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Current Opinion in Internal Medicine - Current Table Of Contents

Epidemiology of anaphylaxis.
Page: 427DOI: 10.1097/MCI.0b013e3283154e8eAuthors: Lieberman, Phil
Multiple actions of high-density lipoprotein.
Page: 432DOI: 10.1097/MCI.0b013e32831550d9Authors: Florentin, Matilda a; Liberopoulos, Evangelos N a; Wierzbicki, Anthony S b; Mikhailidis, Dimitri P c
Cachexia: prevalence and impact in medicine.
Page: 441DOI: 10.1097/MCI.0b013e328315510bAuthors: Tan, Benjamin HL; Fearon, Kenneth CH

PubMed: 0003-4819

Use of levosimendan for cardiogenic shock in a patient with the apical ballooning syndrome.
De Santis V, Vitale D, Tritapepe L, Greco C, Pietropaoli P Related Articles Use of levosimendan for cardiogenic shock in a patient with the apical ballooning syndrome. Ann Intern Med. 2008 Sep 2;149(5):365-7 Authors: De Santis V, Vitale D, Tritapepe L, Greco C, Pietropaoli P PMID: 18765717 [PubMed - in process]
Who owns Vermont's hospitals?
Castonguay ME Related Articles Who owns Vermont's hospitals? Ann Intern Med. 2008 Sep 2;149(5):364 Authors: Castonguay ME PMID: 18765716 [PubMed - in process]
Exogenous lipoid pneumonia: an unexpected complication of substance abuse.
Gurell MN, Kottmann RM, Xu H, Sime PJ Related Articles Exogenous lipoid pneumonia: an unexpected complication of substance abuse. Ann Intern Med. 2008 Sep 2;149(5):364-5 Authors: Gurell MN, Kottmann RM, Xu H, Sime PJ PMID: 18765715 [PubMed - in process]
Lack of nationwide surveillance of antimicrobial resistance of Neisseria gonorrhoeae in Japan.
Deguchi T, Yasuda M, Maeda S Related Articles Lack of nationwide surveillance of antimicrobial resistance of Neisseria gonorrhoeae in Japan. Ann Intern Med. 2008 Sep 2;149(5):363-4 Authors: Deguchi T, Yasuda M, Maeda S PMID: 18765714 [PubMed - in process]
Treatment intensification does not always lead to better quality of care in patients with hypertension.
Valderas JM Related Articles Treatment intensification does not always lead to better quality of care in patients with hypertension. Ann Intern Med. 2008 Sep 2;149(5):362; author reply 362-3 Authors: Valderas JM PMID: 18765713 [PubMed - in process]
Effect of Testosterone therapy versus other factors on the self-reported sexual satisfaction of premenopausal women.
Hong L, Wu K, Fan D Related Articles Effect of Testosterone therapy versus other factors on the self-reported sexual satisfaction of premenopausal women. Ann Intern Med. 2008 Sep 2;149(5):361; author reply 361-2 Authors: Hong L, Wu K, Fan D PMID: 18765712 [PubMed - in process]

Archives of Internal Medicine current issue

ABOUT THIS JOURNAL: About This Journal
Mon, 11 Aug 2008 00:00:00 -0000

IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE: In This Issue of Archives of Internal Medicine
Mon, 11 Aug 2008 00:00:00 -0000

EDITORIAL: Body Fat Distribution and Cardiovascular Risk: A Tale of 2 Sites
Landsberg, L. Mon, 11 Aug 2008 00:00:00 -0000

