MANCHESTER, England -- Patients with inflammatory polyarthritis, often a precursor to rheumatoid arthritis, are 40% more likely than the general population to die of cancer, according to a prospective cohort study.

SEATTLE -- Aspirin and other NSAIDs decrease the risk of progression of the most aggressive form of Barrett's esophagus to esophageal cancer, researchers here reported.

Research Focus: Recent Developments in HIV Therapeutics

The results of the first prospective study on diet and the risk of venous thromboembolism (VTE) were recently reported by Steffen and colleagues. The bottom line: higher consumption of fish, fruit, and vegetables and lower consumption of red meat and processed meat are associated with reduced risk of VTE.

The authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.

In addition to causing classic symptoms such as heartburn, gastroesophageal reflux (GER) is thought to cause a number of non-GI symptoms, such as cough and sore throat. Animal studies also suggest that GER may cause eustachian tube dysfunction. Now, a study from Japan indicates that there may be a link between GER and otitis media with effusion (OME) in adults.

To relieve the pain of plantar fasciitis, have patients roll their foot over a can of frozen concentrated juice. This massages the fascia and also reduces inflammation.

This infection is caused by reactivationof varicella-zoster virus (VZV),which may remain latent in thedorsal root and cranial nerve gangliafor decades. Reactivation oftenoccurs for no apparent reason, althoughstress and immunosuppressionmay increase the risk.

ABSTRACT: Antiplatelet agents used to treat non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina include aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors. Aspirin is recommended for all patients with acute coronary syndromes (ACS). Clopidogrel can also be used in all patients with ACS, although this agent increases the risk of major bleeding complications if coronary artery bypass grafting is performed less than 5 days after the last dose. Early use of a GP IIb/IIIa inhibitor provides additional benefit in patients with NSTEMI, particularly those who undergo percutaneous coronary intervention. Agents used for anticoagulation in patients with NSTEMI or unstable angina include unfractionated heparin, low molecular weight heparins (LMWHs), and the direct thrombin inhibitor bivalirudin. Enoxaparin-the only LMWH currently indicated for treatment of patients with NSTEMI-can be considered as an alternative to unfractionated heparin, particularly in those who do not require urgent cardiac catheterization.

In his "What's Your Diagnosis?" case of an 89-year-old woman with advanced Alzheimer disease who had injuries attributed to a fall in a nursing home (CONSULTANT, October 2006, page 1373), Dr Henry Schneiderman notes that "the fall was not observed" and that "many prior falls have been ascribed to her lack of safety awareness in negotiating the environment."

Vitamin B12 deficiency is common; the estimated prevalence is about 15%. It can also be cumbersome to treat. The "gold standard" for therapy has been monthly intramuscular injections of 1000 µg of vitamin B12. The hidden costs of this treatment are the pain of the injections and the travel requirements for either the patient (who is often an older adult) or the visiting nurse.

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

A 14-year-old girl came to the officewith severe hip pain, which occurredafter she attempted a cheerleadingmaneuver on a trampoline. She reportedthat she was bouncing as highas she could and landed on the trampolinewith her left knee flexed andher right hip extended. On impact,she felt a “pop” that was immediatelyfollowed by right hip pain.

Hydroxyurea and oxygen therapy have been used to reduce the frequency of sickle cell crises. Can you tell me whether there is a role for vasodilators (eg, hydralazine and angiotensin-converting enzyme [ACE] inhibitors) and/or pentoxifylline in the treatment of affected patients?

The assessment of cogwheel rigidity requires checking for smooth flexion and extension of the elbows and wrists. However, many patients stiffen their joints when they are aware that you are checking for stiffness. To obviate this problem, begin by asking whether they have any joint pain, then proceed to flex and extend their joints.

Many patients have difficulty with self-administration of eyedrops. Refrigerating the eyedrops may help them determine whether they have instilled the drops appropriately: they will be able to feel where the cold drops land.

To relieve the pain of plantar fasciitis, have patients roll their foot over a can of frozen concentrated juice.

Because we see many sexually abused children in our practice, we invite the mother to help with superficial labial/vaginal examinations in young girls.

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SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.