Obesity Medicine

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?

Child With Dysphagia, Fever, and Weight Loss

A description of the evaluation of the various manifestations of chronic venous disease.

BOSTON -- It may seem axiomatic, but a pedometer-based study here has provided empirical confirmation that adults who watch more television are less physically active.

BOSTON -- The increase of obesity in the U.S. has doubled the number of poor-quality radiology reports, labeled "limited by body habitus," over 15 years, researchers reported.

BOSTON -- Two common genetic variants appear to contribute to the development of type 2 diabetes for some patients with impaired glucose tolerance, found researchers here. But lifestyle moves seem to be able to combat the enhanced risk.

BETHESDA, Md. -- Dietary supplements such as antioxidants, vitamins, and garlic do little if anything to prevent cancer, but antibiotics aimed at cancer-causing bacteria appear to prevent some tumors.

NEW YORK -- For super morbidly obese patients, Roux-en-Y gastric bypass surgery is a better approach than gastric banding, according to researchers here.

BOSTON -- Hefty teens may pay a heavy price later on, dying long before they are Medicare-eligible, researchers here reported.

PHILADELPHIA -- Extremely overweight teens lost an average of 14 pounds in one year with a combination of behavioral therapy and the weight-loss drug Meridia (sibutramine), researchers reported.

AARHUS, Denmark -- Older women and men who live alone have a two- to three-fold higher risk for unstable angina, myocardial infarction, or sudden cardiac death, researchers here reported.

BOSTON -- Women with type 2 diabetes have a nearly two-fold increased risk of developing primary open-angle glaucoma, the most common form of the disease, found researchers here.

BOSTON -- Women who gain weight as adults and after menopause are at an increased risk for breast cancer, but the reverse is also true, researchers here reported.

ROCHESTER, N.Y. -- Patients taking the antipsychotic Clozaril (clozapine) for schizophrenia need to be monitored for signs of metabolic syndrome, according to investigators here.

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)