ORIGINAL INVESTIGATION: Identification and Characterization of Metabolically Benign Obesity in Humans
Stefan, N., Kantartzis, K., Machann, J., Schick, F., Thamer, C., Rittig, K., Balletshofer, B., Machicao, F., Fritsche, A., Haring, H.-U. Mon, 11 Aug 2008 00:00:00 -0000
Background  Obesity represents a risk factor for insulin resistance, type 2 diabetes mellitus, and atherosclerosis. In addition, for any given amount of total body fat, an excess of visceral fat or fat accumulation in the liver and skeletal muscle augments the risk. Conversely, even in obesity, a metabolically benign fat distribution phenotype may exist. Methods  In 314 subjects, we measured total body, visceral, and subcutaneous fat with magnetic resonance (MR) tomography and fat in the liver and skeletal muscle with proton MR spectroscopy. Insulin sensitivity was estimated from oral glucose tolerance test results. Subjects were divided into 4 groups: normal weight (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], <25.0), overweight (BMI, 25.0-29.9), obese–insulin sensitive (IS) (BMI, ≥30.0 and placement in the upper quartile of insulin sensitivity), and obese–insulin resistant (IR) (BMI, ≥30.0 and placement in the lower 3 quartiles of insulin sensitivity). Results  Total body and visceral fat were higher in the overweight and obese groups compared with the normal-weight group (P < .05); however, no differences were observed between the obese groups. In contrast, ectopic fat in skeletal muscle (P < .001) and particularly the liver (4.3% ± 0.6% vs 9.5% ± 0.8%) and the intima-media thickness of the common carotid artery (0.54 ± 0.02 vs 0.59 ± 0.01 mm) were lower and insulin sensitivity was higher (17.4 ± 0.9 vs 7.3 ± 0.3 arbitrary units) in the obese-IS vs the obese-IR group (P < .05). Unexpectedly, the obese-IS group had almost identical insulin sensitivity and the intima-media thickness was not statistically different compared with the normal-weight group (18.2 ± 0.9 AU and 0.51 ± 0.02 mm, respectively). Conclusions  A metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans. Furthermore, ectopic fat in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity.
ORIGINAL INVESTIGATION: The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999-2004)
Wildman, R. P., Muntner, P., Reynolds, K., McGinn, A. P., Rajpathak, S., Wylie-Rosett, J., Sowers, M. R. Mon, 11 Aug 2008 00:00:00 -0000
Background  The prevalence and correlates of obese individuals who are resistant to the development of the adiposity-associated cardiometabolic abnormalities and normal-weight individuals who display cardiometabolic risk factor clustering are not well known. Methods  The prevalence and correlates of combined body mass index (normal weight, <25.0; overweight, 25.0-29.9; and obese, ≥30.0 [calculated as weight in kilograms divided by height in meters squared]) and cardiometabolic groups (metabolically healthy, 0 or 1 cardiometabolic abnormalities; and metabolically abnormal, ≥2 cardiometabolic abnormalities) were assessed in a cross-sectional sample of 5440 participants of the National Health and Nutrition Examination Surveys 1999-2004. Cardiometabolic abnormalities included elevated blood pressure; elevated levels of triglycerides, fasting plasma glucose, and C-reactive protein; elevated homeostasis model assessment of insulin resistance value; and low high-density lipoprotein cholesterol level. Results  Among US adults 20 years and older, 23.5% (approximately 16.3 million adults) of normal-weight adults were metabolically abnormal, whereas 51.3% (approximately 35.9 million adults) of overweight adults and 31.7% (approximately 19.5 million adults) of obese adults were metabolically healthy. The independent correlates of clustering of cardiometabolic abnormalities among normal-weight individuals were older age, lower physical activity levels, and larger waist circumference. The independent correlates of 0 or 1 cardiometabolic abnormalities among overweight and obese individuals were younger age, non-Hispanic black race/ethnicity, higher physical activity levels, and smaller waist circumference. Conclusions  Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy. Further study into the physiologic mechanisms underlying these different phenotypes and their impact on health is needed.
ORIGINAL INVESTIGATION: 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population
Melamed, M. L., Michos, E. D., Post, W., Astor, B. Mon, 11 Aug 2008 00:00:00 -0000
Background  In patients undergoing dialysis, therapy with calcitriol or paricalcitol or other vitamin D agents is associated with reduced mortality. Observational data suggests that low 25-hydroxyvitamin D levels (25[OH]D) are associated with diabetes mellitus, hypertension, and cancers. However, whether low serum 25(OH)D levels are associated with mortality in the general population is unknown. Methods  We tested the association of low 25(OH)D levels with all-cause, cancer, and cardiovascular disease (CVD) mortality in 13 331 nationally representative adults 20 years or older from the Third National Health and Nutrition Examination Survey (NHANES III) linked mortality files. Participant vitamin D levels were collected from 1988 through 1994, and individuals were passively followed for mortality through 2000. Results  In cross-sectional multivariate analyses, increasing age, female sex, nonwhite race/ethnicity, diabetes, current smoking, and higher body mass index were all independently associated with higher odds of 25(OH)D deficiency (lowest quartile of 25(OH)D level, <17.8 ng/mL [to convert to nanomoles per liter, multiply by 2.496]), while greater physical activity, vitamin D supplementation, and nonwinter season were inversely associated. During a median 8.7 years of follow-up, there were 1806 deaths, including 777 from CVD. In multivariate models (adjusted for baseline demographics, season, and traditional and novel CVD risk factors), compared with the highest quartile, being in the lowest quartile (25[OH]D levels <17.8 ng/mL) was associated with a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant. Conclusion  The lowest quartile of 25(OH)D level (<17.8 ng/mL) is independently associated with all-cause mortality in the general population.
ORIGINAL INVESTIGATION: Reduced Disability and Mortality Among Aging Runners: A 21-Year Longitudinal Study
Chakravarty, E. F., Hubert, H. B., Lingala, V. B., Fries, J. F. Mon, 11 Aug 2008 00:00:00 -0000
