This is Journal Watch, a twice-weekly survey
of new medical research, produced by the
Massachusetts Medical Society, publishers
of The New England Journal of Medicine,
Health News, AIDS Clinical Care and Clinical
Care for Prostatic Diseases.
  Twice a week, our physician-editors summarize
clinical research from a group of about 25
journals. We post the top two summaries,
along with the complete table of contents,
to selected news groups in sci.med.
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  Contents copyright 1995, Mass. Medical Society.

Journal Watch Summaries for Tuesday, April 25, 1995

INTENSIVE INSULIN THERAPY DELAYS DIABETIC NEUROPATHY.
  Ann Intern Med 1995 Apr 15; 122:561-8.

AN INCREASE IN GONORRHEA.
  MMWR 1995 Apr 14; 44:282-6.

TMP-SMX MAY PREVENT BACTERIAL PERITONITIS IN CIRRHOTIC
PATIENTS.
  Ann Intern Med 1995 Apr 15; 122:595-8.

BROMOCRIPTINE TREATMENT FOR {*filter*}ISM?.
  Nature Medicine 1995 Apr; 1:337-41.

ANTICOAGULATION FOR ANTIPHOSPHOLIPID ANTIBODY
SYNDROME.
  N Engl J Med 1995 Apr 13; 332:993-7.

MORE CASES OF HUMAN RABIES.
  MMWR 1995 Apr 14; 44:269-72.

ACELLULAR PERTUSSIS VACCINE GIVEN TO {*filter*}S DURING AN
OUTBREAK.
  J Infect Dis 1995 Apr; 171:1053-6.

DT.-950425.

AN.-1.
HL.-INTENSIVE INSULIN THERAPY DELAYS DIABETIC NEUROPATHY.
NS.-The multicenter Diabetes Control and Complications
Trial showed that intensive insulin therapy prevents the
development and progression of retinopathy and nephropathy
in patients with insulin-dependent diabetes, at the expense
of a three-fold increase in severe hypoglycemic episodes
(see N Engl J Med 1993; 329:977). This
report gives results relevant to neuropathy.
   Initially, none of the 1441 patients had severe
symptomatic neuropathy that would necessitate pharmacologic
treatment. They were randomized to conventional insulin (one
to two times daily) or intensive therapy (three or more
daily insulin injections or continuous subcutaneous
infusion).
   After five years of follow-up, significantly fewer
intensively-treated than conventionally-treated patients had
a history or physical findings of neuropathy (5 vs. 13
percent). Intensively treated patients also had
significantly fewer abnormal nerve-conduction studies (26
vs. 46 percent.) The benefits of intensive therapy did not
appear to depend on age, duration of diabetes, or the
initial presence of complications such as retinopathy and
nephropathy.
   Comment: These results show further benefits of treating
patients with insulin-dependent diabetes intensively.
Hopefully, the decrease in neuropathy will eventually
translate into fewer amputations and foot ulcers.
--CD Mulrow.
AU.-The Diabetes Control and Complications Trial Research
Group.
TI.-The effect of intensive diabetes therapy on the
development and progression of neuropathy.
SO.-Ann Intern Med 1995 Apr 15; 122:561-8.

AN.-2.
HL.-AN INCREASE IN GONORRHEA.
NS.-The incidence of gonorrhea in Minnesota fell an
average of 8.5 percent each year between 1981 and 1993. Now,
that state reports a 32 percent increase between 1993 and
1994, and preliminary national surveillance data suggest
similar increases in other states as well.
   The Minnesota increase occurred in all racial and ethnic
groups, and among all age groups except 10- to 14-year-olds.
The highest rate (379 per 100,000) was among 15- to 19-year-
olds. The reported rate in black non-Hispanics was almost
2000 cases per 100,000 in 1994. Although authorities find no
clear cause for the increasing incidence, it appears to be
real, and could not be explained by changes in case
reporting or by treatment failures due to resistant strains.
   On the national level, 18 of 35 states with more than
1000 gonorrhea cases annually reported an increase in the
first three quarters of 1994.
   Comment: Gonorrhea is the major cause of pelvic
inflammatory disease and is a cofactor in HIV transmission.
This early sign of increasing incidence should be taken
seriously and should lead to redoubled surveillance and
treatment efforts, especially in adolescents. --DM Berwick.
TI.-Increasing incidence of gonorrhea -- Minnesota, 1994.
SO.-MMWR 1995 Apr 14; 44:282-6.