Obesity Medicine

A 13-year-old girl who had leukemia presented to the emergency department with fever; chills; weight loss; fatigue; and a painful, erythematous rash with a central black lesion on the upper thigh. The patient was neutropenic and had been undergoing chemotherapy for 1 week.

A 6-year-old boy is brought for evaluation of bloody diarrhea, fatigue, decreased appetite, weight loss, and occasional, mild abdominal pain of 2 months' duration. The child had 6 to 8 bowel movements daily, 1 or 2 of which occurred at night.

The dark red plaques seen here developed rapidly under both arms of this markedly obese 43-year-old woman. The lesions spread concentrically, forming necrotic ulcerations with overhanging borders, and there was surrounding violaceous discoloration. No other areas of the patient's body were involved, and she was otherwise in good health.

Severe shortness of breath, a dry cough, and a 10-day history of fever sent a 37-year-old man with HIV disease to the emergency department. He complained of a poor appetite and had lost 10 lb over the last 10 days.

A 35-year-old Nigerian man presented to the emergency department with a distended, tender abdomen; fever; and weight loss. His abdomen had grown increasingly large during the past several months as his appetite diminished. The patient reported no allergies, took no medication, and denied tobacco, alcohol, and illicit drug use. His only significant medical history was jaundice during adolescence.

A 53-year-old woman had complained of pain in the lower right quadrant of her abdomen for 1 year. She claimed that the pain intensified when she bent forward in a particular position but believed it was unrelated to food, bowel movements, or urination. There was no weight loss, vomiting, or melena. There was no family history of colon cancer or inflammatory bowel disease.

A 30-year-old woman was brought to the hospital with syncope, bradycardia, and hypotension. For the past 6 years, she had vomited after eating meals and after occasional episodes of binge eating.

A 65-year-old man was hospitalized with dyspnea and fever of a few days' duration. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The patient had a history of alcohol abuse.

A 41-year-old man with a past history of tuberculosis presented to the emergency department with massive hemoptysis. The patient denied fever or chills but reported a 20-lb weight loss and intermittent hemoptysis during the last 6 months. Six years ago, he had been treated for tuberculosis.

During the past few months, a 50-year-old woman had experienced cough, dyspnea, mild hemoptysis, and a 30-lb weight loss. She had no fever, chills, or rigors. The patient had smoked cigarettes for 30 years.

An obese 61-year-old man who had chronic obstructive pulmonary disease and sleep apnea heard a “pop” in his stomach while lifting a heavy weight; severe abdominal pain followed. He was short of breath the next morning, and his physician empirically prescribed cephalexin.

A 67-year-old man with a 5-month history of cough, shortness of breath, and pain in the left anterior chest wall sought medical evaluation. The patient denied fever, chills, and hemoptysis. He reported a recent weight loss of 25 lb. The patient had smoked cigarettes for 37 years.

A 70-year-old man-nursing home resident-had had a cough, fever, and copious foul-smelling sputum for 1 week. Hemoptysis was noted off and on during the previous 3 days. The patient had no recent weight loss. A chest x-ray film and a CT scan showed an air-fluid level in the left oblique fissure of the lung as well as pleural thickening and infiltrates in the left lower zone.

A 37-year-old man presented with fever, chills, myalgia, headache, and left-sided pleurisy of 2 weeks' duration. He also complained of weight loss and loss of appetite. The patient had recently returned from a family visit to Missouri.

Systemic lupus erythematosus (SLE) was diagnosed in an 18-year-old man who presented with polyarthritis, fever, hypoxia, fatigue, anemia, neutropenia, and abnormal urinary sediment. A renal biopsy showed diffuse mesangial proliferative glomerulonephritis (World Health Organization class II). Serologic tests were positive for fluorescent antinuclear antibody (FANA), SS-A, SS-B, anti-Sm and anti-dsDNA antibodies, and rheumatoid factor; a direct Coombs' test result was positive as well.

Here are two cases that demonstrate the discovery of aortic aneurysms through careful and complete physical examination and via radiographic studies obtained to evaluate other conditions.

A 67-year-old woman presented to the emergency department (ED) with severe, sharp, central chest pain of sudden onset and mild shortness of breath. The pain had been present for 15 minutes. The patient was obese; her medical history included hypertension, myocardial infarction, and osteoarthritis.

