Obesity Medicine

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

An obese 52-year-old woman with a 5-year history of type 2 diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food "sticking" in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

ABSTRACT: In addition to appropriate pharmacotherapy and assistance with smoking cessation, a secondary prevention plan should include counseling about a heart-healthy diet, a structured exercise program and/or increased physical activity, and assessment of psychosocial risk factors, such as depression. Advise patients to reduce their intake of salt, sugars, refined carbohydrates, and saturated and trans fats; incorporate more fruits, vegetables, and fish into their diet; and balance caloric intake and physical activity to achieve and maintain a body mass index between 18.5 and 24.9 kg/m2. Cardiorespiratory fitness is the key to cardioprotection; the threshold for improving it in persons with coronary heart disease is about 70% of the mea-sured maximal heart rate. Encourage patients to engage in multiple short bouts of physical activity daily, such as taking the stairs instead of the elevator or walking the dog. Among previously sedentary persons, this approach has effects on cardiorespiratory fitness, body composition, and coronary risk factors similar to those of a structured exercise program.

o avoid the trauma to the fingers that can occur when you percuss a patient's chest or abdomen, use a reflex hammer to percuss the finger that is flush with the chest.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

A 45-year-old man sought medical advice after suffering for 6 months with recurrent pain and a purulent discharge at the sacrococcygeal region. Two weeks before this consultation, an abscess on the patient's right buttock had been drained by another physician. The patient had type 1 diabetes mellitus for 5 years; his medical history was otherwise unremarkable.

Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

BETHESDA, Md. -- Heart disease risk factors in early adulthood presage atherosclerosis in middle age, suggesting that early intervention may be beneficial, researchers found.

BOSTON -- The gender gap in multiple sclerosis has doubled over the past six decades, reaching about four women with the disease for every affected man, investigators reported here.

ALAMEDA, Calif. -- In patients with chronic hepatitis C, a seven-gene test may outdo usual clinical risk factors in predicting the likelihood of advance to cirrhosis.

COLORADO SPRINGS, Colo. -- For prospective gastric bypass patients, surgeons may have a better tool to help gauge the risk of mortality from the procedure, researchers said here.

ANN ARBOR, Mich. -- Several genetic regions appear to contribute to the risk of developing type 2 diabetes, three research groups have found in a major collaborative effort.

BOSTON -- Patients 90 or older with acute coronary syndromes have decreased hospital mortality when recommended therapy guidelines are followed, researchers have reported.

BOSTON -- The risk of progression for advanced age-related macular degeneration may involve common variations in two genes, an effect amplified by risk factors such as smoking and obesity.

MIDDLESBROUGH, England -- Whole-grain oats can carry the lipid-lowering banner higher than other whole grains -- but not too high.

DURHAM, N.C. -- Strains, sprains, and pains are more common in obese employees than in normal-weight workers, costing U.S. companies billions of dollars, researchers here reported.

WINSTON-SALEM, N.C. -- Vitamin D deficiency in older patients has been associated with poor performance on simple physical tasks, according to investigators here.

SAN ANTONIO, Tex. -- Enoxaparin (Lovenox), a low-molecular-weight heparin, proved more effective than unfractionated heparin for preventing potentially fatal leg and lung clots after acute ischemic stroke, researchers reported.

CHICAGO -- Those habitual college keggers could be chugging toward heart disease later in life, investigators reported here.

OXFORD, England -- Use of hormone replacement therapy for at least five years added up to 1,300 additional ovarian cancers over 14 years in Britain and 1,000 extra deaths, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

SEATTLE -- Increases in fasting plasma glucose in non-diabetic patients appear to be caused by decreased glucose clearance rather than an increase in hepatic glucose production.

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

NEW YORK -- More than half the states have tied payment to performance for Medicaid services for some of their health care programs, according to a survey just published.