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BARCELONA, Spain -- Two Swiss meta-analyses have found an increased rate of myocardial infarction and death with the Cypher (sirolimus-eluting) coronary stent, which is likely to put a serious chill in interventional cardiology's infatuation with drug-coated devices.

BARCELONA, Spain -- The concept of a single pill packed with the potency of aspirin, statins, and ACE inhibitors-the triad proven to prevent a recurrent heart attack-got a powerful push at the opening of the World Congress of Cardiology here.

In his “What’s Your Diagnosis?” column, Dr Henry Schneiderman discussed thecase of a young man with periorbital swelling caused by nephrotic syndrome(CONSULTANT, June 2001, page 1017) (Figure 1).

DALLAS -- For those with renal calculi who are intolerant of Urocit-K (potassium citrate), orange juice may outdo lemonade, according to small, crossover study.

ABERDEEN, Scotland -- Children whose mothers consume more foods containing vitamin E during pregnancy are less likely to develop wheeze or asthma by the age of five, according to researchers here.

While playing soccer, a 24-year-old man fell on his outstretched hand, felt a "pop," and immediately noticed a deformity of his wrist. He was in severe pain when he presented to the emergency department.

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This year, the American Academy of Allergy, Asthma, and Immunology (AAAAI) published guidelines for referring patients to an allergist/immunologist.1 The AAAAI's recommendations for patients with asthma were summarized in the July 2006 issue of

Two recent studies provide encouraging data about the effectiveness of voriconazole in the treatment of aspergillosis. One study found that voriconazole was effective in the management of subacute invasive aspergillosis and chronic pulmonary aspergillosis. The other study found that it was beneficial in the treatment of chronic cavitary pulmonary aspergillosis.

My patient, in whom allergic rhinitis has been diagnosed, has been receiving weekly allergy shots since June 2003 for allergies to dust, grass, mountain cedar trees, and ragweed. She has benefited greatly from these shots. However, she complains that she sometimes smells "cigarette smoke" for periods of 2 to 3 days--even though she is never exposed to it. What might be the cause of this?

ABSTRACT: The number of medical therapies for patients with erectile dysfunction (ED) has increased in recent years because of our expanded understanding of the physiologic and neurologic causes of ED. Oral agents range from testosterone to antidepressants to phosphodiesterase inhibitors. Nitroglycerin and minoxidil have shown some effectiveness as topical agents. Alprostadil, which can be applied intraurethrally, is also effective as intracavernosal injection therapy. Prostaglandin E1 and papaverine are effective as intracavernosal injection agents. Some studies have shown that combined use of intracavernosal injection and oral therapy produces satisfactory erections.

ABSTRACT: Our knowledge of chronic diseases has advanced significantly in recent decades, but patient outcomes have not kept pace. This is largely because the traditional acute care model does not adequately address the needs of patients with chronic disease. Patients play an active role in the management of chronic disease, and successful outcomes are highly dependent on adherence to treatment. Thus, clinicians need to have skills in coaching and encouraging as well as an awareness of factors in patients' backgrounds that are likely to affect their ability or willingness to follow treatment plans. Provider- and system-related factors, such as lack of reimbursement for counseling and high copayments, can also act as barriers to compliance. Among the strategies that can improve adherence are the use of community resources, multidisciplinary approaches, and regular follow-up.

An 11-month-old infant was referred by his pediatrician for possible surgical correction of a bilateral entropion. The mother stated that her son's lashes appear to turn in on occasion; however, he never rubbed his eyes, the eyes were not red, and no discharge or drainage was noted.

The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?" (CONSULTANT, July 2006, page 845), prompted a number of readers to write in. A selection of the comments received, along with a response from Dr Nash, appears below. Additional comments appear on www.ConsultantLive.com.

Five days after starting aspirin and warfarin with an enoxaparin bridge for new-onset atrial fibrillation, a 92-year-old man presented with abdominal pain, nausea, and vomiting. The patient appeared ill and was tachycardic. He had dry mucous membranes; pale sclerae; diminished bowel sounds; and a large, tender left lower abdominal mass. Hematocrit was 22% (baseline, 39%); hemoglobin, 6.8 g/dL; blood urea nitrogen, 65 mg/dL; and creatinine, 3.2 mg/dL (baseline, 1.3 mg/dL). His "pre-renal" ratio was 20. These findings were consistent with bleeding and acute renal failure. He also had a supratherapeutic international normalized ratio (INR) of 4.1.

A 62-year-old man presents with a violaceous, nonpruritic eruption that arose 2 weeks earlier on the hands and feet, including the palms and soles, and spread to the arms and legs (Figure 1). Over the past 3 to 4 weeks, he has had malaise, nonproductive cough, and a decline in mental status but no fever, headache, nausea, light-headedness, hemoptysis, or melena.

When young children have an irritant in their eyes, it can be very difficult to get them to open their eyes so that they can be irrigated. To reduce the stinging and make opening the eyes easier, try putting a drop of an ocular anesthetic in each medial canthus while the child is supine; be sure to wait for it to seep in.- D. Brady Pregerson, MD Los AngelesMore Practical Pointers