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Nontraumatic perforation of the small bowel is rare. A 71-year-old man presented with a perforated jejunum 8 weeks after receiving streptokinase therapy for acute myocardial infarction. This was complicated by a bleeding duodenal ulcer, renal failure, ischemia of one toe and confusion. Renal biopsy showed cholesterol emboli. Examination of the resected specimen of jejunum revealed multiple cholesterol emboli but no other disorder. Cholesterol embolization has been associated with angiography, vascular surgery and thrombolytic therapy for myocardial infarction. Acute renal failure and ischemia of the digits as seen in this patient is also a common presentation of cholesterol embolization syndrome.

Aerobic fitness classes are a popular form of exercise for many people. A questionnaire survey of 410 participants and a clinical review of 100 patients presenting for treatment, showed that 67.3% of respondents had significant pain resulting from the classes, but only 21% stopped exercising because of it. The majority of injuries are to the lower extremities, including tibial stress syndrome and patellofemoral pain. This study suggests that most of these injuries are preventable, especially by advice on proper footwear, pace of activity, how many classes to attend and how frequently to increase activity.