Lipid disorders

ORLANDO -- In gastrointestinal stromal tumors (GIST), the central -- and potentially initiating -- oncogenic mechanisms can be identified in virtually all cases, a pathologist said here.

STANFORD, Calif. -- The fact that Ponce de Leon grew old and died should have been an object lesson, but the search goes on for the fountain of youth. Take human growth hormone, a recent popular and expensive candidate. No way, say investigators here.

HOUSTON -- Investigators at the M. D. Anderson Cancer Center here have begun a small clinical trial of gene therapy for advanced non-small-cell lung cancer.

PHILADELPHIA -- An investigational drug appears to be effective against homozygous familial hypercholesterolemia, according to a small preliminary dose-escalation trial.

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.

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.

SEATTLE -- Starbucks, the giant coffee shop chain, has announced that it is banning trans fats, climbing aboard the nutritional bandwagon championed by the city of New York and promoted by the American Heart Association.

BOSTON -- More severe posttraumatic stress disorder (PTSD) increased the risk of coronary heart disease and myocardial infarction in older male veterans, researchers reported.

Salivary gland enlargement, most commonly involving one or both parotid glands, is sometimes seen in association with HIV infection. Enlargement of the parotid gland may be due to diffuse infiltrative lymphocytosis syndrome; lymphoepithelial cysts; or malignant tumors, such as squamous cell carcinoma, Kaposi sarcoma, and Hodgkin and non-Hodgkin lymphomas.1,2 Non–HIV-related causes of parotid enlargement include acute and chronic viral infection, granulomatous disease, malnutrition, alcoholism, and diabetes mellitus.3,4 Here we report the case of a 41-year-old HIV-infected man with fat maldistribution syndrome associated with type 2 diabetes and hyperlipidemia. Sialadenosis developed presumably as a result of HIV infection and hypertriglyceridemia.

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.

Your middle-aged patientwith type 2 diabetes wishesto start a weight-trainingprogram. What recommendationswill you offerhim? Another diabetic patient hasperipheral neuropathy; which exercisesare safest for her?

The FDA has approved injectable Acetadote (acetylcysteine)from Cumberland Pharmaceuticals Incto prevent or lessen liver damage resulting from an overdoseof acetaminophen. According to the FDA, unintentionalacetaminophen overdose is responsible for 100deaths and 56,000 emergency department visits per year.

Use this scale to easily rememberdesirable lipid levels:

In his "Consultations & Comments" response to a reader’scomments about statins and cancer risk in elderly patients(CONSULTANT, October 2003, page 1389), Dr David Nashnotes that the increased number of deaths from cancer thatoccurred in the second year of the Pravastatin in Elderly Individualsat Risk of Vascular Disease (PROSPER) study canprobably be attributed to disease that was already present beforethe start of the trial.

A number of my patients have very high high-density lipoprotein cholesterol (HDL-C)levels as well as elevated total cholesterol and low-density lipoprotein cholesterol(LDL-C) levels. One such patient is a nonsmoking middle-aged woman whose weightand blood pressure are normal.

Should statin therapy be initiated in all patients with diabetesregardless of their HbA1c and low-density lipoprotein(LDL) cholesterol levels?

“Put yourself out of business"

In his article, "Dyslipidemia: Closing the Treatment Gap"(CONSULTANT, April 1, 2003, page 451), Dr David Nashrecommends statin therapy for all eligible elderly patients.

When should children who have a family history of either type 1 or type 2 diabetesbe screened for prediabetes?

A46-year-old white man is hospitalized with increasing dyspnea of 3weeks’ duration. He has a history of stable chronic obstructive pulmonarydisease secondary to heavy smoking (2 packs of cigarettes a day for 27years, discontinued 6 years previously) and uses inhaled bronchodilators.

A chest film obtained as part of a routine insurance evaluation reveals a nodulein the right lower lobe of a 67-year-old man.

Q:Should we be prescribing α-blockers to control hypertension in lightof the ALLHAT findings of adverse effects?

A 45-year-old woman is admitted for evaluation of intermittentmidsternal chest pain that began 48 hours earlier.The pain is intense and radiates down both arms to theelbows; it has been accompanied by several episodes ofnausea and diaphoresis. She denies classic angina pectorisbut reports that she has experienced episodes of chestdiscomfort that is similar to her current pain-but muchless severe and without radiation-for about 3 months.She has no history of dyspnea on exertion, orthopnea, orparoxysmal nocturnal dyspnea.

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).

For 2 days, a 43-year-old woman has had a slightly tender rash on her trunk andextremities. Five days earlier, the patient was given levofloxacin for an upperrespiratory tract infection; because she is prone to yeast infections while takingantibiotics, fluconazole also was prescribed. Her only other medication is an oralcontraceptive, which she has been taking for several years.