Erythromycin-induced hepatitis: simulator of malignancy

A 67-year-old patient was admitted with a 2-week history of epigastric discomfort that began after an episode of upper respiratory tract infection treated with erythromycin. Results of liver function tests were abnormal. Abdominal ultrasound (US) and computed tomography showed multiple, poorly demarcated irregular lesions in both hepatic lobes, suggestive of diffuse metastatic invasion. Histologic examination of the biopsy specimen revealed drug-induced hepatitis. Ten weeks after withdrawal of the erythromycin, US showed complete resolution of the hyperechogenic liver lesions.     

Relationship of physical activity vs body mass index with type 2 diabetes in women

CONTEXT: Physical inactivity and body mass index (BMI) are established independent risk factors in the development of type 2 diabetes; however, their comparative importance and joint relationship with diabetes are unclear. OBJECTIVE: To examine the relative contributions and joint association of physical activity and BMI with diabetes. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 37 878 women free of cardiovascular disease, cancer, and diabetes with 6.9 years of mean follow-up. Weight, height, and recreational activities were reported at study entry. Normal weight was defined as a BMI of less than 25; overweight, 25 to less than 30; and obese, 30 or higher. Active was defined as expending more than 1000 kcal on recreational activities per week. MAIN OUTCOME MEASURE: Incident type 2 diabetes, defined as a new self-reported diagnosis of diabetes. RESULTS: During the follow-up, 1361 cases of incident diabetes occurred. Individually, BMI and physical activity were significant predictors of incident diabetes. Compared with normal-weight individuals, the multivariate-adjusted hazard ratio (HR) was 3.22 (95% confidence interval [CI], 2.69-3.87) for overweight individuals and 9.09 (95% CI, 7.62-10.8) for obese individuals. For overall activity (kilocalories expended per week), compared with the least active first quartile, the multivariate-adjusted HRs were 0.91 (95% CI, 0.79-1.06) for the second quartile, 0.86 (95% CI, 0.74-1.01) for the third, and 0.82 (95% CI, 0.70-0.97) for the fourth (P for trend =.01). In the combined analyses, overweight and obese participants, whether active or inactive, had significantly elevated risks, compared with normal-weight active individuals. The multivariate-adjusted HRs were 1.15 (95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-5.15) for overweight active, 4.16 (95% CI, 3.05-5.66) for overweight inactive, 11.5 (95% CI, 8.34-15.9) for obese active, and 11.8 (95% CI, 8.75-16.0) for obese inactive participants. CONCLUSIONS: Although BMI and physical inactivity are independent predictors of incident diabetes, the magnitude of the association with BMI was greater than with physical activity in combined analyses. These findings underscore the critical importance of adiposity as a determinant of diabetes.     

Significant association of acute lymphoblastic leukemia with HLA-Cw7

Frequencies of all defined HLA-A, -B, -C (-DR) antigens were determined in 142 (59) Germans suffering from acute lymphoblastic leukemia (ALL) with differentiation of immunologically defined or age-related subgroups of the disease. A highly significant rise of the HLA-C locus antigen Cw7 was found in ALL patients, particularly those over the age of 11 in comparison with local German and Caucasian controls of the Ninth Int. Histocompatibility Workshop (WS). Only slight differences of HLA-Cw7 frequencies were observed within the four immunologically defined ALL subtypes of all or age-related patient groups. HLA-A, -B, or -DR antigens, as well as HLA-ABC three-locus haplotypes were similarly distributed in patients and their local or Caucasian controls. The results indicate HLA-linked genetic factors conferring susceptibility to ALL in adults, particularly those presenting with B-, T-, and Null-ALL.     

