NEW YORK -- Cardiac surgery can be performed safely in many patients with mild liver cirrhosis, and in select patients with moderate cirrhosis, according to investigators here.

WASHINGTON -- Medicare's Part B physician fee schedule will be cut 9.9%, starting next January, the government has announced, prompting anguished warnings from the AMA of decreased access to medical services for seniors.

BOSTON -- Testing for cystatin C appears to be as good as, if not better than, standard measures of kidney function to predict mortality risk in advanced chronic kidney disease, researchers found.

STANFORD, Calif. -- Compared with nifedipine (Procardia), magnesium sulfate was significantly more likely to cause serious maternal site effects when used to prevent preterm labor.

NEW YORK -- Showing evidence of a link between environmental factors and migraine, investigators here found that a higher family income may protect adolescents against migraine -- if they have no genetic predisposition to it.

A 38-year-old HIV-infected man with a CD4+ cell count of 4/µL and an HIV RNA level of more than 750,000 copies/mL was admitted to the hospital after 1 month of painful right neck swelling and 1 week of dysphagia.

Pain is recognized as a significant disability in HIV-infected persons.

Both HIV and its treatment, particularly protease inhibitors, can cause dyslipidemia similar to that seen with the metabolic syndrome. The most notable effects are elevated triglyceride levels and decreased high-density lipoprotein cholesterol levels, with or without elevated low-density lipoprotein cholesterol (LDL-C) levels.

Elevated fasting triglyceride levels and low levels of high-density lipoprotein cholesterol (HDL-C) are the hallmarks of HIV-associated dyslipidemia. Despite the perception of many HIV-infected patients and their clinicians, low-density lipoprotein cholesterol (LDL-C) levels among persons infected with HIV-even those receiving antiretroviral therapy––tend to be lower than those in uninfected controls.1,2 During antiretroviral therapy, increases in all lipid parameters are common; however, it is dramatic rises in triglyceride levels that for a number of reasons can be of the most concern.

One of the 2 feature articles this month in The Aids Reader is a review of the literature on the management of dyslipidemia. In this article, Dr Craig E. Metroka of Columbia University and colleagues focus on the use of fish oil to reduce elevated triglyceride levels, an independent risk factor for cardiovascular disease and a hallmark of antiretroviral-related dyslipidemia.

For many of us, the term "prejudice" translates into racism and then into the range of negative, stereotyped assumptions about others based on no more than externally observable features such as skin color or eye shape. We further translate this into discrimination and the full negative history of treating those whom we observe to be racially different.

AIDS Seen as New Threat to African Democracy A new study suggests that HIV/AIDS is hitting elected officials hard in southern Africa, thus posing a new threat to democracy and governance (Felix B. Reuters. June 4, 2007). The report was released in advance of South Africa's biannual AIDS conference in Durban.

In a midsummer issue of the Journal of Infectious Diseases, Dr Anthony Fauci1––who is as close as the United States comes to a tsar of AIDS medicine––describes 7 HIV-infected persons who had received protease inhibitor (PI)-based antiretroviral therapy for an average of 40.4 months (range, 31.1 to 54 months).

abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)

The effectiveness of corticosteroids in the prevention of postextubation laryngeal edema is controversial, but a recent study conducted in France indicates that the administration of methylprednisolone before a planned extubation does, in fact, reduce the incidence of laryngeal edema and reintubation.

The development of an enzyme-linked immunosorbent assay (ELISA) that detects the glycoprotein galactomannan represents an important advance in the diagnosis of invasive aspergillosis. Foy and associates found evidence that the galactomannan ELISA is a highly specific diagnostic tool when used to screen patients who are undergoing hematopoietic stem cell transplantation (HSCT).

At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.

Guest Commentary

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

Young children are prone to scrapes and bruises. I recommend to their parents keeping a tray of miniature party-type ice cubes in the freezer.