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Medical News for Week Ending November 5, 1989
Copyright 1989: USA TODAY/Gannett National Information Network
Reprinted with Permission
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Oct. 30, 1989
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{*filter*} ABUSE COULD RISE:
As the baby boomers age, {*filter*} abuse will most likely get worse, said a
psychiatrist and researcher at the University of Michigan Medical Center. Why:
Loneliness. Findings: By year 2000 there will be 30 million Americans over age
60. About 700,000 will develop a drinking problem after that age.
EXERCISE FADES AWAY YEARS:
An average woman in her 50s who exercise 30 minutes three times a week is
about equal in heart and lung function to a sedentary woman 20 years younger
and some are as young as those in their 20s, said Dr. Barbara Drinkwater of
Pacific Medical Center, Los Angeles. Exercise lowers risk for obesity,
hypertension and diabetes, builds bone strength.
KOOP SPEAKS ABOUT CHOLESTEROL:
The cholesterol bubble is about to burst Former Surgeon General C. Everett
Koop said Friday at a forum at the National Academy of Sciences, Boston.
Reason: Skepticism about the campaign to lower serum cholesterol levels
through diet and {*filter*} would peak in about two months.
ASTHMA DRUG BEING PULLED:
A new version of a widely used asthma drug, sold under the brand name
Alupent, is being taken off market shelves. Why: Increased reports of side
effects including coughing and {*filter*}, said the cooking.net">food and Drug Administration.
(From the USA TODAY Life section.)
IMPLANT HELPS TREAT GLAUCOMA:
A mechanical drain placed inside the eye to control fluid build-up that
characterizes glaucoma is successfully treating black people who haven't
responded well to conventional surgical techniques, reports the American
Academy of Opthalmology, San Francisco. Using this method, researchers were
able to control the disease in 72 percent of 83 patients.
LENS CASE SOURCE OF BACTERIA:
Improper cleaning routines and length of wear are probably causes for
corneal infection among contact lens wearers, reports the American Academy of
Opthalmology, San Francisco. Study revealed that ineffective storage solutions
and practices presented a serious source of bacterial contamination that can
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Volume 2, Number 41 November 8, 1989
lead to eye infection.
RHINOPLASTY NOT ALWAYS WANTED:
Most people think changing the shape of their nose will make them happy,
reports the American Society of Plastic and Reconstructive Surgeons. Findings:
Ninety percent of 120 rhinoplasty patients evaluated felt the surgery had been
worthwhile.
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Oct. 31, 1989
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PREGNANT WOMEN NEED CENTERS:
Many pregnant women who are {*filter*}ed to {*filter*} are being turned away from
treatment centers. Reason: Many don't offer programs to treat pregnant women.
This problem and the problem of too few drug treatment centers were discussed
Monday before a House subcommittee considering a $700 million substance abuse
treatment bill. (From the USA TODAY News section.)
FINGERPRINT DETECTS EYE CANCER:
The same genetic fingerprinting that can identify suspected criminals has
enabled ophthalmologists to better determine if an infant is at risk of
developing retinoblastoma - a rare eye cancer that is often hereditary,
reports the American Academy of Ophthalmology. Study: In six out of six
families, experts were able to trace the inherited mutated gene.
DISORDER LINKED TO CAT SCRATCH:
A researcher has confirmed a connection between neuroretinitis - a sudden,
severe loss of vision that can last for several weeks - and cat scratch
disease, reports the American Academy of Opthalmology. Facts: A scratch of a
kitten whose claws are infected with a certain rod-shaped bacillus can cause
the disorder.
FABRIC AIDS HEALTH PROGRESS:
Johnson & Johnson has begun marketing a biodegradable called Interceed
Absorbable Adhesion Barrier. Use: Surgeons are placing the fabric around
organs to separate them from body tissue following gynecologic pelvic surgery.
The fabric then forms a barrier between the organs and tissue and keeps
unnatural adhesions between the two from forming.
CHECK KIDS HEALTH AT NIGHT:
Day care experts advise parents that if they can't check their children's
health in the morning, to check it the night before. Reason: More children
are arriving at daycare centers in the morning sick. Parents should also check
for "pink eye" and never send a child to school with a temperature of 100 or
above.
PRESSURE MAKES USER STOP {*filter*}:
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Volume 2, Number 41 November 8, 1989
New York-based Phoenix House has become a model for other drug treatment
center around the nation. Why: Center uses counseling and peer pressure to
force a user to face the problems that led to {*filter*}ion. Success rate: Center
boasts a 70 percent success rate.
HELP FOR STROKE VICTIMS ON WAY:
New technology could help prevent the disabilities caused by stroke, said a
doctor at the University of California, San Diego. How: By restoring {*filter*}
flow to the brain and preventing acute nerve cell damage by administering
{*filter*} right after stroke. The treatment could be available in five years,
experts said. (From the USA TODAY News section.)
SOFTWARE CAN ANALYZE DNA:
Two new software packages for the Discovery Series scanning and analysis
system were introduced by Protein Databases Inc. Use: DNA Code rapidly reads
DNA sequences from autoradiographic films, allows researchers to determine 500
bases of sequence from films in 3-4 minutes. Quantity One tells the amount of
protein and DNA present in gels.
