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Updated Guidelines Provide Diagnosis and Treatment Recommendations for Bacterial Sinusitis Guidelines Underscore Importance of Selecting the Most Effective Antibiotics for the 20 Million Infections Each Year WASHINGTON, DC -- January 21, 2004 -- Updated guidelines released today by the Sinus and Allergy Health Partnership (SAHP) highlight the importance of accurate diagnosis and treatment of acute bacterial rhinosinusitis (ABRS), ...Full Story LETROZOLE CUTS BREAST CANCER RECURRENCESBreast cancer survivors may have a new and improved option for adjuvant hormonal therapy, according to a study that was stopped early because of its promising findings. The aromatase inhibitor letrozole (Femara), when started within three months after completing five years of adjuvant therapy with tamoxifen cut breast cancer recurrences by almost half, in an international study of 5,187 postmenopausal women.
Aromatase inhibitors, first approved for the treatment of recurrent breast cancer in December 2000, reduce estrogen levels in postmenopausal women by inhibiting peripheral conversion of androgens into estrogens. The study was published in October on the Web site of the New England Journal of Medicine and appeared in the November 6 print issue (2003;349:1793–1802). Out of the 5,187 women in the study, 207 had cancer recurrences or new primaries—75 in the group taking letrozole and 132 in the placebo group. From these results, the researchers estimated that the women on letrozole would have a four-year disease-free survival rate of 93%, compared with 87% for women in the placebo group. Although the breast cancer death rate was twice as high in the placebo group as in the letrozole group, this difference was not statistically significant. Lead author Paul Goss, MD, PhD, of Princess Margaret Hospital in Toronto and colleagues from several North American and European cancer centers designed the study to determine the efficacy of five years of letrozole. Before this report, there hasn’t been any treatment that has been proven to ward off recurrence after completing five years of tamoxifen. Goss and colleagues created the study to address that problem. "Over 50% of recurrences from breast cancer occur in the long-term after diagnosis, and that hangs like a black cloud over survivors and their families," he said. However, the first interim data analysis (with a median follow-up of 2.4 years) found that the risk of a local recurrence, metastatic recurrence, or a new contralateral primary breast cancer was 43% lower for the women on letrozole. Because the interim results exceeded thresholds specified in the initial design of the study, the data and safety monitoring committee advised that the study be stopped and the women in the placebo arm be offered letrozole. In fact, the trial’s consent form included a statement assuring participants that they would be informed if such thresholds were exceeded and that women receiving a placebo would have an opportunity to switch to letrozole. One of the problems with stopping the study early, however, is that researchers will no longer be able to determine the optimal duration of treatment with letrozole, they may be unable to tell whether letrozole has a statistically significant impact on overall survival, and they will be less able to evaluate the drug’s long term safety. Researchers will continue to follow the study participants to get answers about long-term use, but will not have a placebo group for comparison. New cases of osteoporosis were very slightly more frequent in the group taking letrozole. The researchers recommended women on letrozole also take calcium and vitamin D, and have bone density tests, until the long-term effects of letrozole on bone are better understood. They also noted that studies are underway to evaluate whether bisphosphonates can maintain bone density in women also receiving aromatase inhibitors. Other side effects of letrozole were mild and included low-grade hot flashes, arthritis, arthralgia, and myalgia. Patricia Ganz, MD, of the Jonsson Cancer Center and Professor, Schools of Medicine and Public Health, University of California, Los Angeles said the trial was well designed and well executed. While noting that letrozole reduced the likelihood of recurrence in both node-negative and node-positive patients, she said the risk of competing morbidities like osteoporosis and fracture may outweigh the benefits of the therapy in some very low risk patients. "Unfortunately, the early termination of the trial limits the conclusions we can make about the magnitude of long-term survival benefit, as well as the risks of side effects," she said. "Although it would be tempting to recommend letrozole to all women who have completed adjuvant tamoxifen, even if some time period has elapsed, we can only make clinical recommendations for patients who fit the eligibility and treatment plan associated with this trial." Ganz said that overall, this trial and other recent trials such as the Arimidex, Tamoxifen, Alone or in Combination trial provide ongoing evidence for the pivotal role of therapies that target the estrogen receptor in modulating the recurrence of previously diagnosed cancer and the development of new cancers in the contralateral breast. "We are fortunate to have a broad menu of endocrine therapies to apply in early stage breast cancer," she said, "and the strategic questions for the future will be the maximization of benefit with minimization of acute and late side effects." FALSE BELIEFS A THREAT TO LUNG CANCER PATIENTSAlmost 40% of patients with lung disease believe that surgery can make cancer spread by exposing the tumor to air, according a newly published survey. This myth was more common among African Americans than Whites, and researchers suggest it may contribute to lower lung cancer surgery and survival rates for African Americans.
Lead author Mitchell Margolis, MD wrote that "...widespread acceptance of the study belief could undermine the best chance for cure of early-stage lung cancer." The study is published in the Annals of Internal Medicine (2003;139:558–563). Margolis designed the survey because his patients at the Philadelphia Veterans Affairs Medical Center often mentioned the false belief, and several African American patients refused to see a surgeon on that basis. A total of 626 patients with lung cancer or other pulmonary diseases took the survey at clinics around Philadelphia, in Los Angeles, and in Charleston, South Carolina. Overall 38% believed air exposure during surgery would cause a tumor to spread. By race, 61% of African Americans and 29% of White respondents agreed with this belief. In univariate analysis, this belief was also associated with lower income and education levels, but in multivariate analysis, race was the only factor significantly associated with this concern about surgery. Nineteen percent of African Americans and 5% of Whites said they would refuse lung surgery based on the myth. Some 14% of African Americans and 5% of Whites would stick to their belief even if their doctors told them it was false. Few people remembered where they first heard of the notion that surgery causes lung cancer to spread; some named "the gossip mill." What many people did remember were unfavorable medical outcomes for loved ones with cancer. "The reality is that people come in very late in the disease and a few months later they die," explained Harold Freeman, MD, of North General Hospital in New York City and an expert on racial disparities in cancer. "People who believe myths have a life experience that supports their beliefs," he continued, "and if people’s relatives and friends are being operated on and dying, that’s a strong personal experience." Margolis speculates that past experiences with poor surgical or perioperative care could play a role, as well as "the legacy of racial discrimination against African Americans, mistrust and disenfranchisement from the current health care system." Overall, the outlook for surviving localized lung cancer has improved somewhat, largely due to better surgical techniques. The five-year survival rate for White patients at this stage is 49%. But African Americans don’t do as well; only 43% survive five years or longer after diagnosis. In his journal article, Margolis cites a recent study of elderly patients with localized lung cancer (based on the linked SEER-Medicare database) that found a 13% lower rate of surgery and an 8% lower five-year survival rate for African Americans compared with Whites. Freeman says doctors and patients must both make changes so false beliefs don’t prevent patients from pursuing the best treatment. "The key to this is that we have to ask physicians to be very sensitive and understanding and open about the myths or beliefs that people share with us," he said. "There are reasons for patient’s beliefs," said Freeman. "Doctors have to take more time and try to bring some logic to the issue without insulting the dignity of the person," he continued. "If all cancers touched by air did spread quickly, you could logically assume that all people whose cancers are treated with surgery would die. And that’s clearly not the case." 
HERPES PREVENTION, DIAGNOSIS, EPIDEMIOLOGY, AND MANAGEMENT Consider epidemiology of genital herpes, as well as asymptomatic shedding, clinical manifestations, and acyclovir resistance. Read "Sexually Transmitted Diseases," featured in the Latest From the Literature section of the Genital Herpes Resource Center from Medscape.