原发性高血压患者左室构型与儿茶酚胺的关系

目的：了解原发性高血压心脏超声构型的分型与血浆儿茶酚胺水平的关系。方法：实验于2003—02／2005—07在泰安市中心医院完成。选择102例原发性高血压患者，采用超声心动图（Ganau标准）将患者分为：①正常构型组：左室质量指数及相对室壁厚度均在正常范围。②向心性重构组：左室质量指数正常，但相对室壁厚度增加。③向心性肥厚组：左室质量指数与相对室壁厚度均增加。④离心性肥厚组：左室质量指数增加但相对室壁厚度正常。另选择50名年龄相当的健康查体者做为正常对照组。高血压患者停用降压药2周，所有受检者实验前1d禁用烟、酒、茶及咖啡，禁食12h，于清晨采静脉血10mL，以高效液相色谱法检测其血浆中的肾上腺素及去甲肾上腺素含量。结果：152名研究对象全部进入结果分析。向心性重构组、向心性肥厚组和离心性肥厚组的肾上腺素水平、去甲肾上腺素水平均高于正常对照组及正常构型组（P分别〈0．01），而且向心性重构组〉正常构型组，向心性肥厚组〉向心性重构组，离心性肥厚组〉向心性肥厚组（P〈0．05或0．01）。结论：原发性高血压患者血浆肾上腺素、去甲肾上腺素水平的升高促进了左室构型的发展。     

Changes in intention to donate blood under a hypothetical condition of reduced confidentiality

Lawsuits related to transfusion-associated human immunodeficiency virus infections have increasingly resulted in requests for the release of confidential information about volunteer blood donors. Concern that loss of confidentiality might change blood donor behavior led to a survey of donors at collection sites within an American Red Cross Blood Services Region. Of the 361 respondents, 50.3 percent (181) indicated reduced intent to provide accurate medical and personal history information under conditions of reduced confidentiality. Ten percent (34) indicated that they were not sure whether they would or would not donate blood in the future under this condition. The results indicate that the possibility of release of donors' medical and personal information may have a negative effect on the safety and adequacy of the nation's volunteer blood supply.     

The influence of external orthotic support on the adaptive gait characteristics of individuals with chronically unstable ankles

External orthotic supports or braces are used clinically to treat individuals with chronically unstable ankles. Braces have efficacious effects on dynamic strength, passive tissue tension, and proprioception, but their effects on gait remains undetermined. The purpose of this study was to determine if overground locomotion, including walking up a step and a curb are influenced by orthotic device use. Twenty subjects, 10 with no previous injury and 10 with chronically unstable ankles, performed with no brace, a flexible brace and a semi-rigid brace while walking on a level surface, up a step and on a ramp. Differences were noted in kinematic and kinetic gait parameters between groups and between step and ramp conditions, suggesting that gait patterns vary between individuals who have had ankle sprain and those who have not. Few differences were noted between the brace and no brace conditions for both groups. Adding to the previously described efficacious benefits, we conclude that bracing does not alter selected gait parameters in individuals who have chronic ankle instability.     

Characteristics of the first two years of applicants to a new emergency medicine residency program

Background

To the best of our knowledge, no study has compared the effect of using the Electronic Residency Application Service (ERAS) on applicant pool characteristics for a new emergency medicine (EM) residency program.

Objective

We sought to compare applicants in an EM residency program’s first year, in which the ERAS is not typically used, to applicants in year 2 (using ERAS).

Methods

We reviewed the applications to the new University of Utah EM residency program for the entering classes of 2005 (year 1) and 2006 (year 2).

Results

In total, 130 and 458 prospective residents applied during year 1 and year 2, respectively. Applicants using and not using ERAS were similar in average Step 1 score (211.8 vs. 212.4, respectively; p = 0.791), previously failed Step 1 or Step 2 attempt (12.1% vs. 11.0%, respectively; p = 0.729), previous failure to match in a residency program (8.6% vs. 4.6%, respectively; p = 0.083), previous residency training (18.8% vs. 14.9%, respectively; p = 0.288), and the percent who had completed an EM clerkship (95.3% vs. 93.0%, respectively; p = 0.342). Applicants not using ERAS were more likely to have been remediated in medical school (13.2% vs. 4.2%; p < 0.001) and to have a Standardized Letter of Recommendation (SLOR) (87% vs. 78%; p = 0.024). Applicants using ERAS were more likely to have a SLOR match estimate of “very competitive” (38.2% vs. 54.1%; p = 0.004). Applicants were similar in having attended a “top tier” medical school (44.5% vs. 41.3%, p = 0.508).

Conclusion

Despite significantly fewer applicants, those applying without the use of ERAS to a new EM residency program were generally comparable to the applicant pool that did permit the use of ERAS. The larger number of applicants the second year likely reflects the use of ERAS.