Background  Exercise has been shown to improve many health outcomes and well-being of people of all ages. Long-term studies in older adults are needed to confirm disability and survival benefits of exercise. Methods  Annual self-administered questionnaires were sent to 538 members of a nationwide running club and 423 healthy controls from northern California who were 50 years and older beginning in 1984. Data included running and exercise frequency, body mass index, and disability assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI; scored from 0 [no difficulty] to 3 [unable to perform]) through 2005. A total of 284 runners and 156 controls completed the 21-year follow-up. Causes of death through 2003 were ascertained using the National Death Index. Multivariate regression techniques compared groups on disability and mortality. Results  At baseline, runners were younger, leaner, and less likely to smoke compared with controls. The mean (SD) HAQ-DI score was higher for controls than for runners at all time points and increased with age in both groups, but to a lesser degree in runners (0.17 [0.34]) than in controls (0.36 [0.55]) (P < .001). Multivariate analyses showed that runners had a significantly lower risk of an HAQ-DI score of 0.5 (hazard ratio, 0.62; 95% confidence interval, 0.46-0.84). At 19 years, 15% of runners had died compared with 34% of controls. After adjustment for covariates, runners demonstrated a survival benefit (hazard ratio, 0.61; 95% confidence interval, 0.45-0.82). Disability and survival curves continued to diverge between groups after the 21-year follow-up as participants approached their ninth decade of life. Conclusion  Vigorous exercise (running) at middle and older ages is associated with reduced disability in later life and a notable survival advantage.
ORIGINAL INVESTIGATION: Long-term Clinical Outcomes Following Coronary Stenting
Anstrom, K. J., Kong, D. F., Shaw, L. K., Califf, R. M., Kramer, J. M., Peterson, E. D., Rao, S. V., Matchar, D. B., Mark, D. B., Harrington, R. A., Eisenstein, E. L. Mon, 11 Aug 2008 00:00:00 -0000
Background  Clinical trials of drug-eluting stents (DES) vs bare metal stents (BMS) report a reduced need for target lesion revascularization with no difference in death or myocardial infarction. However, these trials selectively enrolled patients with lower risk, single-vessel coronary artery disease (CAD) and limited the follow-up period to 1 year or less. Thus, it is not known how these short-term results apply to patients with higher risk, multivessel CAD seen in community practice settings. The objective of this study was to compare the long-term clinical outcomes of patients receiving DES vs BMS in a clinical practice setting. Methods  Patients from the Duke Databank for Cardiovascular Disease undergoing their initial revascularization with DES or BMS from January 1, 2000, through July 31, 2005, were included in the study population. Propensity scores and inverse probability weighted estimators were used to adjust for treatment group imbalances. Results  The study population included 1501 patients who received DES and 3165 who received BMS. After adjustment, DES reduced target vessel revascularization (TVR) rates at 6, 12, and 24 months compared with BMS (24-month rates: DES, 6.6%; BMS, 16.3%; difference, –9.7%; 95% confidence interval [CI], –11.7% to –7.7%; P < .001). The TVR benefit for DES increased among patients with multivessel CAD (1-vessel CAD: –8.3%; 95% CI, –10.9% to –5.8%; P < .001; 2-vessel CAD: –9.7%; 95% CI, –3.6% to –5.8%; P < .001; 3-vessel CAD: –16.2%; 95% CI, –25.2% to –7.2%; P < .001). However, in the overall cohort there were no statistically significant differences in the composite of death or myocardial infarction. Conclusions  Patients receiving DES vs BMS in a clinical practice setting have lower TVR rates, albeit with less absolute benefit than those observed in clinical trials. Patients with multivessel vs single-vessel disease experience a greater reduction in TVR.
ORIGINAL INVESTIGATION: Prediction of Progression to Overt Hypothyroidism or Hyperthyroidism in Female Relatives of Patients With Autoimmune Thyroid Disease Using the Thyroid Events Amsterdam (THEA) Score
Strieder, T. G. A., Tijssen, J. G. P., Wenzel, B. E., Endert, E., Wiersinga, W. M. Mon, 11 Aug 2008 00:00:00 -0000
Background  Genetic and environmental factors are involved in the pathogenesis of autoimmune thyroid disease (AITD). Family members of patients with AITD are at increased risk for AITD, but not all will develop overt hypothyroidism or hyperthyroidism. Our goal was to develop a simple predictive score that has broad applicability and is easily calculated at presentation for progression to overt hypothyroidism or hyperthyroidism within 5 years in female relatives of patients with AITD. Methods  We conducted a prospective observational cohort study of 790 healthy first- or second-degree female relatives of patients with documented Graves or Hashimoto disease in the Netherlands. Baseline assessment included measurement of serum thyrotropin (TSH), free thyroxine (FT4), and thyroid peroxidase (TPO) antibody levels as well as evaluation for the presence and levels of Yersinia enterocolitica antibodies. We also gathered data on family background, smoking habits, use of estrogen medication, pregnancy, and exposure to high levels of iodine. In follow-up, thyroid function was investigated annually for 5 years. As main outcome measures, termed events, we looked for overt hypothyroidism (TSH levels >5.7 mIU/L and FT4 levels <0.72 ng/dL) or overt hyperthyroidism (TSH levels <0.4 mIU/L and FT4 levels >1.56 ng/dL). Results  The cumulative event rate was 7.5% over 5 years. The mean annual event rate was 1.5%. There were 38 hypothyroid and 13 hyperthyroid events. Independent risk factors for events were baseline findings for TSH and TPO antibodies in a level-dependent relationship (for TSH the risk already starts to increase at values >2.0 mIU/L) and family background (with the greatest risk attached to subjects having 2 relatives with Hashimoto disease). A numerical score, the Thyroid Events Amsterdam (THEA) score, was designed to predict events by weighting these 3 risk factors proportionately to their relative risks (maximum score, 21): low (0-7), medium (8-10), high (11-15), and very high (16-21). These THEA scores were associated with observed event rates of 2.7%, 14.6%, 27.1%, and 76.9%, respectively. Conclusions  An accurate simple predictive score was developed to estimate the 5-year risk of overt hypothyroidism or hyperthyroidism in female relatives of patients with AITD. However, in view of the small number of observed events, independent validation of the THEA score is called for.