Experts Skeptical of Human Cloning Claim News in the media that a human embryo has been cloned and transferred into a woman has been received with a large dose of skepticism by numerous experts in the field of reproductive health, and they are challenging the maverick fertility expert to prove it. Reuters Health Information 2004 UK Scientists Urge Worldwide Cloning Ban Britain's national academy of science called on Wednesday for a worldwide ban on "cowboy cloners" and published a checklist for assessing cloning claims. Reuters Health Information 2004 Polymorphism Modulates Cancer Sensitivity to Chemotherapy Drugs A common polymorphism in a gene controlling folate metabolism affects the response of colon and breast cancer cells to methotrexate and 5-fluorouracil, a multinational research team reports. Thus, Dr. Young-In Kim and colleagues suggest in the January 21st issue of the Journal of the National Cancer Institute, that patient genotype could be used to individually tailor cancer chemotherapy. Reuters Health Information 2004 Modified Virus Vectors Selectively Deliver Genes to Vascular Tissue Researchers have created special adeno-associated virus (AAV) vectors that selectively target vascular tissue for gene delivery, according to a report published in the January 20th rapid access issue of Circulation: Journal of the American Heart Association. Reuters Health Information 2004 Dengue Fever Fusion Proteins Analogous to Those in Influenza, HIV Two different types of viral fusion protein interactions with host cells share important mechanistic features, investigators report in the January 22nd issue of Nature. Reuters Health Information 2004 LDL Receptor MRNA-to-Protein Ratio Is a Marker for Coronary Atherosclerosis In patients with coronary atherosclerosis, mRNA levels of the LDL receptor-related protein/alpha2-macroglobulin receptor (LRP/A2MR) are higher than normal while expression of the protein is down-regulated, results of a study published in the December issue of the International Journal of Cardiology indicate. Reuters Health Information 2004 Genetic Males Often Self-Identify as Male Despite Female Assignment Males born with severe phallic inadequacy are often assigned at birth to the female sex. Over time, many of these individuals assume a male identity, despite hormonal treatments and rearing practices, investigators report in The New England Journal of Medicine for January 22nd. Reuters Health Information 2004 Antibody Therapy for Rheumatoid Arthritis Shows Promise in Mice An antibody that induces apoptosis of activated T cells could represent a useful treatment for rheumatoid arthritis (RA), findings from a recent animal study suggest. Reuters Health Information 2004
COMPREHENSIVE, PRINTABLE DRUG INFORMATION Medscape DrugInfo provides clinical information on drug indications, adverse effects, interactions, and other cautionary guidance, as well as handouts for your patients. Click DrugInfo from the top of any page, or search by drug name.
 Factors
Associated with Health-Related Quality of Life in Chronic Pancreatitis
Chronic pancreatitis may lead to considerable reduction in health-related quality of life, but factors associated with a poor perceived health status have not been investigated. Am J Gastroenterol 99(1) 2004 From the Editor - January 2004: On Tour With Medscape Gastroenterology's Videoendoscopic Surgery Series The Editor introduces the reader to the newest interactive clinical-challenge series that highlights the importance of minimally invasive surgical techniques in clinical gastroenterology. Medscape Gastroenterology 6(1) 2004 Clinical Usefulness of Carbohydrate Antigen 19-9 as a Screening Test for Pancreatic Cancer in an Asymptomatic Population Measurement of serum carbohydrate antigen 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients with pancreatic cancer. Will this method work for asymptomatic patients? J Gastroenterol Hepatol 19(2) 2004 Colorectal Cancer in Inflammatory Bowel Disease Patients with IBD are at an increased risk for developing colorectal carcinoma, and an optimal strategy for reducing this risk has yet to be defined. Curr Opin Gastroenterol 20(1) 2004 Different Patterns of Oesophageal Acid Exposure Distinguish Complicated Reflux Disease From Either Erosive Reflux Oesophagitis or Non-Erosive Reflux Disease Are high levels of supine nocturnal esophageal acid exposure associated with complicated reflux disease? Aliment Pharmacol Ther 18(11) 2003 Cytokine Gene Polymorphisms and the Susceptibility to Liver Cirrhosis in Patients With Chronic Hepatitis C The study authors analyzed whether cytokine gene polymorphisms are associated with a progressive course of this disease. Liver Int 23(6) 2003 Evaluating Chronic Cough In the majority of nonsmoking, immunocompetent adults, chronic cough that is not caused by use of an angiotensin-converting enzyme inhibitor can be explained by postnasal drip syndrome, gastroesophageal reflux disease, asthma, or eosinophilic bronchitis. Clinician Reviews 13(10) 2003 HIGHLIGHTS IN CME Capsule Endoscopy and New Endoscopic Technologies Klaus Mergener, MD, FACP, FACG, reviews current applications of capsule endoscopy in patients with obscure lower GI bleeding and detection of small-bowel mucosal abnormalities, as well as comments on the current state of endoscopic antireflux procedures. Read this report and more from Medscape's coverage of ACG 2003. Medscape Gastroenterology 2003 Clinical Update - IBS: Improving Diagnosis, Serotonin Signaling, and Implications for Treatment Lucinda Harris, MD, and Lin Chang, MD, discuss the potential role of serotonergic mechanisms in the pathophysiology of IBS, with a view toward issues in treatment. Medscape Gastroenterology 2003 FEATURED RESOURCE CENTER Hepatitis C Medscape's Hepatitis C Resource Center is a collection of the latest medical news and clinical information on this disease entity, with an emphasis on approach to management. Medscape Gastroenterology COLORECTAL CANCER AND CLINICAL APPLICATION OF BIOLOGIC THERAPIES Where are we with biologic therapies and angiogenesis inhibition in management of colorectal cancer? Read more in the CME activity "Targeted Therapies in Colorectal Cancer," featured in the Colorectal Cancer Resource Center from Medscape.
Occult Hepatitis B Virus Infection Still Oncologic The findings from a new study suggest that infection with hepatitis B virus promotes oncogenesis even in the absence of circulating surface antigen. Reuters Health Information 2004 Anti-HBV Agent Helpful HAART Supplement in HIV/HBV Coinfection Results of a small study of HIV patients with hepatitis B virus (HBV) coinfection show that it is possible to recover some HBV-specific T cell responses by adding a drug with specific anti-HBV activity to highly active antiretroviral therapy [HAART]. Reuters Health Information 2004
 Health
Providers Welcome Bush Attention to Health Issues, Split Over Impact
Private-sector approach to expand coverage to the uninsured is welcomed by some, dismissed by others. Read more of the reaction to the State of the Union address. Medscape Medical News2004 20% Dietary Saturated Fat Recommended in Atkins Diet A New York Times report outlines what Atkins proponents have been trying to get across all along -- that a limit on carbohydrates does not mean an increase in saturated fat. ALLERGY/CLINICAL IMMUNOLOGY Ethnicity and Skin Test Reactivity to Aeroallergens Among Asthmatic Children in Connecticut In the United States, childhood asthma is a major public health problem among Hispanics in general, and among individuals of Puerto Rican descent in particular. CHEST 125(1) 2004 CARDIAC RHYTHM MANAGEMENT Vasopressin vs Epinephrine: What is the Optimal CPR Strategy? European study finds vasopressin superior to epinephrine in treating asystole; vasopressin plus epinephrine also may be better than epinephrine alone in patients with refractory cardiac arrest. Medscape CRM News2004 CARDIOLOGY NCEP and Next Steps: Rosuvastatin and the Therapeutic Index As the NCEP target cholesterol levels continue to become ever more strict, how can patients' cholesterol levels be brought into compliance? Medscape Cardiology 8(1) 2004 ECG of the Week - What Cardiac Condition? Which cardiac condition that could produce this electrocardiogram? The Need for More General Cardiologists Are more cardiologists needed for the future? J. Willis Hurst, MD, shares his views. |
