ROCHESTER, N.Y. -- Abdominal obesity in America's children has increased by more than 60% since 1988 through 1994, apparently thanks to supersized fast food, TV, and video games, according to researchers here.

BOSTON, Nov. 6 -- More than half of HMOs that responded to a national survey said they routinely incorporated pay for performance into 2005 physician contracts.

COLUMBUS, Ohio -- An estimated 17,000 school-age kids are treated in emergency departments for bus-related injuries annually, twice the number cited by previous estimates based on highway safety data.

INNSBRUCK, Austria -- Multiple organ dysfunction syndrome is the main cause of death in the intensive care unit, according to researchers here.

CHICAGO -- Abnormal fluorescence in situ hybridization (FISH) probe results significantly increase the risk of invasive lung cancer in smokers with severe or moderate dysplasia on bronchial biopsy, researchers reported here.

MONTREAL, Nov. 3 -- For the first time, researchers have shown directly that a deficiency in folate can lead to colorectal cancer -- at least in mice.

WARSAW, Poland -- Men are significantly more likely than women to have advanced colorectal cancer detected on colonoscopy screening, suggesting that gender should be factored into screening programs.

CHICAGO -- The tyrosine kinase inhibitor Sutent (sunitinib) has single-agent activity in patients with recurrent and advanced non-small cell lung cancer who have previously been treated with platinum-based regimens.

TORONTO -- Methamphetamine can be detected in the hair of newborns, the first direct evidence that crystal meth can cross the placenta and affect the growing fetus, researchers here reported.

PHILADELPHIA -- Low-intensity laser treatment is not effective at preventing complications or associated vision loss from the dry type of age-related macular degeneration, reported researchers here.

 A trip to the supermarket or a meal in a restaurant can be a challenge for patients who have celiac disease. Treatment of the disease consists of strict adherence to a gluten-free diet. This regimen can be difficult to follow because gluten is found not only in such obvious sources as wheat-based cereals and pasta but also in many processed foods (eg, salad dressings and gravies).1

Abstract: Allergic drug reactions are mediated by IgE. Other immunologic drug reactions are mediated by IgG and complement, T cells, systemic cytokine release, and mast cell activation. True drug allergies, which are IgE-mediated, account for less than 10% of all adverse drug reactions. IgE-mediated reactions are commonly seen with penicillins, but also occur with some other antibiotics, chemotherapeutic agents, therapeutic proteins, and neuromuscular blockers. They are often limited to urticaria but also include life-threatening anaphylaxis. Skin testing to identify patients who are allergic is available for many agents associated with IgE-mediated reactions. Protocols for desensitization permit the use of some culprit agents when indicated. (J Respir Dis. 2006;27(11):463-471)

Most established smoking cessation therapies are based on nicotine replacement therapy (NRT), which has shown only moderate effectiveness and been associated with health risks and compliance challenges. To date, the most widely used non-NRT treatment is the antidepressant bupropion hydrochloride. Now, however, another non-NRT agent, varenicline tartrate, has been developed specifically for smoking cessation. Two multicenter double-blind studies have demonstrated that this agent has both short- and long-term effectiveness.

ABSTRACT: Melanomas usually do not arise from nevi; they are thought to result from UV radiation-induced DNA damage and genetic factors. The most important risk factors for melanoma are a personal history of atypical nevi, a family or personal history of melanoma, and large numbers of nevi. The ABCD criteria (asymmetry, border irregularity, color variegation, diameter larger than 6 mm) help identify early, thin tumors that might otherwise be confused with benign pigmented lesions. The E criterion has recently been added: an evolving lesion (one that shows any change in size, shape, symptoms, surface, or color) warrants prompt evaluation. If melanoma is suspected, total excision--rather than shave biopsy--is required. Melanomas that are detected and treated in the radial or early vertical phase have an excellent prognosis.

When a patient with a history of severe anaphylactic reactions needs an epinephrine auto-injector, prescribe two rather than just one. An injector at home does a patient no good if he or she is at the office or out backpacking when a reaction occurs.

THECASE:An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema. Congestive heart failure is diagnosed, and the patient is admitted to the care of a hospitalist. A standard therapeutic regimen, including diuretics, angiotensin-converting enzyme inhibitors, and oxygen, is instituted, in addition to the patient's home regimen of isosorbide mononitrate, glipizide, and amlodipine. The hospitalsubstitutes pravastatin for the patient's atorvastatin. A Foley catheter is inserted by a urologist because of the patient's benign prostatic hypertrophy. The patient complains of insomnia and is given diphenhydramine. His hospital course is otherwise uneventful.

After shooting himself in the finger during target practice in his backyard, a 37-year-old man presented with a traumatic injury to the left second digit. The patient said he was looking through the scope at the target when he released the trigger. However, he failed to realize that his finger was still at the base of the barrel of his 22-caliber pistol. He reported no significant medical history, routine medication use, or drug allergies, and denied smoking. The patient, a social drinker, admitted to having 2 to 3 beers that day.

Inflamed hemorrhoids are traditionally treated with hemorrhoidal pads impregnated with witch hazel. I have found that ordinary baby wipes work just as well and in addition are readily available, less expensive, and less painful to use. Be sure to remind patients to purchase flushable wipes so that they don't later present you with a bill from the plumber!

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

To simplify knee aspiration (after a standard knee prep), use a regular vacuum tube with an adapter and a 21-gauge needle supplied by your laboratory. By switching tubes, you can remove as much fluid or blood as needed as well as a sample for cell count, culture, or crystal analysis if these are called for. Not having to change the syringe minimizes patient discomfort.