Obesity Medicine

A 72-year-old man was evaluated for worsening dysphagia and weight loss. The dysphagia had been intermittent for 20 years, but in the past year it had begun to occur daily. He regurgitated food after every meal, often many hours after ingestion.

For years, a 46-year-old African American woman had had progressive weight gain (despite a low-calorie diet), fatigue, and severe muscle cramps. On examination, Mandeep Hundal, MD, Rashid Khan, MD, Rajeev Garg, MD, and Niraj Mehta, MD, of the University of Texas Health Science Center at Houston, noted symmetrically distributed fatty lumps in the patient's neck, axillary and mammary regions, and proximal segments of the arms and legs. These findings are characteristic of Madelung disease, which is also known as multiple symmetric lipomatosis (MSL) or Launois-Bensaude syndrome.

BALTIMORE -- A poor childhood more than doubles the risk of early heart disease even among white male physicians who achieve a high socioeconomic status, found researchers here.

LEXINGTON, Ky. -- Yo-yo weight loss may increase the risk of gallstone disease in men, researchers reported.

BOSTON -- Cross ovulation and menstrual cycle patterns off the list for an explanation of why overweight women have less of a risk for premenopausal breast cancer, says a Harvard group. Instead, think hormonal for the perplexing protective effect.

DALLAS -- Weight-loss surgery may be too risky for older patients, according to a population-based study of outcomes.

SAN DIEGO -- High blood pressure during pregnancy may be a warning sign for stroke or other cardiovascular events later in life, reported researchers here.

WASHINGTON -- For overweight patients with osteoarthritis of the knee, even a relatively minor weight loss can make a significant long-term difference in improving quality of life, a researcher said here.

CHICAGO -- In a head-to-head trial with the sulfonylurea Amaryl (glimepiride), Actos (pioglitazone), a thiazolidinedione, appeared to slow the progression of a marker for atherosclerosis in patients with type 2 diabetes, researchers reported here.

PHILADELPHIA -- When a patient with an orthopedic implant develops a rash or inflammatory symptoms, think metal allergy, suggested researchers here.

STOCKHOLM -- Habitually downing one soft drink after another may nearly double the risk of pancreatic cancer, according to investigators here.

BOSTON -- Women who say no to carbs, but yes to protein as recommended in the South Beach and Zone diets, do not increase their risk of coronary heart disease, according to researchers here.

ST. LOUIS -- Decreasing caloric intake and increasing activity are equally effective at reducing the risk of diabetes, reported researchers here.

NEW YORK -- Uncomplicated diabetes does not affect 10-year heart transplant survival, but patients with diabetes-related renal disease or stroke do not do as well, reported surgeons here.

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.

STANFORD, Calif. -- Being poor in a rich neighborhood may be a health hazard, according to researchers here.

A 28-year-old man is hospitalized because of highfever with rigors and chills and rapid weight loss(5.4 kg [12 lb] in 2 weeks). During the past 48 hours,generalized throbbing headache, intermittent vomiting,blurry vision, and seizures have developed. The progressiveseizures started in the left hand and have becomegeneralized grand mal.

BOSTON -- Resveratrol, a compound in the skin of grapes and in red wine, lets mice chow down a high-calorie Big Mac-style diet without suffering many of the associated ill effects, according to researchers here.

ROSTOCK, Germany -- Obese youngsters in an intensive exercise regimen over six months shed not only pounds but signs of early atherosclerosis, researchers here reported.

Abstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)

A 23-year-old woman was referred to our interstitial lung disease (ILD) clinic with a diagnosis of LAM, a progressive cystic ILD that affects women of childbearing age. The patient had been a smoker since the age of 16, but she quit smoking about 2 months before the clinic visit, when she had a pneumothorax. At that time, she complained of sudden onset right-sided chest pain with shortness of breath for which she was admitted to her hometown hospital.

A 61-year-old woman presented with progressive dyspnea of 5 months' duration. She first noticed dyspnea while engaged in her usual daily activities, and it gradually progressed in severity. A primary care physician prescribed bronchodilators without relief. She was subsequently referred for a pulmonary evaluation.

A 20-year-old woman presented with a painless left facial mass that had slowly enlarged over the previous 2 years. There was no facial numbness or weakness. Her medical history was unremarkable, and there was no recent weight loss.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

In his recent editorial "Why We Need to Know the Limitations of Evidence-Based Medicine", Dr Gregory Rutecki questioned whether the findings of randomized controlled trials (RCTs) can be extrapolated to patients in primary care practices, who often have multiple comorbidities.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

A 20-year-old woman presented with a painless left facial mass that had slowly enlarged over the previous 2 years. There was no facial numbness or weakness. Her medical history was unremarkable, and there was no recent weight loss.

MADISON, Wis. -- Regular exercise three or more times a week reduced the risk of developing age-related macular degeneration by as much as 70%, researchers here reported.

SAN DIEGO, Calif. -- Strattera (atomoxetine) given to children with attention deficit hyperactivity disorder does not appear to stunt growth over the long term, according to a lengthy study.

LAS VEGAS -- A dozen patients have undergone safe and effective transoral stomach stapling, researchers reported here.