Current Opinion in Internal Medicine - Current Table Of Contents

Epidemiology of anaphylaxis.
Page: 427DOI: 10.1097/MCI.0b013e3283154e8eAuthors: Lieberman, Phil
Multiple actions of high-density lipoprotein.
Page: 432DOI: 10.1097/MCI.0b013e32831550d9Authors: Florentin, Matilda a; Liberopoulos, Evangelos N a; Wierzbicki, Anthony S b; Mikhailidis, Dimitri P c
Cachexia: prevalence and impact in medicine.
Page: 441DOI: 10.1097/MCI.0b013e328315510bAuthors: Tan, Benjamin HL; Fearon, Kenneth CH
Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred.
Page: 449DOI: 10.1097/MCI.0b013e3283154e74Authors: Heidegger, Claudia-Paula a; Darmon, Patrice b; Pichard, Claude b
Diagnosis and management of primary aldosteronism.
Page: 456DOI: 10.1097/MCI.0b013e328315508eAuthors: Boscaro, Marco; Ronconi, Vanessa; Turchi, Federica; Giacchetti, Gilberta
Adult-onset growth hormone deficiency: causes, complications and treatment options.
Page: 463DOI: 10.1097/MCI.0b013e32831550adAuthors: Mathioudakis, Nestoras; Salvatori, Roberto

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