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Conference
Report - Adjuvants and Delivery: Improving on Vaccine Immunogenicity |
Friday, January 30, 2004 |
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| Is there evidence showing that endocervical
scraping should not be done during Pap smears in pregnant patients? SMOKING CESSATION DURING PREGNANCY Are there any indications that patients should not attempt smoking cessation during pregnancy? INDUCING A PRIMIGRAVIDA WITH AN UNRIPE CERVIX FOR SUSPECTED MACROSOMIA Is this a wise and safe procedure? NON-ESTROGEN TREATMENT OF VASOMOTOR SYMPTOMS Can you recommend an effective treatment for patients who can't/don't want to be on estrogens and/or experience disabling hot flashes? PRETERM LABOR AND TOCOLYTICS Nifedipine is not licensed in developed countries for use in preterm labor. What happens if something goes wrong with mother or baby? FLUID IN POUCH OF DOUGLAS POST-CAESARIAN What is the cause of this free fluid, and how should this patient be managed? |
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Headlines From the Last Issue
| A spoonful of cinnamon helps treat diabetes NEW YORK (Reuters Health) - People with diabetes can help keep their bodies healthy by simply adding a dash of spice to their diet, new research reports. In a study, diabetics who incorporated one gram -- equivalent to less than one-quarter teaspoon -- of cinnamon per day for 40 days into their normal diets experienced a decrease in levels of blood sugar, cholesterol and blood fats. And for people with diabetes, the less of those substances in the body, the better. Type 2 diabetes arises when the body loses sensitivity to insulin, a hormone that shuttles the sugars from food into body cells to be used for energy. As a result, the amount of sugar, or glucose, in the blood remains high, leading to fatigue and blurred vision. Over the long term, excess blood glucose can increase the risk of heart disease, kidney failure and blindness. The current findings suggest that a small amount of cinnamon can help protect diabetics from these and other potential complications of their condition, study author Dr. Richard A. Anderson of the Beltsville Human Nutrition Research Center in Maryland told Reuters Health. Diabetics could add a dash of cinnamon to their morning servings of coffee, orange juice or cereal, Anderson noted. "You can also make a cinnamon tea by simply boiling water with stick cinnamon," he suggested. Anderson noted that cinnamon may also help stave off the onset of type 2 diabetes in people at risk of the condition. He added that cinnamon contains some substances that can be toxic in high amounts, so people should be sure not to get too much of a good thing. "Certainly, a gram per day is not a high amount," he reassured. During the study, Anderson and his colleagues asked 60 people with type 2 diabetes to consume 1, 3, or 6 grams of cinnamon each day for 40 days, or the equivalent amount of wheat flour, as a placebo. Both the cinnamon and wheat flour were administered in capsule form. Reporting in the journal Diabetes Care, Anderson and his team found that all cinnamon-takers experienced a drop in blood levels of glucose, fats and cholesterol by up to 30 percent. No change was seen in the people taking placebo capsules. Anderson explained that cinnamon contains compounds that help make insulin more efficient, improving the hormone's ability to bring glucose to the cells that need it. As an added bonus, cinnamon contains virtually no calories, Anderson said, allowing diabetics to add zest to their meals without adding to their waistlines. Cinnamon contains less than 3 calories per gram, "negligible in the total dietary intake," Anderson said. Previous research has shown that cinnamon appears to help fat cells recognize and respond to insulin. In test tube and in animal studies, the spice increased glucose metabolism by about 20 times. SOURCE: Diabetes Care, December 2003.
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Papers and
articles, pertaining to General Medicine, most read by your colleagues in the
past 7 days
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Some Cancers
May Be Due to Diagnostic X-Rays
Avian Flu:
What Clinicians Need to Know
Subthalamic
Nucleus Stimulation May Be Better Than Surgery in Parkinson's Disease
Bush Under
Fire Over Global AIDS Funding
Soluble
TREM-1 May Help Diagnose Bacterial or Fungal Pneumonia
New 'Food
Pyramid' to Address Obesity Epidemic
Cholesterol
Reduction May Help Dialysis Patients
U.N. Health
Agency Seeks to Speed Avian Influenza Vaccine
FDA Big
Factor Behind High US Drug Costs -- Economist
Laparoscopic
Versus Open Appendectomy: Outcomes Comparison Based on a Large Administrative
Database
On Tour With
Medscape Gastroenterology's Videoendoscopic Surgery Series
Few Data on
Surgical Quality Available to California Patients
Migraine May
Increase Stroke Risk in Some Patients
Placental
Growth Factor Helps Determine Prognosis in Acute Coronary Syndromes
Breast
Augmentation Decreases Screening Mammography Sensitivity
WHO Open
Access to Research Initiative: An Expert Interview With Barbara Aronson
California
Moves to Ban Smoking in Prisons
| Volume 239 (2004) | ||
| • January, 2004 (pp.1-131) | • February, 2004 (pp.133-294) | |
| Volume 238 (2003) | ||
| • July, 2003 (pp.1-160) | • August, 2003 (pp.161-305) | • September, 2003 (pp.307-445) |
| • October, 2003 (pp.447-639) | • November, 2003 (pp.641-775) | • December, 2003 (pp.777-905) |
| Volume 237 (2003) | ||
| • January, 2003 (pp.1-148) | • February, 2003 (pp.153-290) | • March, 2003 (pp.291-448) |
| • April, 2003 (pp.449-596) | • May, 2003 (pp.597-739) | • June, 2003 (pp.741-907) |
| Volume 236 (2002) | ||
| • July, 2002 (pp.1-132) | • August, 2002 (pp.137-262) | • September, 2002 (pp.263-395) |
| • October, 2002 (pp.397-541) | • November, 2002 (pp.543-697) | • December, 2002 (pp.699-846) |
| Volume 235 (2002) | ||
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| Volume 234 (2001) | ||
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| Volume 233 (2001) | ||
| • January, 2001 (pp.1-145) | • February, 2001 (pp.149-291) | • March, 2001 (pp.293-453) |
| • April, 2001 (pp.455-596) | • May, 2001 (pp.597-723) | • June, 2001 (pp.725-874) |
| Volume 232 (2000) | ||
| • July, 2000 (pp.1-150) | • August, 2000 (pp.155-286) | • September, 2000 (pp.287-453) |
| • October, 2000 (pp.455-618) | • November, 2000 (pp.619-727) | • December, 2000 (pp.729-821) |
| Volume 231 (2000) | ||
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| • April, 2000 (pp.449-616) | • May, 2000 (pp.617-779) | • June, 2000 (pp.781-926) |
| Volume 230 (1999) | ||
| • July, 1999 (pp.1-120) | • August, 1999 (pp.131-276) | • September, 1999 (pp.279-450) |
| • October, 1999 (pp.453-607) | • November, 1999 (pp.613-737) | • December, 1999 (pp.739-826) |
| Volume 229 (1999) | ||
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| Volume 228 (1998) | ||
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| Volume 227 (1998) | ||
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| Volume 226 (1997) | ||
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| Volume 225 (1997) | ||
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| Volume 224 (1996) | ||
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| Volume 223 (1996) | ||
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| • April, 1996 (pp.349-451) | • May, 1996 (pp.453-628) | • June, 1996 (pp.629-798) |
=http%3A//ipsapp002.lwwonline.com/ips/frames/frames.asp%3FJ%3D160%26S%3D2%26cookie%3D1){kind=small}
| Volume 56 (2004) | ||
| • January, 2004 (pp.1-236) | ||
| Volume 55 (2003) | ||
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| • October, 2003 (pp.595-804) | • November, 2003 (pp.805-1006) | • December, 2003 (pp.1007-1205) |
| Volume 54 (2003) | ||
| • January, 2003 (pp.1-218) | • February, 2003 (pp.219-421) | • March, 2003 (pp.423-631) |
| • April, 2003 (pp.633-801) | • May Supplement, 2003 (pp.S1-S234) | • May, 2003 (pp.803-1039) |
| • June, 2003 (pp.1041-1276) | ||
| Volume 53 (2002) | ||
| • July, 2002 (pp.1-171) | • August, 2002 (pp.201-399) | • September, 2002 (pp.407-619) |
| • October, 2002 (pp.621-809) | • November, 2002 (pp.811-1036) | • December, 2002 (pp.1037-1231) |
| Volume 52 (2002) | ||
| • January, 2002 (pp.1-191) | • February, 2002 (pp.205-412) | • March, 2002 (pp.415-609) |
| • April, 2002 (pp.611-816) | • May, 2002 (pp.817-1015) | • June, 2002 (pp.1017-1226) |
| Volume 51 (2001) | ||
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| Volume 50 (2001) | ||
| • January, 2001 (pp.1-173) | • February, 2001 (pp.185-387) | • March, 2001 (pp.389-587) |
| • April, 2001 (pp.589-763) | • May, 2001 (pp.765-972) | • June, 2001 (pp.973-1163) |
| Volume 49 (2000) | ||
| • July, 2000 (pp.1-169) | • August, 2000 (pp.171-361) | • September, 2000 (pp.387-573) |
| • October, 2000 (pp.575-793) | • November, 2000 (pp.795-982) | • December, 2000 (pp.985-1159) |
| Volume 48 (2000) | ||
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| Volume 47 (1999) | ||
| • July, 1999 (pp.1-223) | • August, 1999 (pp.225-440) | • September, 1999 (pp.441-616) |
| • September Supplement, 1999 (pp.S1-S110) | • October, 1999 (pp.617-822) | • November, 1999 (pp.825-994) |
| • December, 1999 (pp.995-1165) | ||
| Volume 46 (1999) | ||
| • January, 1999 (pp.1-208) | • February, 1999 (pp.209-360) | • March, 1999 (pp.361-534) |
| • April, 1999 (pp.535-749) | • May, 1999 (pp.751-985) | • June, 1999 (pp.987-1145) |
| Volume 45 (1998) | ||
| • July, 1998 (pp.1-204) | • August, 1998 (pp.205-428) | • September, 1998 (pp.429-648) |
| • October, 1998 (pp.649-856) | • November, 1998 (pp.857-982) | • December, 1998 (pp.983-1120) |
| Volume 44 (1998) | ||
| • January, 1998 (pp.1-240) | • February, 1998 (pp.243-432) | • March, 1998 (pp.433-574) |
| • April, 1998 (pp.575-742) | • May, 1998 (pp.743-939) | • June, 1998 (pp.941-1116) |
| Volume 43 (1997) | ||
| • July, 1997 (pp.1-122) | • August, 1997 (pp.209-394) | • September, 1997 (pp.395-564) |
| • October, 1997 (pp.565-731) | • November, 1997 (pp.733-873) | • December, 1997 (pp.875-991) |
| Volume 42 (1997) | ||
| • January, 1997 (pp.1-153) | • February, 1997 (pp.169-348) | • March, 1997 (pp.353-573) |
| • April, 1997 (pp.577-758) | • May, 1997 (pp.763-983) | • May Supplement, 1997 (pp.2S-71S) |
| • June, 1997 (pp.987-1197) | ||
| Volume 41 (1996) | ||
| • July, 1996 (pp.1-171) | • August, 1996 (pp.203-371) | • September, 1996 (pp.375-578) |
| • October, 1996 (pp.581-765) | • November, 1996 (pp.769-932) | • December, 1996 (pp.935-1078) |
| Volume 40 (1996) | ||
| • January, 1996 (pp.1-171) | • February, 1996 (pp.185-330) | • March, 1996 (pp.335-497) |
| • March Supplement, 1996 (pp.6S-223S) | • April, 1996 (pp.501-675) | • May, 1996 (pp.679-852) |
| • June, 1996 (pp.855-1055) | ||
| Volume 39 (1995) | ||
| • July, 1995 (pp.1-142) | • August, 1995 (pp.179-398) | • September, 1995 (pp.401-621) |
| • October, 1995 (pp.625-808) | • November, 1995 (pp.811-1022) | • December, 1995 (pp.1027-1206) |
| Volume 38 (1995) | ||
| • January, 1995 (pp.1-157) | • February, 1995 (pp.161-321) | • March, 1995 (pp.323-465) |
| • April, 1995 (pp.469-676) | • May, 1995 (pp.681-840) | • June, 1995 (pp.845-981) |
=http%3A//ipsapp006.lwwonline.com/ips/frames/subframe.asp%3FJ%3D2281%26S%3D20943%26M%3D17779%26ADS%3D0%26I%3D0%26ASP%3Dissues){kind=small}
Rupture of internal iliac artery aneurysm presenting as rectus sheath hematoma: Case report
Gianmarco de Donato, MDa |
This report describes a ruptured internal iliac artery aneurysm that presented as a rectus sheath hematoma (RSH). The patient developed abdominal pain and a large, tense lower abdominal wall mass without peritoneal signs. Computed tomography scan demonstrated a massive RSH contiguous with a ruptured left internal iliac artery aneurysm. Hypovolemic shock prompted immediate laparotomy, aneurysmorrhaphy of the ruptured aneurysm, and evacuation of the rectus hematoma. This uncommon presentation of internal iliac aneurysm rupture should caution against a simple diagnosis of “spontaneous” RSH in a patient with a potentially ruptured iliac aneurysm.
Insulin decreases hepatic acute phase protein levels in severely burned children
Xiaowu Wu, MD [MEDLINE LOOKUP] |
Background Severe burn induces the hepatic acute phase response. In this study, we wondered whether continuous insulin treatment decreases acute phase protein levels in the severely burned.
Methods Eighteen children aged 2 to 17 years with burns >40% of
total body surface area were randomized to receive either insulin (n=9) or no
treatment (n=9) within 72 hours after injury until the wounds were 95% healed.
Insulin was given at a continuous rate of 
1.5 µU/kg/min to maintain
euglycemia (serum glucose 100–140 µg/dL). Plasma was examined at days 7, 14, 21,
and 28 for acute phase protein levels including C-reactive protein, C3
complement, 
1-acid glycoprotein, haptoglobin, 2-macroglobulin,
prealbumin, transferrin, and retinol-binding protein. Statistical analysis was
by ANOVA and t test.
Results With insulin treatment, 1-acid
glycoprotein, C3 complement, 2-macroglobulin, and haptoglobin levels decreased
(P<.05) after a severe burn compared with control, especially at days
21 and 28. Additionally, the hepatic constitutive proteins (prealbumin,
transferrin, and retinol-binding protein) were lower in the insulin-treatment
group than those of the control group at day 21 (P<.05).
Conclusions Continuous insulin treatment decreases acute phase protein
levels after a severe burn. The results suggest insulin downregulation of the
hepatic acute phase response to injury.
Arch Facial Plast Surg. 2004;6:16-20.
Objective To examine the indications for, and the success of, free flap reconstruction in patients with forehead and scalp defects.
Design Case series.
Setting Two tertiary referral university teaching hospitals.
Patients Twenty-six consecutive patients, aged 31 to 85 years, presenting with 26 scalp defects, 5 forehead defects, and 1 combined defect (size, 70-672 cm2). Three patients required resection and repair of the dura at surgery.
Intervention Patients were staged according to the size of the defect and the viability of surrounding tissue; free flap reconstruction was performed where indicated.
Main Outcome Measures Flap survival, complications, and disease-free and overall survival.
Results Thirty-four free flap reconstructions were performed (24 latissimus dorsi free flaps, 4 scapular free flaps, 3 rectus abdominis free flaps, and 3 radial forearm free flaps). One failed 2 weeks postoperatively, and 2 required exploration (1 for arterial ischemia and 1 for a hematoma). There were 3 cases of donor site morbidity (2 early seromas and 1 late abdominal hernia). One patient died of a pulmonary embolus 1 week postoperatively. Disease-free survival was 48% at 5 years and overall survival was 59% at 5 years, with a median follow-up of 24 months.
Conclusions Free revascularized tissue transfer is a reliable and safe way of reconstructing large scalp or forehead defects after traumatic injury or neoplastic resection. The muscle-only latissimus dorsi free flap for scalp reconstruction and the cutaneous scapular free flap for the forehead have proved successful in selected patients with a low complication rate and satisfactory cosmesis.
From the Wharton Head and Neck Centre, Princess Margaret Hospital,
Toronto, Ontario.
| Skull fracture as a herald of intracranial abnormality in children with mild head injury: Is there a role for skull radiographs? | |
| Savvas Andronikou ,1
Tracy Kilborn ,1
Maya Patel 1
and Antony Graham Fieggen 2 | |
The aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X-rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1-year period was done. Three-hundred and eighty-one patients were included with a mean age of 6 years. Thirty-one percent of patients had intracranial abnormality. Forty-nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty-five percent of patients with drainable collections had associated fractures. Twenty-three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of 'silent' drainable collections. |
Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps
Department of Cardiovascular and Thoracic Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
Received 2 September 2003; received in revised form 10 November 2003; accepted 11 November 2003.
* Corresponding author. Tel.: +49-69-6301-5850; fax:
+49-69-6301-5849
e-mail: p.kleine@em.uni-frankfurt.de
OBJECTIVE: Severe sternum necrosis requiring extended resection necessitates plastic reconstruction of the resulting defect and stabilization of the chest. We analyzed the outcome of patients undergoing bilateral pectoralis major flap repair on functional and cosmetic results, chest stabilization and pulmonary function.
METHODS: Twelve patients undergoing cardiac surgery between 1997 and 2001 suffered from a deep mediastinal wound infection and sternum necrosis. After a mean of two attempts of extensive wound debridement, all 12 patients underwent complete sternal resection with plastic reconstruction by bilateral pectoralis major flaps. Risk factors were obesity (n=10) and diabetes (n=11). Six months postoperatively patients underwent physical examination, pulmonary function testing and functional CT scan.
RESULTS: Three patients died in hospital (two septic multiorgan failure, one heart failure) and nine were discharged with complete wound closure. One patient suffered a lethal stroke during follow-up. At 6-month follow-up no recurrent sternum infection had occurred. Chest stability was satisfactory without impairment of pulmonary function (VC 77.5±12.1% at follow-up vs 77.8±12.5% preoperatively). Mobility and force of arms and shoulder were adequate; at CT scan the maximum distance change between the former sternoclavicular joint in inspiration versus expiration was minimal. Quality of life questionnaires showed no significant limitations except a disturbed sleep and mild restriction of executing hobbies and social activities.
CONCLUSIONS: Bilateral pectoralis major flap repair is a safe technique to cure severe mediastinitis necessitating complete sternal resection. Wounds close without extensive reconstructive surgery. Cosmetic results as well as stabilization of the chest were good. Patients reported an almost uncompromised quality of life without respiratory impairment.
Key Words: Open heart surgery • Sternum infection • Wound treatment • Pectoralis flaps
The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery
Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, 2nd Floor, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK
Received 26 November 2002; received in revised form 31 July 2003; accepted 12 November 2003.
* Corresponding author. Tel.: +44-207-679-9476; fax:
+44-207-679-9426
e-mail: s.newman@ucl.ac.uk
OBJECTIVE: A randomised clinical trial sought evidence as to whether leucocyte-depleting (LD) arterial line filters added a further degree of neuroprotection in patients undergoing elective coronary artery bypass graft (CABG) surgery.
METHODS: One hundred and ninety-two patients were randomised to the use of a Pall Leukoguard-6 LD filter or either an Avecor Affinity or Pall Autovent-6 control filter. Cerebral microemboli during surgery were recorded by transcranial Doppler (TCD) monitor over the right middle cerebral artery. Evidence of cerebral impairment was obtained by comparing patients' performance in a neuropsychological (NP) test battery (nine tests) administered 6–8 weeks post-operatively with their pre-operative scores.
RESULTS: The groups proved well balanced in pre-operative variables. During cardiopulmonary bypass (CPB) the median number and range of microemboli was 15 (3–180) in the LD group compared to 67 (5–846) and 55 (2–773) for the Avecor and AV6 groups, respectively (P<0.0001). One hundred and sixty-two patients completed all the NP tests. The LD group showed better post-operative performance in all but one of the nine tests although the difference in a total change score just failed to reach significance (P=0.07 one-tailed t-test).
CONCLUSIONS: LD filtration during CABG reduced the number of cerebral microemboli recorded by TCD and showed a strong trend towards improving NP performance post-operatively. These findings suggest that the use of such filters in CABG surgery may offer increased neuroprotection.
Key Words: Coronary artery bypass graft surgery • Neuropsychology • Leucocyte • Filters • Microemboli
SURGERY
Surgical
Treatment of Primary Sacral Tumors: Complications Associated With Sacrectomy
Primary sacral tumors, although rare, include benign neoplasms such as
osteochondroma, giant cell tumors, and osteoid osteoma, as well as chordoma,
osteosarcoma, and myeloma.
Neurosurg Focus 15(5) 2003
Laparoscopic
Versus Open Appendectomy
The objective of this retrospective study was
to compare length of hospital stay, in-hospital complications, in-hospital
mortality, and rate of routine discharge between laparoscopic (LA) and open
appendectomy (OA) based on a large administrative database.
TRANSPLANTATION
Acute Renal
Transplant Rejection Possibly Related to Herbal Medications
The case of
a 59-year old Caucasian female who had received a cadaveric renal transplant 16
years before this admission, illustrates the potentially devastating interaction
between untested herbal medications and immunosuppression.
Am J Transplant
3(12) 2003
Fatal West
Nile Virus Encephalitis in a Renal Transplant Recipient
West Nile virus
(WNV) was first described in 1937 in the West Nile district of
Uganda.
UROLOGY
Bilateral
Multifocal Renal Oncocytoma
Renal oncocytomas account for approximately
5% of all primary renal neoplasms.
Infect Urol 16(4) 2003
| AMA Feature Story | ||
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Attend the Women Physician Leaders Summit |
Impotence may be early sign of artery disease
Last Updated: 2004-01-30 14:44:24 -0400 (Reuters Health)
NEW YORK (Reuters Health) - For some men, erectile dysfunction (ED) could be an early warning sign of heart disease, the results of a small study suggests.
Researchers found that men who had ED but were otherwise healthy showed signs of dysfunction in the arm's brachial artery, signaling that problems with blood flow went beyond the penile arteries.
Most cases of ED arise from impaired blood flow to the penis, and it's known that ED and cardiovascular disease share many of the same risk factors, including high blood pressure, diabetes, high cholesterol and smoking.
The new study suggests that for some men, ED might be the first manifestation of widespread trouble in the blood vessels, according to study author Dr. Alan J. Bank of the St. Paul Heart Clinic in Minnesota.
"We think these people may be at higher risk of future cardiovascular events," such as heart attack, Bank told Reuters Health.
What's needed now, he said, is research that follows otherwise healthy ED patients to see whether they do develop higher-than-average rates of cardiovascular disease.
The current study, which received partial funding from Viagra maker Pfizer Inc., is reported in the Journal of the American College of Cardiology.
Of the 30 men with ED in the study, none was a recent smoker or had high blood pressure, diabetes or high cholesterol. The researchers looked at several measures of blood vessel structure and function in these men, and compared them with those of 27 men the same age without ED.
Bank's team found that in participants with ED, the brachial artery showed less dilation in response to blood flow and in response to nitroglycerin, a drug that promotes blood vessel dilation.
According to the researchers, this suggests the men had widespread dysfunction in a particular chemical "pathway," called NO-cGMP for short, involved in blood vessel dilation. This pathway is known to play a key role in ED, and is also involved in atherosclerosis, a "hardening" and narrowing of arteries that can lead to heart attack and stroke.
Whether men like those in this study eventually develop atherosclerosis "remains to be seen," Bank and his colleagues conclude.
"The important message here is that many patients with ED have a vascular mechanism similar to that seen in atherosclerosis," writes Dr. Melvin D. Cheitlin of the University of California San Francisco in an accompanying editorial. "Its presence," he adds, "should alert the clinician to the possible presence or future development of cardiovascular disease."
SOURCE: Journal of the American College of Cardiology, January 21, 2004.
FDA News
FDA Warns Consumers Not to Feed Infants “Better than Formula Ultra Infant Immune Booster 117”The Food and Drug Administration is warning consumers that a product, Better Than Formula Ultra Infant Immune Booster 117, sold over the internet as a dietary supplement should not be fed to infants. NSP Research Nutrition of Mt. Clemens, Michigan, sells the product as a dietary supplement. Even though NSP Research Nutrition labeled their product as "a dietary supplement," as a result of its labeling claims FDA is concerned that the product may be an infant formula. The term "Better than Formula," in the product name describes this product as a substitute for, or alternative to, other infant formulas. In addition, the "mixing instructions and directions" printed on the label state that "As with adults, infants should have small feedings every 2 to 3 hours throughout the day and should never be overfed." This statement appears to represent the product for use as a meal and not as a dietary supplement. There are a myriad of other promotional claims that appear to describe this product as an infant formula. Under the Federal Food, Drug, and Cosmetic Act, the term "infant formula" means a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk." Any infant formula marketed must be registered with the FDA at least 90 days before marketing. The manufacturer has not submitted a notification required under Section 412 of the Federal Food, Drug, and Cosmetic Act for use of this product as an infant formula. If this product is used as an infant formula, there are no assurances that have been provided to the agency by the manufacturer that this product as represented for use 1) would support growth of infants, 2) contains nutrients essential for infants that are required by law in infant formulas, and 3) is manufactured under good manufacturing practices. In addition, the label lists a number of ingredients that have not been evaluated for safe use in infant formula. "Since the product has not been reviewed as an infant formula, its nutritional value and safety as an infant formula are unknown," said FDA Commissioner Mark B. McClellan, M.D., Ph.D. "We urge parents who have purchased this product to immediately stop feeding it to their infants." To date, FDA is not aware of any illnesses or injuries associated with this product. FDA advises that consumers contact their health-care provider if they have any concerns about possible health problems or illness of their infant.
