Small cell lung cancer presenting as dermatomyositis: mistaken for single connective tissue disease.

Dermatomyositis (DM) is well-known to be associated with several types of malignancy. This case emphasizes the importance of a thorough examination for an underlying cancer, in patients with the symptoms of dermatomyositis. We report the case of a 62-year-old Chinese man who presented with a two-month history of edema of face and neck, together with erythema of the eyelids diagnosed of small cell lung cancer. Initially, it was thought to be single connective tissue disease such as DM. This study highlights the importance of a thorough physical examination when visiting a patient.

[Follow-up study of programmed intervention of hyperuricemia in the prevention and treatment of cardiovascular morbid change].

OBJECTIVE: To investigate the beneficial impact of programmed hyperuricemic intervention upon the alterations of metabolic parameters and the prevention of cardiovascular morbid change. METHODS: A total of 531 subjects of hyperuricemia were randomly divided into two groups: intervention group and control group. There was a 36-month follow-up by this prospective study. The intervention group was managed and followed up while the control group received only the baseline and final assessments. The improved way of life, changes of metabolic parameters and sub-clinical cardiovascular lesions were compared between two groups. RESULTS: (1) Except for smoking and drinking habits, such lifestyle aspects as low-purine diet, low-fat diet, high-salt control and regular exercise had improved significantly and their percentages increased 37.1%, 26.2%, 25.7%, 24.8% respectively after management in the intervention group (P < 0.01). Except for low-purine and low-fat diets, the lifestyle aspects had not improved significantly after follow-up in the control group. The incremental percentages of high-salt control and regular exercise were 2.2% and 2.1% respectively and there was no statistical difference (P > 0.05). (2) The pre-intervention and post-intervention levels of uric acid, body mass index, waist circumference, triglycerides and blood pressure were (449 +/- 3) vs (410 +/- 3) mmol/L, (3.62 +/- 0.30) vs (1.98 +/- 0.02) mmol/L, (93.8 +/- 0.6) vs (90.2 +/- 0.5) cm, (27.13 +/- 0.19) vs (25.67 +/- 0.17) kg/m(2), (129.1 +/- 1.0) vs (123.8 +/- 0.6) mm Hg and (80.7 +/- 0.7) vs (78.5 +/- 0.8) mm Hg respectively (P < 0.01). Those for high density lipoprotein and blood glucose were (1.06 +/- 0.02) vs (1.12 +/- 0.18) mmol/L and (5.54 +/- 0.08) vs (5.36 +/- 0.04) mmol/L respectively (P < 0.05). The levels of cholesterol showed no decline (P > 0.05). During follow-up, the level of blood pressure, body mass index, blood glucose and triglyceride in the control group had been reduced (P < 0.05); the level of other metabolic indicators did not (P > 0.05). (3) The pre-intervention and post-intervention levels of hs-CPR and B-type natriuretic peptide were (1.62 +/- 0.12) vs (1.33 +/- 0.11) mg/L and (6.76 +/- 0.10) vs (5.88 +/- 0.17) ng/L respectively. Compared with the control group, there were statistical differences (P < 0.01). The proportions of positive lesions of carotid artery ultrasound type B, ocular fundus disease and cardiac ultrasound in intervention group were 3.81%, 5.71%, 2.85% vs 12.56%, 13.66%, 10.92% in control group (P < 0.01). The proportions of positive incidences of ECG ST-T changes, treadmill exercise test and coronary CT in intervention group was 5.23%, 0.92%, 0 vs 12.02%, 4.91%, 2.73% in control group (P < 0.05). CONCLUSION: Programmed hyperuricemic intervention can improve the lifestyles of patients and optimize their metabolic parameters and cardiovascular lesions. These measures are of great importance in the prevention and treatment of sub-clinical cardiovascular morbid change.

Case Report: Recurrent severe vomiting due to hyperthyroidism.

Thyrotoxicosis may present in many ways; severe vomiting as a prominent symptom of thyrotoxicosis is uncommon. In this paper, we report a 24-year-old Chinese male with hyperthyroidism who presented with recurrent severe vomiting. The patient had had intermittent vomiting for seven years and had lost approximately 15 kg of weight. Gastroscopic examinations revealed chronic gastritis and one occasion peptic ulcer. He was treated with antacid and proton pump inhibitors, but his symptoms had no relief. His presenting symptoms suggested hyperthyroidism and were confirmed by laboratory data. After a month of propylthiouracil therapy, his symptoms were relieved. It should be noted that hyperthyroidism patients can have unexplained vomiting, and that hyperthyroidism may coexist with peptic ulcer in rare cases. Awareness of such atypical presentations of hyperthyroidism may help to make a correct diagnosis.

Cerebral hemorrhage, splenic and renal embolisms due to infective endocarditis.

Infective endocarditis is occurring more and more frequently in elderly persons and it has been associated with various clinical, bacteriological, and prognostic features. We present a 63-year-old woman with infective endocarditis which is the first reported case with cerebral hemorrhage, splenic and renal embolisms.

Relationship between alanine aminotransferase levels and metabolic syndrome in nonalcoholic fatty liver disease.

