Abstract: Tracheobronchomalacia is a form of expiratory central airway collapse characterized by softening of the airway wall cartilaginous structures. Symptoms often mimic asthma and chronic obstructive pulmonary disease. Pulmonary function test results may suggest a diagnosis, but findings are neither sensitive nor specific. Bronchoscopy and novel dynamic radiographic studies contribute to the diagnosis and help differentiate true malacia from other forms of expiratory central airway collapse. Treatment options include medication; noninvasive ventilatory support; interventional bronchoscopy with airway stent insertion; and open surgical procedures, such as tracheostomy, tracheal resection, and tracheoplasty. (J Respir Dis. 2006;27(8):327-335)

How can I control elevated blood pressure (BP) in an older patient who is already taking 4 antihypertensive agents?

A middle-aged woman is experiencing episodes of chest pain and fatigue. Although stress test results are positive for ischemia, coronary angiography reveals open arteries. What next step would you take?