 Acute Renal
Transplant Rejection Possibly Related to Herbal Medications The case of a 59-year old Caucasian female who had received a cadaveric renal transplant 16 years before this admission, illustrates the potentially devastating interaction between untested herbal medications and immunosuppression. Am J Transplant 3(12) 2003 New Prophylactic Treatment Strategy for Cytomegalovirus Disease The pharmacology, pharmacokinetics, safety, and efficacy of valganciclovir, an oral prodrug for ganciclovir, used to prevent cytomegalovirus disease in solid organ transplant recipients are described. Am J Health-Syst Pharm 60(23) 2003  Fatal West
Nile Virus Encephalitis in a Renal Transplant Recipient The authors report clinical and pathologic findings of fatal encephalitis from the transmission of West Nile Virus from an organ donor to a kidney transplant recipient. Am J Clin Pathol 121(1) 2004 GASTROINTESTINAL COMPLICATIONS IN RENAL TRANSPLANT RECIPIENTS While the incidence and impact of GI complications is diminishing due to better prophylactic and therapeutic options and the use of newer immunosuppressive drugs, diarrhea has emerged as an important complication after renal transplantation |
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Panic
Attack! Lizard Saliva for Diabetes --
Full-Length Doctor's Interview Coping After a
Stroke Single injection promising for heroin addiction Last Updated: 2004-01-30 15:00:54 -0400 (Reuters Health) NEW YORK (Reuters Health) - A single dose of an experimental drug holds promise for the treatment of heroin addiction, according to the results of a small study. The findings suggest that a new, long-lasting formulation of the drug buprenorphine is safe and seems to prevent withdrawal symptoms for 6 weeks. What's more, the long-lasting form of the drug, known as a "depot" formulation, seems to block the effect of other opioid drugs, the class of drugs that includes heroin and morphine. "I believe the depot medication offers promise as a way to make effective treatment more accessible to opioid-addicted patients without the need to worry that the treatment medication itself might be misused or abused," Dr. George E. Bigelow of Johns Hopkins University School of Medicine in Baltimore told Reuters Health. Lead author Bigelow said he was impressed with the drug's effectiveness in providing long-lasting relief from symptoms of withdrawal that usually occur when people stop taking heroin and other similar drugs. The Johns Hopkins researcher said that more research is needed to confirm the results of this small trial and to identify the best use of this new formulation of buprenorphine. Methadone, a synthetic opioid that blocks the effect of heroin and reduces cravings for the drug, has been used for decades to treat heroin addiction. For methadone to work, though, it must be taken every day, and patients are usually required to make frequent visits to a methadone clinic to receive the medication. Buprenorphine, too, blocks the pleasure of heroin and reduces an addict's cravings. In a tablet form, the drug is normally taken once a day. Now, Bigelow and his colleagues report that a single injection of a long-lasting version of buprenorphine is safe and seems effective, at least in a small study. The study included five people who had used heroin for an average of more than 6 years. After receiving a single injection of the long-lasting buprenorphine, participants were monitored for signs of withdrawal for the next 6 weeks. The new formulation was safe, with no major side effects reported. Even though the study was designed to test the drug's safety, not its effectiveness, it seemed to work in helping addicts' get off heroin, Bigelow and his colleagues report in the January issue of the journal Drug and Alcohol Dependence. When participants received inpatient care after 4 weeks of depot buprenorphine, none needed other medications to combat withdrawal symptoms. In fact, participants did not experience clinically significant withdrawal symptoms after receiving the buprenorphine injection. At the end of the 6-week study, urine tests showed that all of the patients had abstained from opioid drugs like heroin with the exception of one person who reported using a prescription opioid drug for dental pain. Two patients reported cocaine use. The drug also seemed to block most of the effect of another opioid medication that was given to the participants. Although other forms of buprenorphine are available in the U.S., Bigelow noted that the slow-release formulation is still experimental and has not been approved by the Food and Drug Administration (FDA). "Gathering sufficient data and experience for FDA approval is likely to take a good while yet," he said. The study was funded by the National Institute on Drug Abuse. Biotek Inc., which makes the experimental buprenorphine formulation, provided the study medication. Two of the study's authors work for Biotek. SOURCE: Drug and Alcohol Dependence, January 2004.
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| January 29, 2004 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PET Scan Assessment of Chemotherapy Response in Metastatic Paraganglioma - American Journal of Clinical Oncology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paragangliomas are indolent tumors that arise from the chief cells of the paraganglia in the head and neck, mediastinum, and retroperitoneal regions. Less than 10% of paragangliomas metastasize. Paragangliomas are known to regress slowly and usually partially after radiation therapy, which has been attributed to the development of fibrosis within the abundant vascular elements of the tumor. Positron emission tomography (PET) scanning was used to monitor a 33-year-old woman with recurrent paraganglioma of the carotid body with lung and bone metastases before and after chemotherapy with cyclophosphamide, doxorubicin (Adriamycin), and dacarbazine... | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phase II Study of Gemcitabine and Vinorelbine Combination Chemotherapy in Patients With Non-Small-Cell Lung Cancer Not Responding to Previous Chemotherapy - American Journal of Clinical Oncology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Both gemcitabine and vinorelbine are new anticancer drugs that have shown activity in the treatment of chemonaïve non-small-cell lung cancer (NSCLC). Their role in the second-line treatment of NSCLC is less clear. We conducted a phase II study of gemcitabine and vinorelbine combination chemotherapy in patients with NSCLC who had not responded to previous platinum-based chemotherapy, to assess the response and toxicity of this regimen... | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Proliferative activity in primary breast carcinomas is a salient prognostic factor - Cancer | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusion: S phase fraction is a valuable predictor of survival and can confidently be assessed in approximately 80% of cases. In conjunction with mitotic activity, SPF should become a prognostic factor that is used in daily practice by oncologists for the management of breast carcinoma ... | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adult Living Donor Liver Transplantation for Patients With Hepatocellular Carcinoma: Extending UNOS Priority Criteria - Annals of Surgery | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusion: Although one third of patients had tumors > 5 cm, the incidence of recurrence as well as patient survival and freedom from recurrence are comparable to results after cadaveric transplant. LDLT allows timely transplantation in patients with early or with large HCC... | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Liver Transplantation for the Treatment of Moderately or Well-Differentiated Hepatocellular Carcinoma - Annals of Surgery | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusions: The routine
pre-orthotopic liver transplantation tumor grading may represent a valid tool in
the selection of unresectable HCC patients for transplantation
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| January 14, 2004 | |
| Racial disparities in the use of and indications for colorectal procedures in Medicare beneficiaries - Cancer | |
| Conclusion: Racial disparities exist not only in the use of colorectal procedures but also in the indications for such testing, with African Americans less likely to undergo screening tests... | |
| Randomized multicenter Phase II trial of two different schedules of irinotecan combined with capecitabine as first-line treatment in metastatic colorectal carcinoma - Cancer | |
| Conclusion: The capecitabine and irinotecan combination was a highly active first-line therapy in metastatic CRC. An acceptable safety profile was observed after dose reduction, particularly when irinotecan was administered on 1 day... | |
| Molecular markers for prognosis after isolated postmastectomy chest wall recurrence - Cancer | |
| Conclusion: The prognosis for patients after local-regional recurrence of breast carcinoma is relatively poor. Longer time to local recurrence and positive PR status were associated with favorable distant metastasis-free rates and long-term survival. Positive HER-2/neu status was associated with poorer local-regional control of disease. Implications for systemic therapy and further studies are discussed... | |
