1/3. calcinosis cutis in a patient with eosinophilia-myalgia syndrome: case report.eosinophilia-myalgia syndrome (EMS) often is a disabling disorder caused by the consumption of contaminated L-tryptophan. Affected patients present with an array of symptoms, including cutaneous manifestations, peripheral eosinophilia, myalgias, and long-term neurocognitive disability. This article is the first reported case of a patient with EMS who developed calcinosis cutis. While many long-term sequelae of EMS are reported in the literature, there are no reports of the development of dystrophic calcification in these patients. The calcinosis cutis in this patient with EMS may represent a new manifestation of EMS that has not been documented to date. If more patients with EMS develop calcinosis cutis, it will present a therapeutic challenge to the physicians managing these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Simultaneous development of two cases of eosinophilia-myalgia syndrome with the same lot of L-tryptophan in japan.A newly recognized and well-described connective tissue disease, eosinophilia-myalgia syndrome, is thought to relate to L-tryptophan ingestion. The suspect L-tryptophan made in japan has been distributed in japan and in the united states. Different from many case reports of eosinophilia-myalgia syndrome in the united states, it has not been reported in japan. We describe the first case reports of two Japanese patients. eosinophilia-myalgia syndrome developed in these patients simultaneously, during L-tryptophan treatment by the same physician using the same lot of prescribed L-tryptophan. Furthermore, both patients had the following HLA types: HLA-Aw33(w19), -B44(12), and -DR6. These findings implicate the existence of another factor in the development of eosinophilia-myalgia syndrome in addition to the suspect L-tryptophan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Diagnostic bias in clinical decision making: an example of L-tryptophan and the diagnosis of eosinophilia-myalgia syndrome.OBJECTIVE: eosinophilia-myalgia syndrome (EMS) has been defined as the clinical presentation of eosinophilia, severe myalgia, and the exclusion of other infectious/malignant illnesses. Since the case definition does not require exposure to L-tryptophan (LT), diagnostic bias would occur if a physician's decision to diagnose EMS were influenced by knowledge of LT use. methods: A random sample of 813 physicians practising in the united states and canada was obtained. physicians were asked to provide diagnoses for 6 case vignettes having diverse resemblances to EMS. Six weeks later, participants were asked to provide diagnoses for a complementary series of cases described in identical text except for different data regarding LT use. RESULTS: physicians who responded (N = 227, 28%) were more likely to diagnose EMS when LT exposure was present compared to the same case without LT use. In the most striking difference, EMS was diagnosed by 48% of physicians when the case was described in a man using LT, but by only 8% of physicians for the same case without LT use. The McNemar bias ratios, which compare responses provided by physicians completing both series, ranged from 0.65 to 1.0. CONCLUSION: These data indicate that the diagnosis of EMS may be biased by knowledge of LT. By showing the presence of diagnostic bias in clinical decision making, we suggest an important methodological problem that may arise in both clinical and research settings.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |