Eosinophilia-myalgia syndrome: a clinical case series of 21 patients

Article Abstract:

The first case of an illness that would later be called eosinophilia-myalgia syndrome (EMS) was reported in 1988. Many more cases were reported during 1989, and the disorder was linked to the consumption of the supplement L-tryptophan. Twenty-one cases of EMS, which occurred in New Mexico between May 1 and November 17, 1989, were recently reviewed. Of these, 20 cases involved women and 20 involved the use of products containing L-tryptophan, which were usually taken for insomnia. All the patients with EMS developed intense myalgia (muscle pain), and over 80 percent developed fever, weakness, and headache. Three-quarters of the patients also developed some type of respiratory problem, including shortness of breath; one patient had to be put on a ventilator. All had eosinophilia, or increased blood levels of eosinophils, a type of white blood cell. Muscle biopsies from four patients revealed perimyositis, or inflammation of the connective tissue around the muscle. Most of the EMS patients who had blood tests for liver function had abnormal results. Physicians advised most of the patients to discontinue L-tryptophan. Half the patients had been given prednisone, a corticosteroid; of six patients so treated, five reported decreased muscle pain, and eosinophil counts returned to normal in four. The remaining patients received a variety of treatments, including analgesics (both narcotic and nonnarcotic pain killers), nonsteroidal anti-inflammatory drugs (NSAIDS), calcium channel blockers, diuretics, and antibiotics. However, the effectiveness of these treatments could not be determined. It is likely that patients with milder forms of EMS were excluded from the study because of the strict criteria used to select patients. EMS resembles toxic oil syndrome (TOS), an illness reported in Spain in 1981, which was linked to the ingestion of contaminated cooking oil. Many TOS patients went on to develop chronic illness; it is possible that this could occur with EMS. More experience with EMS will be needed to determine the appropriate treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, New Mexico, Eosinophilia-myalgia syndrome

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Colon cancer screening

Article Abstract:

In the Unites States colorectal cancer is the most common cause of death due to cancer, affecting almost 150,000 people each year. Screening methods are intended to identify premalignant lesions and detect cancer at an early and curable stage, and thereby prevent disease progression. Recommendations for screening include fecal occult blood testing, or testing feces for the presence of blood, in patients more than 40 years of age, and sigmoidoscopy, the use of an optical instrument to examine a portion of the colon in patients older than 50. Although colon cancer screening has increased, the benefits of screening in reducing death due to colon cancer have not been determined. Death due to colon cancer decreased from 1950 to 1985, but the incidence of the disease increased. The management of patients with positive screening tests is discussed. If positive results are obtained, studies suggest that colonoscopy, examination of the upper portion of the rectum with a specialized instrument, is the most effective method for diagnosing colon cancer. However, colonoscopy is an expensive technique, which causes perforation or rupture of the colon and bleeding in 3 of every 1,000 procedures. The decision to perform colonoscopy depends on the predictive value of a positive screening test in a patient more that 50 years of age and the potential benefit to the patient. The benefits of sigmoidoscopy and fecal occult blood testing have yet to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Colorectal cancer, Colonoscopy, Occult blood

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Screening for the multiple endocrine neoplasia syndrome type I: a study of 11 kindreds in the Netherlands

Article Abstract:

Multiple endocrine neoplasia syndrome type I (MEN-I), Wermer's syndrome, is an inherited disorder characterized by excess secretions caused by tumors on the endocrine glands, the pancreas, parathyroid and pituitary. The tumors may not cause detectable symptoms in affected individuals, which makes the prevalence of the syndrome difficult to determine. Screening of individuals with symptoms can improve prognosis when the identification and treatment of potentially fatal tumors begins early. The screening results of 52 MEN-I patients identified from 11 families living in the Netherlands were evaluated. There were 15 fatalities in the group; some patients died before the screening began. Complications from stomach ulcers were responsible for 11 of the deaths, while tumor cell metastases, which are cancerous cells migrating and growing in other sites, caused death in two patients. Another two patients died from kidney failure caused by a hyperactive parathyroid gland. Screening of families with MEN-I found 43 cases of gland tumors: 21 on the parathyroid gland, 16 on the pancreas and six on the pituitary gland. The earliest manifestation of MEN-I was parathyroidism, found in 44 (94 percent) of the patients. Tumor screening should be performed on all family members afflicted with MEN-I at least once every two years to ensure early detection of endocrine gland tumors.

Health aspects, Care and treatment, Netherlands, Genetic aspects, Genetic disorders, Familial diseases, Adenomatosis, Familial endocrine, Multiple endocrine neoplasia, Endocrine gland tumors

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