Abstract: The idiopathic interstitial pneumonias (IIPs) are the most commonly diagnosed forms of interstitial lung disease. These diseases represent specific clinicopathologic entities characterized by varying degrees of lung parenchymal inflammation and fibrosis. While most patients present with chronic dyspnea and have evidence of restriction on pulmonary function testing, certain findings can help differentiate among the IIPs. For example, patients with idiopathic pulmonary fibrosis (IPF)--the most common IIP--commonly present in the sixth or seventh decade of life, while those with desquamative interstitial pneumonia or respiratory bronchiolitis with interstitial lung disease typically present in the third or fourth decade of life and have a history of smoking. IPF is characterized by usual interstitial pneumonia (UIP) on lung biopsy; a UIP pattern can also be identified by high-resolution CT. (J Respir Dis. 2005;26(9):372-378)

A 53-year-old man presented with a 3-day history of bilateral pain in the lower extremities. He also had a 3-month history of thickening and desquamation of skin, with associated itching, and a 5-lb (2.27-kg) weight loss. The skin changes initially appeared on the hands and subsequently became generalized.

A 63-year-old woman presents to the emergency department with a 3-day history of abdominal pain, nausea, and obstipation. The pain is located in the left lower quadrant and is sharp, constant, and nonradiating.

For 2 days, a 79-year-old moderately obese woman had experienced abdominal pain, nausea, and vomiting. The pain was at the level of the incision for the colon cancer surgery she had undergone several years earlier. The patient was in mild distress. The central abdomen was tender; bowel sounds were high-pitched.

A 51-year-old man presents with a painful inguinal rash that has persisted for 3 months despite application of a combination corticosteroid and antifungal cream. The rash is associated with a strong odor.

Urinary incontinence is common--especially among older adults--but underdiagnosed. Many persons with this disorder are reluctant to discuss it with their physicians; often, only direct questioning can uncover the problem.

57-year-old woman is hospitalized because of a 3-week history of persistent left-sided dull flank pain that worsens with movement and is associated with intermittent high fever.

Although proton pump inhibitors (PPIs) are highly effective, clinical failure in patients with gastroesophageal reflux disease (GERD) is seen regularly--not only in GI clinics but also in primary care offices. In fact, the prevalence of failure with PPIs has increased in proportion to the expanding indications for their use.

These yellow asymptomatic lesions on the inner upper eyelids of a 36-year-old woman had persisted for 2 years. She had a history of type 2 diabetes mellitus, migraine, nicotine dependence, bipolar disorder, and obesity. Her medications included quinapril, insulin aspart injection, sumatriptan, ziprasidone, and temazepam.

Scaling patches that resist antifungals; an outbreak of red papules; a velvety,hyperpigmented rash--can you identify the disorders pictured here?

A 51-year-old man with a 20-year history of asthma and seasonal allergies presented with low-grade fever, progressive dyspnea on exertion, and wheezing that had persisted for 2 weeks. Four days earlier, he had been seen by his primary care physician and had started levofloxacin therapy. However, his respiratory symptoms had worsened, warranting hospitalization. He also reported pain in the abdomen and left flank and pain and swelling in the right metacarpophalangeal and right shoulder joints.

Abstract: Pleural tuberculosis and lymph node involvement are the most common extrapulmonary manifestations of tuberculosis. Most patients with pleural involvement complain of pleuritic chest pain, nonproductive cough, and dyspnea. The pleural effusion is usually unilateral and small to moderate in size. The diagnosis depends on the demonstration of acid-fast bacilli in pleural fluid or biopsy specimens, or the presence of caseous granulomas in the pleura. The gold standard for the diagnosis of lymph node tuberculosis is the identification of mycobacteria in smears on fine-needle aspiration cytopathology, histopathology, or mycobacterial culture. On ultrasonography and CT, the lymph nodes show enlargement with hypoechoic/hypodense areas that demonstrate central necrosis and peripheral rim enhancement or calcification. Treatment involves the combination of 4 antituberculosis drugs for 2 months, followed by 2-drug therapy for 4 months. (J Respir Dis. 2005;26(8):326-332)

What is the evidence that diet can reduce or increase the risk of common cancers? Is this evidence strong enough to warrant counseling patients to follow particular dietary guidelines?