Category: Prior Clinic Blog
JOURNAL: New England Journal of Medicine.
AUTHORS: Christopher Crum
ABSTRACT: Early testing shows an experimental vaccine to be 100 percent effective against the virus that causes cervical cancer, raising doctors’ hopes of someday sending the lethal disease into retreat in the same way as smallpox and polio.
COMMENTARY: The new vaccine, aimed at the viral strain Type 16 responsible for about half the cases of cervical cancer, was tested on women ages 16 to 23 at 16 sites around the country in a study led by Merck & Co. and the University of Washington. Merck developed the vaccine and funded the research. The women were watched on average for almost a year and a half.
Of 768 women who got vaccine injections, none showed Type 16 infections or precancerous tissue. Of 765 who took dummy injections, 41 came down with persistent infections, and nine developed precancerous tissue.
Inoculated women built up almost 60 times the concentration of virus-fighting antibodies seen in naturally infected women. Some researchers had suspected that the mucous membrane on the cervix would pose a barrier to such antibodies.
STUDY: Body fat distribution is a more powerful predictor than is BMI for risk factors, diseases, and mortality
JOURNAL: Am J Clin Nutr. 2002; 76:743-9; 699-700
AUTHORS: Michael J. Lean and Thang S. Han
ABSTRACT: Waist circumference is a better indicator of cardiovascular (CV) risk than is body mass index (BMI), according to results from the National Health and Nutrition Examination Survey (NHANES) III published the American Journal of Clinical Nutrition.
COMMENTARY: Body fat distribution is a more powerful predictor than is BMI for risk factors, diseases, and mortality. Measurements that are more sensitive to individual differences in abdominal fat might be more useful than BMI for identifying obesity-associated risk factors.
Waist circumference correlated more directly than did BMI with overall CV risk. Cutoffs of 90 cm (35 inches) for men and 83 cm (33 inches) for women we found. To minimize CV risk, they recommend advising patients with waist circumference at least as large as the cutoff value to lose weight.
Waist circumference is more closely linked to CV disease risk factors than is BMI [so] it is inappropriate to base waist circumference thresholds on their association with BMI thresholds.
JOURNAL: Neurology 2002;51:97-105
ABSTRACT: A comparison of two different surgical techniques used to fuse vertebrae together and thereby repair unstable sections of the back found that while men experienced fewer temporary complications after undergoing the less-invasive operation, they were much more likely to suffer ejaculation problems caused by nerve damage.
COMMENTARY: During the more invasive "mini-open" procedure, doctors reach the diseased vertebrae by making a series of small incisions, while in the less invasive laparoscopic or "keyhole" approach, doctors use a small video camera and specialized tools inserted through even smaller incisions to repair the area.
Researchers based at the Emory Clinic in Atlanta, Georgia, reviewed the records of 98 patients who had undergone either mini-open or laparoscopic procedures, and found that nearly 18% of mini-open patients experienced complications, as opposed to only 4% of those given the laparoscopic procedure.
However, the investigators also found that 45% of men who underwent laparoscopy experienced a condition known as retrograde ejaculation after the procedure, during which they are able to become aroused and have an erection, but cannot ejaculate any semen. This complication was seen in only 6% of the men who received the mini-open surgery, the authors note. The researchers were unable to determine how long the problem lasted.
According to the report in Neurosurgery, Haid's team found that preparation and procedure time was longer in patients who underwent laparoscopy, while patients often needed to stay in the hospital a bit longer after the mini-open procedure.
Haid explained that given the relatively high risk of ejaculation problems following the laparoscopic approach, he often recommends that younger men opt for the mini-open procedure. Losing the ability to ejaculate will affect a man's fertility, he pointed out, and also likely cause some significant emotional effects.
JOURNAL: Cancer. 2002;95:2455-2464
ABSTRACT: Continuous hormonal replacement therapy (HRT) is associated with an increased risk of lobular breast cancer but not of ductal carcinoma.
COMMENTARY: "The incidence of invasive lobular carcinoma has been increasing among post-menopausal women in some parts of the U.S," writes Janet R. Daling, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues. "Part of this may be due to changes in classification over time. However, the use of combined estrogen and progestin HRT has also increased during the last decade and may account in part for the increase in invasive lobular breast cancer."
This study used data from the NICHD Women's Contraceptive and Reproductive Experiences (CARE) Study, a large case-control breast cancer study of white and African-American women. The investigators conducted in-person interviews of 1,749 postmenopausal women diagnosed with their first invasive breast tumor before the age of 65 years, and compared their responses with those of 1,953 postmenopausal controls identified through random digit dialing.
History of use of unopposed estrogen therapy was not associated with an increase in risk of any histologic type of breast cancer. Women currently using combined HRT had twice the risk of invasive lobular breast cancer.
Although the increase in risk was greater for mixed lobular-ductal than for the pure lobular type, this difference was not statistically significant.
Women who used continuous combined HRT (more than 25 days per month of progestin) for at least five years appeared to be at greater risk of lobular breast cancer than those who used sequential HRT (fewer than 25 days per month of progestin. Use of combined HRT was not associated with risk of ductal breast cancer.
"Post-menopausal women who take combined HRT appear to be at an increased risk of lobular breast cancer," the authors write.
Data from this study suggest that neither unopposed estrogen-HRT use nor combined HRT substantially increase the risk of ductal breast cancer among women less than 65 years of age.
STUDY: Homocycteine, B12 and Folic Acid
JOURNAL: J Am Coll Cardiol 2002;40:766-772.
AUTHORS: Dr. Frank F. Willems
ABSTRACT: Treatment with folic acid and cobalamin appears to improve coronary endothelial function in hyperhomocysteinemic patients with coronary artery disease.
COMMENTARY: The researchers studied 15 patients with hyperhomocysteinemia and coronary artery disease. They were randomized to daily treatment with folic acid 5 mg in combination with cobalamin 400 mcg or to placebo.
At the end of the 6-month study, homocysteine levels fell by 31% in the
combination group, but did not change in placebo patients.
Furthermore, although at baseline, all patients showed severe coronary
endothelial dysfunction after acetylcholine infusion, there was a
significant improvement in coronary blood flow after the combination
Placebo patients showed a 16% decrease in coronary blood flow,
whereas combination patients demonstrated a 96% increase.
Coronary endothelial dysfunction predicts cardiovascular mortality, and
they were able to demonstrate that folic acid and cobalamin can improve
coronary endothelial function thereby lowering the future risk.
Bottom line is get your B12 and folic acid.