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Pulmonary Embolism Associated with Air Travel
It is widely believed that air travel is associated with an increased risk of pulmonary embolism, resulting from prolonged immobilization during flight (the so-called economy-class syndrome). This study estimated the risk of severe pulmonary embolism as a function of the distance flown. The risk increased significantly with flight distances greater than 5000 km (3100 mi).
Pulmonary embolism associated with air travel appears to be related to venous stasis, injury to vessel walls, and hypercoagulability. In this study, symptoms occurred before the subjects left the jetway at the end of the flight, suggesting that embolism was triggered by walking after being seated for a prolonged period.
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Helicobacter pylori Infection and Gastric Cancer
Although Helicobacter pylori has been found to be associated with the development of gastric cancer, many aspects of the relation remain uncertain. This prospective study from Japan of more than 1500 patients with duodenal ulcers, gastric ulcers, gastric hyperplasia, or nonulcer dyspepsia had a mean follow-up of 7.8 years. Gastric cancer developed in 2.9 percent of persons with H. pylori infection, but not in uninfected persons. Infected persons with gastric ulcers, gastric hyperplasia, and nonulcer dysplasia were at increased risk, but those with duodenal ulcers were not.
These findings strengthen the evidence linking H. pylori infection to the development of gastric cancer. They suggest that steps should be taken to eradicate the infection in patients with a variety of gastric abnormalities.
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Diet, Lifestyle, and Type 2 Diabetes in Women
The risk of type 2 diabetes has been associated with a number of individual dietary and lifestyle factors, but the combined effect of these factors has not been quantified. These investigators studied the 3300 new cases of type 2 diabetes that occurred in a cohort of more than 84,000 women followed for 16 years. Five risk factors — overweight, lack of exercise, a poor diet, smoking, and abstinence from alcohol consumption — accounted for nearly 90 percent of the attributable risk; obesity was the most important factor.
Although multiple factors contribute to the risk of type 2 diabetes, these data show that body weight is the most important factor. The inference is that weight loss, along with dietary modification and exercise, can prevent type 2 diabetes.
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Mushroom Poisoning as a Cause of Rhabdomyolysis
Rhabdomyolysis, although rare, is potentially fatal. This article documents rhabdomyolysis in 12 persons who ingested meals made from the wild mushroom tricholoma, of whom 3 died. The authors demonstrated that extracts from Tricholoma equestre cause rhabdomyolysis in mice, thus strongly supporting a causative relation. The toxic metabolite in T. equestre remains to be identified.
Since eating wild mushrooms has become increasingly popular, the incidence of mushroom poisoning has been on the rise. The present report documents that a mushroom species can cause rhabdomyolysis.
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Current Concepts: Cephalosporin Allergy
Common reactions to cephalosporins include skin eruptions, serum-sickness–like reactions, and fever. Although anaphylactic reactions are rare, the risk may be increased in patients with a history of allergy to penicillin. This review outlines strategies for the use of antibiotics in patients with allergies to cephalosporins or penicillin.
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Drug Therapy: Changing Drugs from Prescription to Over-the-Counter Status
An increasing number of drugs are becoming available to patients without the need for a prescription. This article reviews the regulatory requirements that must be met for a drug to be sold over the counter and considers the potential benefits and harm that may ensue when a drug previously available only by prescription becomes available on an over-the-counter basis.
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