| The future of surgery in the treatment of breast cancer - The Breast | |
| The role of surgery cannot be discussed independently, but in relationship to the other modalities of treatment. Sentinel lymph node mapping and biopsy has revolutionized the role of surgery in axillary staging. Techniques of sentinel node mapping, the timing relative to chemotherapy, possible contraindications, and the necessity of completion axillary dissection are all under active investigation... | |
| Features of the Metabolic Syndrome after Childhood Craniopharyngioma - Journal of Clinical Endocrinology and Metabolism | |
| Obesity and multiple pituitary hormone deficiency are common complications after surgery for childhood craniopharyngioma. We hypothesized that post craniopharyngioma surgery, children are at high risk for the metabolic syndrome, including insulin resistance due to excess weight gain and GH deficiency... | |
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| The Satisfaction with Life Domains Scale for Breast Cancer (SLDS-BC) - The Breast Journal | |
| Despite improved overall survival rates, the diagnosis of breast cancer continues to generate fear and turmoil in the lives of many women. All phases related to diagnosis, treatment, and recovery create challenges and problems that patients and survivors must face. Clearly, at the time of diagnosis and during the first phases of treatment, patients experience uncertainty, confusion, and distress... | |
| Sequential High-Dose Alkylating Therapy and Stem Cell Support for High-Risk Stage III Breast Cancer - The Breast Journal | |
| Patients who receive neoadjuvant chemotherapy for locally advanced breast cancer and have four or more ipsilateral axillary lymph nodes involved at surgery are at high risk for recurrence, with a median time to relapse of 18 months. We offered such patients high-dose chemotherapy with stem cell rescue. Patients received cyclophosphamide or paclitaxel and granulocyte colony-stimulating factor (G-CSF) to mobilize stem cells... | |
| Evaluation of Lung Injury after Three-dimensional Conformal Stereotactic Radiation Therapy for Solitary Lung Tumors: CT Appearance - Radiology | |
| Conclusion: The reaction to SRT of the lungs seems similar to the reaction to conventional radiation therapy... | |
| Percutaneous Radiofrequency Ablation for Inoperable Non–Small Cell Lung Cancer and Metastases: Preliminary Report - Radiology | |
| Conclusion: RF ablation appears to be a safe and promising procedure for the treatment of inoperable NSCLC and metastases... | |
| Recurrent Hepatocellular Carcinoma: Percutaneous Radiofrequency Ablation after Hepatectomy - Radiology | |
| Conclusion: Percutaneous RF ablation is an effective and safe method for treating recurrent HCC in the liver after hepatectomy, with a good overall patient survival rate... | |
MOLECULAR MEDICINE
Conference Report - Adjuvants and Delivery: Improving on Vaccine Immunogenicity
Virosomes and polytope-based vaccines are being investigated as an alternative to classic immunization strategies.
Medscape General Medicine 6(1) 2004
MONEY & MEDICINE
Insurance Status of HIV-Infected Adults in the Post-HAART Era: Evidence From the United States
Treatment of HIV poses tremendous challenges to the public and private health care financing system in the United States.
Appl Health Econ Health Policy 2(2) 2003NURSING
DermaDiagnosis: Recurrent Infection Near a Young Woman's Eye
A 27-year-old woman is referred to dermatology for evaluation of a recurrent "staph infection of the eye."
Clinician Reviews 13(11) 2003
NP and PA Professional Organizations
Don't miss this useful resource. Contact information is provided for both NP and PA state and national professional organizations.
Health Status Among Women with Menstrual Symptoms
Menstrual symptoms (including irregular menses, menorrhagia, dysmenorrhea and premenstrual symptoms) are common, but little is known about their impact on health status.
ORTHOPAEDICS
Trunk Muscle
Strength, Cross-sectional Area, and Density in Patients With Chronic Low Back
Pain
Lumbar fusion rates for chronic low back pain have increased
markedly over the last 20 years, but variations between countries do
exist.
Spine 29(1) 2004
Fungal
Osteomyelitis of the Skull Base
A 59-year-old man with diabetes
complained of having complete hearing loss and tinnitus in the left ear for the
last 2 months.
PEDIATRICS 
Conference
Coverage - American Academy of Pediatrics Annual Meeting
Conference
coverage from the 2003 AAP Annual meeting provides updates on influenza and
combination vaccines, MRSA, smallpox, SARS, and more.
Recent
Advances in Pediatric Pharmacokinetics
A large number of significant
papers were published this year in the area of pharmacokinetics.
PHARMACOTHERAPY
Meropenem and Imipenem for Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa
The principal goal of antimicrobial therapy for infection is complete eradication of the pathogen as quickly as possible with the fewest adverse effects to the patient.
Pharmacotherapy 24(1) 2004
PSYCHIATRY
Journal Scan - Psychiatry
Studies comparing atypical vs conventional antipsychotic medications for bipolar disorder and for schizophrenia are among those discussed in this month's Journal Scan.
Medscape Psychiatry & Mental Health 8(2) 2003
Journal Scan - Child and Adolescent Psychiatry
This month's Journal Scan includes long-term studies looking for predictors of major depression and mood and anxiety disorders, among others.
Medication Adherence
When treating patients with major psychiatric disorders, clinicians continue to deal with the challenges of treatment adherence.
PUBLIC HEALTH & PREVENTION
The Consequences of Sunlight Exposure for Human Viral Infections
The main source of ultraviolet radiation (UVR) for most people is the sun.
Appl Env Sci Public Health 1(1) 2003
RADIOLOGY
Investigating Back Pain
On the basis of your assessment of the imaging findings in this case, should this patient be managed by an orthopedic specialist or an oncology team?
CT is us 4(10) 2003
Endovascular Brachytherapy for the Treatment of Renal Artery In-Stent Restenosis Using a Beta-Emitting Source
Restenosis of vessels treated by percutaneous transluminal coronary angioplasty (PTCA) is one of the greatest limitations of this procedure's effective use.
Metastatic Disease or Pheochromocytoma?
The clinicians managing this case were concerned that there was metastatic disease to the adrenals.
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FDA News
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FOR IMMEDIATE RELEASE |
Media Inquiries: 301-827-6242 |
President Proposes Increase in Medical Device Budget for FY 2005
The President's budget request for the Food and Drug Administration's medical device program for fiscal year (FY) 2005 (Oct. 1, 2004 - Sept. 30, 2005) totals $216.7 million in budget authority, an increase of $25.6 million over the FY 2004 level.
This increase will ensure that the FDA succeeds in meeting the ambitious performance goals negotiated with the medical device industry for prompt review of safe and effective medical devices so that patients can enjoy the benefits of those products sooner. These funds will strengthen the medical device review process and enable FDA to fully apply medical device user fees to the review of medical device applications.
The budget authority increase would be augmented by a total of $33.9 million in user fees, an increase of $2.3 million over FY 2004.
The Medical Device User Fee and Modernization Act (MDUFMA), passed in 2002, enables FDA to strengthen its medical device review process by collecting user fees from industry to supplement its appropriated budget for the review of medical device applications. The long-term goal of MDUFMA is to provide the medical device program with sufficient resources to ensure that safe and effective new products get to consumers as quickly as possible.
"FDA is committed to reaching all of the original performance goals negotiated in MDUFMA through FY 2008," said FDA Commissioner Mark B. McClellan, M.D., Ph.D. "The proposed budget increase for the medical device review program, along with the user fees, will enable us to move aggressively to meet those goals.
"FDA's goal is to provide the most health protection at the least cost for the public by making the review process more efficient. The proposed budget increase will enable FDA to reduce the cumulative review time it requires to approve and clear medical device applications," he said.
The requested budget authority increase for medical devices will allow FDA to:
- Meet all the performance goals specified in MDUFMA by FY 2008;
- Enhance reviewer training and skill maintenance to enable FDA reviewers to understand and keep pace with device technologies that are rapidly developing and becoming more complex;
- Invest in laboratory and infrastructure, as recommended by the FDA Science Board, to facilitate device review and oversight;
- Enhance the IT systems that support the current pre-market review process, facilitating device application review;
- Expand small business assistance to help ensure regulatory requirements are met, especially for first time applicants;
- Recruit and contract with subject matter experts to develop guidance and standards for industry; and,
- Conduct pre-approval inspections for device manufacturers.
