Infectious Disease

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.

ALAMEDA, Calif. -- In patients with chronic hepatitis C, a seven-gene test may outdo usual clinical risk factors in predicting the likelihood of advance to cirrhosis.

SILVER SPRING, Md. -- An FDA advisory panel has unanimously recommended accelerated approval of a novel antiretroviral drug as an add-on treatment for adult infected with CCR5-tropic HIV-1.

COPENHAGEN -- The use of protease inhibitors to treat HIV is associated with an increased risk of a heart attack, according to a large observational study.

COLOGNE, Germany -- For treating candidemia and invasive candidosis, micafungin (Mycamine) is as effective as liposomal amphotericin B, with fewer side effects, according to researchers here.

BOSTON -- Girls perinatally infected with HIV early in the AIDS epidemic have reached adolescence and a mixed picture is emerging on their reproductive health, researchers here reported.

NEW YORK -- Children with Helicobacter pylori infection have reduced risks of asthma and allergy, researchers here reported.

BRADFORD, England -- Well-meaning physicians may unwittingly induce delirium in older patients when they prescribe medications such as antihistamines or sleep aids, according to a literature review.

HOUSTON -- A large percentage of influenza deaths are the result of disease-triggered acute myocardial infarctions, researchers here reported.

ATLANTA -- A rabies-therapy protocol that saved an unvaccinated Wisconsin teenager from death in 2004 has not rescued two other youngsters, the CDC reported.

LONDON -- It's not easy to find clean studies on how to improve hand hygiene, reported investigators here after a literature search.

BALTIMORE -- Projections notwithstanding, easy access to so-called morning-after pills does not reduce population-level pregnancy rates, according to a meta-analysis.

LOS ANGELES -- Cervarix, an investigational cervical cancer vaccine, prevented all precancerous lesions because of human papillomavirus types 16 and 18 for 5.5 years, researchers reported here.

ROCKVILLE, Md. -- A vaccine against the H5N1 avian flu has been approved by the FDA.

HOUSTON -- Rotavirus infection, the most common cause of severe pediatric diarrhea, spreads beyond the intestines into the bloodstream, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

LOS ANGELES -- Darbepoetin alfa (Aranesp) should not be used for treatment of anemia caused by cancer, researchers here reported. Compared with placebo, darbepoetin hastened death despite significantly reducing the need for transfusion.

BARCELONA, SPAIN -- The ability of the investigative protease inhibitor telaprevir to rapidly reduce levels of hepatitis C virus hints that shorter treatment regimens may be possible, researchers reported here.

How long does immunity against polio last in a person vaccinated with oral poliovirus vaccine (OPV)? With inactivated poliovirus vaccine (IPV)?

Topical corticosteroids remain the mainstay of treatment, especially in patients with erythematous, acutely inflamed psoriatic plaques. The topical immunomodulators tacrolimus and pimecrolimus are used to treat psoriasis, although neither has FDA approval for this indication. Unlike corticosteroids, immunomodulators do not cause skin atrophy, irreversible striae, acne, or tachyphylaxis. Newer topical vehicles of delivery (eg, foam clobetasol propionate) and newer drug combinations (eg, once-daily calcipotriene/betamethasone dipropionate ointment) may improve efficacy and reduce side effects. Reserve systemic therapy for patients with moderate to severe psoriasis. Until more long-term safety data become available, be cautious about prescribing biologic agents for patients at risk for infection (particularly tuberculosis) and malignancy.

A 60-year-old man was hospitalized with fever and hypotension secondary to recurrent cellulitis of the left leg. He had a history of polysubstance abuse and hepatitis C. Elephantiasis nostras verrucosa was diagnosed based on bilateral nonpitting edema and hyperkeratotic verrucous lesions in the pretibial area. The patient's erythrocyte sedimentation rate and white blood cell count showed evidence of infection; osteomyelitis of the left fifth metatarsal head was suspected.

A 29-year-old sailor presented with a painless, enlarging, reddish, mobile lump under his left nipple. Four months earlier, while on deployment in the South Pacific, he had his nipples pierced on a whim.

A 63-year-old man with myelodysplasia presented with oral thrush, intranasal dryness, and congestion that developed 2 months earlier. Intranasal saline rinse and sleeping with the head elevated temporarily relieved the nasal symptoms.

ROCKVILLE, Md. -- The FDA has given a thumbs up to a topical antibiotic treatment for impetigo in children who are nine months or older.

BIRMINGHAM, England -- A cluster of six matching cases of tuberculosis here in 2005 originated from one person's exposure to bovine TB, strongly suggesting human-to-human spread, British researchers reported.

ATLANTA -- The rate of fluoroquinolone-resistant gonorrhea has become so high in the U.S. that physicians have been urged to switch to the last line of defense, the cephalosporins.

RIO DE JANEIRO -- The novel investigational drug raltegravir was highly effective at reducing the level of virus in their blood of extremely sick HIV patients, many of them with AIDS, according to researchers here.

BARCELONA, Spain -- Patients with hepatitis C virus infection who achieve a sustained virologic response to therapy should be considered cured, said investigators today.

ROCHESTER, Minn. -- The source of Staphylococcus aureus bloodstream infections that develop after cardiac devices are implanted may be the devices themselves, researchers reported.