OBJECTIVE: To investigate the relationship between alanine aminotransferase (ALT) levels and metabolic syndrome (MS) in nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 26527 subjects who received medical health checkup in our hospital from January 2005 to July 2007 were enrolled in the study. The diagnosis of fatty liver was based on ultrasound imaging. MS was defined according to the criteria of the Adult Treatment Panel III. ALT, triglyceride (TG), high density lipoprotein cholesterol (HDL-c), fasting plasma glucose (FPG), height, weight, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in each subject to analyze the relationship between MS and ALT activity. RESULTS: (1) The prevalence of NAFLD in men (30.94%) was significantly higher than that in women (15.65%); (2) The incidence of MS in NAFLD (33.83%) was significantly greater than that in non-NAFLD (10.62%); (3) Of the 6470 subjects with NAFLD, in the age-adjusted partial correlation analysis, there were statistically significant correlations between the ALT levels and most metabolic risk factors in each sex (P<0.01), except that ALT levels had no correlation with HDL-c in women. Moreover, in the multiple stepwise regression analysis, SBP lost its significance, and WC, body mass index (BMI), age, DBP, TG and FPG were independently associated with ALT levels in both sexes (P<0.05). HDL-c remained significant and was independently related to ALT levels in men; (4) ALT levels were significantly higher in subjects with MS compared to those without MS (P<0.001). Mean ALT levels increased with the number of MS components in each sex (P<0.05 for trend). CONCLUSION: We found a strong relationship between ALT levels and MS in NAFLD and revealed that the cluster of MS components might be the predictor for ALT elevations.

Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of a short messaging service (SMS) text messaging and phone reminder to improve attendance rates at a health promotion center. METHODS: A total of 1 859 participants who had scheduled appointments in the health promotion center of our hospital from April 2007 to May 2007 were enrolled in the study and randomly assigned into 3 groups: control (no reminder) group, SMS text messaging reminder group and telephone reminder group. Attendance rates and costs of interventions were collected. RESULTS: A total of 1848 participants were eligible for analysis. Attendance rates of control, SMS and telephone groups were 80.5%, 87.5% and 88.3%, respectively. The attendance rates were significantly higher in SMS and telephone groups than that in the control group, with odds ratio 1.698, 95% confidence interval 1.224 to 2.316, P=0.001 in the SMS group, and odds ratio 1.829, 95% confidence interval 1.333 to 2.509, P<0.001 in the telephone group. However, there was no difference between the SMS group and the telephone group (P=0.670). The cost effectiveness analysis showed that the cost per attendance for the SMS group (0.31 Yuan) was significantly lower than that for the telephone group (0.48 Yuan). CONCLUSION: SMS and telephone are effective reminders for improving attendance rate at a health promotion center. SMS reminder may be more cost-effective compared with the telephone reminder.

Relationship between hyperuricemia and metabolic syndrome.

OBJECTIVE: To investigate the relationship between metabolic syndrome and hyperuricemia. METHODS: A total of 2 374 subjects who received health examination in our hospital from Jan. 2004 to Dec. 2006 were enrolled in our study. Hyperuricemia is defined as >or=7 mg/dl (in men) or >or=6.0 mg/dl (in women). Metabolic syndrome was defined using AHA/NHLBI (American Heart Association/National Heart, Lung, and Blood Institute) criteria. RESULTS: (1) The overall prevalence of hyperuricemia was 13.10%. The condition was more common in men than in women (19.07% vs 3.42%). (2) Among men, uric acid concentration is statistically significantly positively correlated with waist circumference, blood pressure, and triglyceride. Uric acid is negatively correlated with serum high-density lipoprotein-cholesterol (HDL-C). Uric acid concentration is most strongly correlated with serum triglyceride (r=0.379) and waist circumference (r=0.297). Among women, statistically significant positive correlations were noted for the serum uric acid concentrations with waist circumference, triglyceride and fasting plasma glucose. Serum triglyceride (r=0.329) and waist circumference (r=0.234) are most strongly correlated with uric acid concentrations. (3) Men with hyperuricemia had a 1.634-fold increased risk of metabolic syndrome as compared with those without hyperuricemia [odds ratio (OR)=1.634, P=0.000]. Women with hyperuricemia had a 1.626-fold increased risk of metabolic syndrome (OR=1.626, P=0.000) as compared with those without hyperuricemia. CONCLUSION: Hyperuricemia is prevalent among Chinese population. Additionally, serum uric acid is positively associated with metabolic syndrome.

Nutritional intervention in the metabolic syndrome.

OBJECTIVE: Through an interventional study in the metabolic syndrome, evaluate the feasibility of the standard nutritional intervention. DESIGN: Select metabolic syndrome patients from people who received a health check in our hospital and randomly allocate them into four groups. The standard interventional group received both the nutritional intervention and health education; the simple interventional group only received the nutritional intervention; the simple health educational group only received health education; the control group did not receive any intervention measure. Examine the related index of the metabolic syndrome of each group before and half a year after the intervention: waistline, blood pressure, triglyceride, fasting plasma glucose etc. K-W test and Chi-square test, Bonferroni correction was used in our study. OUTCOMES: The index of the metabolic syndrome was significantly different for each of the four groups before and after intervention (p<0.05). Relative to the control group the total index for the standard nutritional interventional group and for, the simple health education group was significantly different, but there was no difference for the other indices (p>0.05) between the standard nutritional interventional group and simple nutritional interventional group, except that the waistline difference (p<0.005) showed statistical significance. CONCLUSION: The standard nutritional intervention is an effective strategy for patients with the metabolic syndrome.