Obesity Medicine

NEW YORK - Tenor Luciano Pavarotti has had what was described as successful surgery for pancreatic cancer and will be undergoing additional treatment, presumably chemotherapy, over the coming months here.

CHICAGO - Patients with peripheral arterial disease who remain active in daily tasks such as shopping and walking have a third the risk of dying compared with those who are more sedentary.

Depression and obesity are often partners in pathology, according to investigators here.

Abstract: Although excessive daytime sleepiness is most often simply the result of inadequate sleep, other causes must be considered as well. Common causes of daytime sleepiness include obstructive sleep apnea/hypopnea syndrome (OSAHS) and medication side effects. The differential diagnosis also includes narcolepsy and restless legs syndrome (RLS). In many cases, the answers to a few simple questions can provide the necessary clues to the diagnosis. Loud snoring is associated with OSAHS, while sudden muscle weakness triggered by intense emotion is consistent with narcolepsy. Referral for sleep evaluation is indicated to evaluate for OSAHS, narcolepsy, RLS, and idiopathic hypersomnia. Methods of measuring daytime sleepiness include the Multiple Sleep Latency Test and the Epworth Sleepiness Scale. (J Respir Dis. 2005;26(6):253-259)

Abstract: Elderly persons with active tuberculosis may present with the classic features, such as cough, hemoptysis, and fever, but some patients present with less typical signs, such as hepatosplenomegaly, liver function abnormalities, and anemia. A high index of suspicion is required when a patient presents with cough or pneumonia unresponsive to conventional therapy. Acid-fast smear and mycobacterial culture of a sputum specimen are recommended for diagnosis. For an elderly patient who tests positive with purified protein derivative, 9 months of isoniazid prophylaxis is recommended. For patients who are intolerant of isoniazid or have been exposed to or infected by an isoniazid-resistant strain, rifampin single-agent preventive therapy may be an effective alternative. (J Respir Dis. 2006;27(7):307-315)

abstract: There is increasing evidence that close monitoring and early intervention lead to better outcomes in patients with cystic fibrosis. At each office visit, spirometry should be performed and sputum culture specimens should be obtained; if the patient cannot produce sputum, a throat culture can be done instead. New respiratory symptoms or other evidence of worsening lung disease should prompt antibiotic therapy, increased airway clearance, and adjunctive anti-inflammatory medication as appropriate. Close attention should be paid to the patient's diet, appetite, stooling pattern, and growth measurements. Adolescents should be given additional information about their medications and adjunctive therapies to encourage them to take on a larger role in their own care. (J Respir Dis.2006;27(7):298-305)

The authors describe a patient who presented with episodic hemoptysis and other respiratory symptoms. His chest radiograph showed a diffuse reticulonodular pattern. Bronchoscopy led to the diagnosis of pulmonary blastomycosis.

A 68-year-old woman presents with recurrent nausea, vomiting, left upper quadrant pain, decreased appetite, and a 2.3-kg (5-lb) weight loss 1 month after she underwent selective splenic artery embolization for refractory thrombocytopenia secondary to hypersplenism.

For 2 days, a 60-year-old man with a history of gout had excruciating pain in the left big toe. During 2 previous episodes, colchicine had relieved his symptoms. On this occasion, colchicine failed to provide relief. The patient's first metatarsophalangeal joint of the left foot was erythematous, hot, and tender. He could not bear weight on the foot. Other physical examination findings were normal.

Which of the rashes pictured here is cellulitis?

LOS ANGELES ? Children with headaches are more likely to be overweight or obese, researchers said here.

SAN FRANCISCO ? The 90-day risk of mortality from gastric bypass surgery can be calculated by a simple scoring system based on patient characteristics.

ROCKVILLE, Md. - The FDA has given Exelon (rivastigmine), already approved for treatment of mild-to-moderate Alzheimer's dementia, the added indication of mild-to-moderate Parkinson's dementia. It is the first agent approved for the Parkinson's condition.

DALLAS ? The American Diabetes Association (ADA) and the American Heart Association (AHA) have decided to paper over their differences on the validity of the metabolic syndrome as a treatable diagnosis.

GHENT, Belgium ? Inexpensive pedometers can't be counted on to keep step accurately, researchers reported here, and may send the wrong message in fitness-walking programs

ROCHESTER, Minn. - Heartburn is mainly a phenomenon of western culture, according to a systematic review of gastroesophageal reflux disease (GERD).

BOSTON ? High levels of retinol binding protein 4 (RBP4), which transports vitamin A as its main job, may be an early warning sign for insulin resistance and type 2 diabetes, according to researchers here.

HOUSTON - Unexplained vision loss may be related to vitamin A deficiency in patients with a history of intestinal or bariatric surgery, no matter how long ago, according to ophthalmologists here.

WASHINGTON - Lorcaserin, an investigational drug for the treatment of obesity, was successful at producing weight loss ranging between four and 7.9 pounds (1.8 to 3.6 kg) in a 12-week study, reported investigators here.

WASHINGTON - Liraglutide, an investigational injectable drug for type 2 diabetes, has produced significant decreases in HbA1c levels, as well as significant and sustained weight loss, according to phase 2 studies.

OAKLAND, Calif. ? Coffee may help protect the livers of heavy alcohol drinkers. In a cohort study of Kaiser Permanente members, drinking one to three cups of coffee a day was associated with a 40% decrease in the risk of alcoholic cirrhosis versus drinking less than one cup.

ROCKVILLE, Md. - The FDA today approved Wellbutrin XL (bupropion extended release) for prevention of major depressive episodes in patients with a history of seasonal affective disorder (SAD). It is the first drug approved for SAD.

WASHINGTON ? Januvia (sitagliptin), an investigational oral agent for type 2 diabetes, appears to be effective when given as a monotherapy or as an adjunct to Glucophage (metformin) or Actos (pioglitazone), reported researchers here.

WASHINGTON ? Antidepressant medications appears to further increase the risk of developing type 2 diabetes in those with impaired glucose tolerance, researchers reported here.

WASHINGTON ? Preeclampsia is an independent risk marker for type 2 diabetes, even when gestational diabetes is taken into account, reported researchers here today.

ROCHESTER, Minn. ?Treating obese patients with chronic hepatitis C infection with a diet-and-exercise regimen could improve both their overall health and their response to antiviral therapies, researchers suggest.

A 22-year-old woman presents with fever and malaise of1 month’s duration. About 3 weeks earlier she went to theemergency department. Erythromycin was prescribed,and the patient was told to seek medical attention if hercondition did not improve. Since that time, her healthhas worsened, the fever has continued, and she has lostweight. She says she has had painful areas on her handsand feet but no rash.

Patients with psychiatric disordersoften present a diagnostic challenge-even for psychiatrists. Their demeanormay not readily reveal the nature orseverity of the problem. Nevertheless,there are clues that can help you sortthrough the differential and arrive atthe correct diagnosis.

The authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.

Diabetic nephropathy, the leading cause of end-stage renal disease (ESRD) in the United States, affects 20% to 30% of patients with diabetes. Early diagnosis and aggressive treatment may delay the progression of kidney disease.