The requested budget authority in conjunction with user fees, plus any compensating adjustment for prior fiscal year revenue shortfalls, will continue efforts begun in FY 2003 and FY 2004 for FDA to:
- Acquire and train staff to meet a set of aggressive FY 2005-FY 2007 performance goals to expedite the review of medical device applications;
- Promote public health with major improvements in the review of breakthrough medical technologies and improvements in review of expedited device submissions; and
- Make major improvements in review performance in areas where fees are collected, while maintaining performance in other areas.
Specifically, FDA's pre-market device review performance goals include:
- Complete review and decision on 70 percent of expedited PMA actions within 300 days
- Complete review and decision on 75 percent of PMA supplement actions within 180 days;
- Complete review and decision on 75 percent of Pre-market Notification (510k) application first actions within 90 days; and
- Conduct 295 domestic and foreign bio-research monitoring inspections with an emphasis on scientific misconduct, data integrity and innovative products, and vulnerable patients.
In FY 05, FDA anticipates it will expend $141,082,000 for medical device reviews in the device and radiological health program. A total of $216,699,000 is requested for the medical device and radiological health program for both pre-market and post-market activities.
In addition to announcing the budget proposal for the medical device program for FY 2005, FDA today announced its accomplishments in FY 2003 in the medical device review program.
Last year FDA completed the processing of 9,570 major medical device applications for devices and tests used to diagnose and treat a wide variety of medical conditions. This total included the clearance of 4,132 pre-market notifications (510ks), and the approval of 31 pre-market approval applications (PMAs), 494 PMA supplements, 2 humanitarian device exemptions (HDEs), 24 investigational device exemptions (IDEs), and 217 IDE amendments and 4,424 IDE supplements. HDEs are designed to encourage the discovery and use of devices, based on limited clinical data, for diseases or conditions affecting fewer than 4,000 patients a year. IDEs allow medical devices to be studied in humans to determine the product's safety and effectiveness.
The average review time for 510ks and PMAs decreased in FY 03. FDA average review time from submission to decision for 510ks decreased from 79 days in FY 02 to 76 days in FY 03. Total average review time for 510ks decreased from 100 days to 96 days. Total average elapsed time for PMAs from filing to approval decreased from 364 days in FY 02 to 359 days in FY 03. For PMA supplements reaching approval, the average elapsed time decreased from 105 days in FY 02 to 93 days in FY 03.
Many of the products FDA approved during FY 03 represent significant advances in patient care. Among these are the first drug-eluting stent for angioplasty procedures to open clogged coronary arteries; the first test for West Nile virus infection; the first fully automated test for diagnosing congestive heart failure; the first left ventricular assist device for long term use in patients with heart failure who are not eligible for a heart transplant; a new sterilization procedure for women that does not require incisions or general anesthesia; and a stair climbing wheelchair.
Details on these and the other medical device approvals are available in FDA's "ODE/OIVD FY 03 Annual Report" at htt
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One in every hundred men born in
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| A concurrent chemoirradiation with cisplatin followed by adjuvant chemotherapy with ifosfamide, 5-fluorouracil, and leucovorin for stage IV nasopharyngeal carcinoma - Head & Neck | |||||||||||
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| Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: A tricuspid annular motion–based study - Journal of the American Society of Echocardiography | |||||||||||
| Conclusion: One year after CABG, RV
function remained depressed and septal motion remained paradoxical compared with
the preoperative investigation, suggesting that these postoperative findings
might be permanent in the majority of patients. Despite the reduced RV function,
exercise performance 3 months after CABG was improved. The depressed RV
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| Pharmacokinetics of intravenous flucloxacillin and amoxicillin in neonatal and infant cardiopulmonary bypass surgery - European Journal of Cardio-Thoracic Surgery | |
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| Arterial switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery - European Journal of Cardio-Thoracic Surgery | |
| Conclusion: This new coronary reallocation technique avoids problems related to coronary translocation such as traction and kinking. It spares the need for dissection of proximal coronary artery and its branches, and thereby eliminates the risk of development of fibrosis and stenosis. The same technique can be used regardless of the sinus of origin of the coronary artery. It is a reliable and a reproducible technique. The early and mid-term results appear excellent in this series... | |
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| Conclusion: We have shown that coronary angiography did not affect the occurrence of CABG and was not associated with improved hospital survival. Furthermore, there is a considerable delay to surgery caused by angiography. Therefore in this setting coronary angiography is not recommended... | |
| Supraventricular tachyarrythmia prophylaxis after coronary artery surgery in chronic obstructive pulmonary disease patients - European Journal of Cardio-Thoracic Surgery | |
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| Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps - European Journal of Cardio-Thoracic Surgery | |
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| Conclusion: Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk... | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Impact of Obesity on Biochemical Control After Radical Prostatectomy for Clinically Localized Prostate Cancer: A Report by the Shared Equal Access Regional Cancer Hospital Database Study Group - Journal of Clinical Oncology | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusion: The percentage of obese men undergoing RP in our data set doubled in the last 10 years. Obesity was associated with higher-grade tumors, a trend toward increased risk of positive surgical margins, and higher biochemical failure rates among men treated with RP. A BMI 35 kg/m2 was associated with a higher risk of failure than a BMI between 30 and 35 kg/m2... | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Efficacy of Oral Adjuvant Therapy After Resection of Colorectal Cancer: 5-Year Results From Three Randomized Trials - Journal of Clinical Oncology | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusion: Oral fluoropyrimidines improve disease-free survival and survival of patients after resection of early-stage colorectal cancer. These observations support the use of these agents alone after resection of early-stage disease, as well as further testing of oral agents in combination with new drugs that have recently shown antitumor activity in advanced colorectal cancer... | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Antioxidants and Cancer Therapy: A Systematic Review - Journal of Clinical Oncology | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusion: These inconsistencies preclude a definitive conclusion as to the effect of chemotherapy on antioxidant status in patients undergoing anticancer therapy. However, our review suggests that total antioxidant status (measured by total radical antioxidant parameter) declines during cancer treatment... | |||||||||||||||||||||||||||||||||||||||||||||||||||
| January 29, 2004 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| The treatment of early laryngeal cancers (T1-T2 N0): surgery or irradiation? - Head & Neck | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Conclusions: Both surgery and
irradiation are equally effective at treating early laryngeal carcinoma. Speech
and voice were highly significantly better in patients treated by irradiation
than in those treated by surgery
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| January 14, 2004 |
| Histopathology of primary breast cancer 2003 - The Breast |
| The histologic and immunophenotypic characterisation of primary breast carcinoma admittedly is a finite and imperfect source of information for an ideal prognostic and predictive evaluation, and for tailoring the most appropriate adjuvant intervention for each individual patient. Complementary data coming from molecular profiling assays hopefully will significantly add to our current skills in predicting the future... |
| Epidemiology of breast cancer – selected highlights - The Breast |
| The main risk factors for breast cancer can be usefully grouped into four major categories––family history/genetic, reproductive/hormonal, proliferative benign breast pathology, and mammographic density. These factors are briefly reviewed and quantitative estimaters of risk are given... |
| Efforts to link biological and clinical breast cancer research - The Breast |
| Important issues that underpin efforts to link new biological data on breast cancer to clinical research are considered. While animal models have been helpful in drug development, the changes in some key markers (oestrogen receptor and Ki67) in response to hormonal therapy are very different in patients... |
| The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry - The Breast |
| Conclusion: Women diagnosed with LCIS were 2.6 (95% confidence interval, 2.0–3.4%) times more likely than women with DCIS to be diagnosed with a contralateral breast cancer within the first six months of the first breast primary. The risk of developing a contralateral breast cancer more than 6 months after the initial breast cancer was independent of surgical or radiation therapy, time since diagnosis, age at diagnosis, histology, race, marital status, or anatomic location of the cancer within the breast... |
| Ductal carcinoma in situ: surgery and radiotherapy - The Breast |
| As a consequence of mammographic breast screening programmes, ductal carcinoma in situ is diagnosed with increasing frequency. There are widely disparate philosophies concerning diagnosis, classification and treatment. This review discusses the management of DCIS in light of the new data from randomised trials... |
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