Hypertension, athletes, and the sports physician: Implications of JNC VII, the Fourth Report, and the 36th Bethesda Conference guidelines

Over the past decade, numerous studies have contributed to a growing evidence-based recommendation that the prevention, diagnosis, and management of hypertension can significantly lower cardiovascular morbidity and mortality. Several leading guidelines have been updated recently. Because hypertension is a common cardiovascular disease in athletes, sports medicine providers must remain vigilant in diagnosing this disorder and current with treatment and participation recommendations.     

Dietary fiber and colorectal cancer risk: the multiethnic cohort study

OBJECTIVE: To investigate the association of dietary fiber with colorectal cancer METHODS: A total of 85,903 men and 105,108 women completed a quantitative food frequency questionnaire in 1993-1996. A total of 1,138 men and 972 women were subsequently diagnosed with adenocarcinoma of the large bowel. Cox proportional hazards models were used to calculate multivariate adjusted relative risks (RR) and 95% confidence intervals (95% CI) for colorectal cancer. RESULTS: High consumers of dietary fiber were more active, less overweight, and less likely to be cigarette smokers than low consumers in both sexes. Fiber was inversely associated with colorectal cancer risk after adjustment for age and ethnicity in men (RR = 0.49; 95% CI, 0.41-0.60, highest vs. lowest quintile) and women (RR = 0.75; 95% CI, 0.61-0.92). After further adjustment for lifestyle and dietary factors, the inverse association remained significant in men (RR = 0.62; 95% CI, 0.48-0.79), but not in women (RR = 0.88; 95% CI, 0.67-1.14). Adjustment for the combination of replacement hormone use with either cigarette smoking or body mass index accounted for the lack of association with fiber in women. CONCLUSION: Dietary fiber was inversely associated with colorectal cancer risk in men, but its relation to replacement hormone use and other factors affected its inverse association in women.     

Granulocyte colony stimulating factor in neonatal alloimmune neutropenia: A possible association with induced thrombocytopenia

Neonatal alloimmune neutropenia (NAIN) is a rare cause of congenital neutropenia seen in <1% of births. Significant morbidity, usually infections, may result from this disease. The pathophysiology of NAIN, mediated by maternal antibodies crossing the placenta to destroy fetal cells expressing paternal antigens, is similar to that of neonatal alloimmune thrombocytopenia, as well as Rh/ABO hemolytic disease of the newborn. The use of high‐dose granulocyte colony stimulating factor in patients with NAIN may cause a reversible thrombocytopenia in some patients. Pediatr Blood Cancer 2010;54:1014–1016 © 2010 Wiley‐Liss, Inc.     

Pediatric post-traumatic headache

Post-traumatic headache after craniocerebral trauma is not an uncommon occurrence in children and adolescents. It can occur after mild, moderate, or severe injury. The headache may have features of tension-type headache, migraine, or probable migraine and is rarely seen in isolation. It is often part of a syndrome encompassing a variety of somatic and psychobehavioral symptoms. In time, the headache and accompanying symptoms gradually resolve over a period of 8 to 12 weeks. However, sometimes it may become chronic, requiring a multidimensional management approach including pharmacologic intervention, physical rehabilitation, and cognitive-behavioral therapy as used in the adult population.     

Anatomical Factors Triggering Platypnea‐Orthodeoxia in Adults

Right to left shunting through a patent foramen ovale (PFO) or atrial septal defect (ASD) can cause platypnea‐orthodeoxia even in a setting of normal pulmonary artery pressures. However, the late onset of symptoms despite the congenital origin of the anatomical defects is not well understood. We report a case series of patients presenting with dyspnea and orthodeoxia who developed right to left shunting as a result of associated anatomical changes that occur with aging such as tortuosity and elongation of the aorta. We propose that these acquired anatomical changes can favor right to left shunting in the setting of congenital abnormalities, therefore explaining the late onset of symptoms. Copyright © 2009 Wiley Periodicals, Inc.     

Chemical Injury to the Eye from EMLA Cream During Erbium Laser Resurfacing

BACKGROUND: EMLA cream is commonly used as a topical anesthetic by physicians performing dermatologic surgery. OBJECTIVE: The purpose of this article is to inform physicians that EMLA cream is highly alkaline and can be particularly toxic to the eye. Symptoms of eye irritation may be initially masked because of local anesthetic effects. METHODS: Two patients are described who developed corneal abrasions from inadvertent exposure of the eye to EMLA cream prior to erbium laser resurfacing. RESULTS: The patients developed corneal abrasions and conjunctivitis, consistent with chemical alkaline burns. CONCLUSION: EMLA cream should be used with extreme caution near the eye and probably should be avoided when there is a need to insert laser eye shields.     

The Inclusion of Women and Minorities in Smoking Cessation Clinical Trials: A Systematic Review

This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA‐approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under‐represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry‐sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.