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Nov. 1, 1989
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DRUG SETS BIOLOGICAL CLOCK:
In about five years, new {*filter*} could be available to help people who work
nights or suffer from jet lag. The breakthrough comes with the discovery of
receptors on nerve cells that act as targets for the clock-regulating hormone
melatonin. A researcher at Northwestern University says the first drug in
development is luzindole. (From the USA TODAY News section.)
DOCTOR IDENTIFIES HAIR GROWER:
Skin Researcher Peter H. Proctor, Ph.D, of Houston, has discovered how the
hair growth product minoxidil works by identifying the body's natural hair
growth stimulator -endothelium-derived relaxing factor. Normally, EDRF lives
only a few seconds in the body. Minoxidil is a stable for EDRF and prevents
its breakdown.
BREAKTHROUGH IN EYE SURGERY:
Aura Medical Systems Inc. announced Monday a new cataract removal procedure
that keeps the lens capsule intact, which in turn allows the internal eye
muscles to retain the ability to focus. How: A tiny magnetic bead is injected
by syringe into the cataract. A surgeon controls the bead to destroy the
cataract. Cataract particles and bead are then withdrawn.
FOSCARNET DETERS BLINDNESS:
Foscarnet, an antivirul drug that fights an AIDS-related eye infection, is
effectively controlling a blinding retinal disorder, reported the American
Academy of Ophthalmology. Study: The disorder was controlled in 88 percent of
60 patients treated in clinical trials. Trial results will go to the cooking.net">food and
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Volume 2, Number 41 November 8, 1989
Drug Administration for approval of the drug.
SURGERY AIDS PHALLIC FUNCTION:
Phallic reconstruction can now restore a man's ability to urinate and have
sex, said the American Society of Plastic and Reconstructive Surgeons. How: By
using a flap of skin from the outer part of the forearm to create a "tube
within a tube" - one for the urethra and one for the penile shaft.
LASER GETS RID OF BIRTHMARKS:
Physicians have begun using a new type of device called a "flashlamp pulsed
tunable dye laser" to remove or lighten birthmarks. The laser is effective on
portwine stains and can remove {*filter*} vessel overgrowths that can obscure
vision and distort {*filter*} features.
GENETICS LINKED TO DISEASE:
Studies have shown that some forms of periodontitis run in families,
reports the American Academy of Periodontology. Suggests: Testing family
members of patients suffering from juvenile, prepubertal or rapidly
progressive periodontitis. Reason: Periodontitis can be a warning sign for
other diseases that need medical attention.
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Nov. 2, 1989
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SURGEON GENERAL NOMINEE NAMED:
President Bush has selected R. Antonia Novello as the nominee for surgeon
general, said the U.S. Department of Health and Human Services Secretary Louis
W. Sullivan M.D. Wednesday. Novello has been involved in improving the health
of the nation's children and has worked with children with AIDS.
GLOBAL AIDS OUTLOOK BLEAK:
Complacency and increasing outbreaks are two major reasons the AIDS
epidemic will likely be worse than expected in the 1990s, said the World
Health Organization Program on AIDS. Also, the gap between the pace of the
epidemic and prevention and control efforts could widen. Future: 5.4 million
new AIDS cases, 10 million to 20 million HIV cases.
SINGLE WOMEN AT RISK FOR AIDS:
A new Gallup poll shows 6 million single women in the USA ages 18 to 40 are
at moderate to high risk of getting AIDS. Why: Because they have multiple sex
partners and are not using {*filter*}s regularly. Other findings - smart, rich
women are fooling themselves into believing AIDS is not an issue for them.
(From the USA TODAY Life section.)
DIABETES RISK FOR WOMEN:
Having children slightly increases a woman's risk for diabetes later in
life. And a University of California, San Diego, study says the risk goes up
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Volume 2, Number 41 November 8, 1989
with each pregnancy. Type Two diabetes affects about 18 percent of the
nation's women by age 74, making them unable to produce enough insulin to
control the sugar in their {*filter*}. (From the USA TODAY Life section.)
PANIC, SUICIDE LINK:
People who suffer from panic attacks are 18 times more likely to attempt
suicide than people without mental illness, reports a Columbia University.
According to a recent study, 18,000 {*filter*}s says these folks are also three
times more likely to attempt suicide than people with other psychiatric
disorders.
MANY WOMEN GET POOR CARE:
Six{*filter*} percent of the women who give birth in the U.S. receive inadequate
prenatal care, said the New York-based Alan Guttmacher Institute. Findings:
Many women start care after the fourth month of pregnancy, or have fewer than
half the number of prenatal checkups recommended by medical experts.
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Nov. 3-5, 1989
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SEARCH IS ON FOR GROWTH FACTOR:
One of the biggest new areas of brain research is the search for a
substance in the body that stimulates growth of specific brain and nerve
cells. Once a "growth factor" is found copies will be genetically engineered
and targeted to where cells are dying, a physician at Johns Hopkins University
said. (From the USA TODAY Life section.)
ONE SUCH STUDY UNDER WAY:
Two new methods for causing human bones to regenerate are now in the
experimental stage, reports the American Society of Plastic and Reconstructive
Surgeons. Purpose: To allow patients with injuries, birth defects and other
problems heal faster and have fewer operations. Researchers are testing
electrically charged "beads" and a specific "growth factor" to promote bone
growth.
WHITES PRONE TO TYPE I DIABETES:
White children are more likely than black children to develop insulin-
dependent diabetes, according to epidemiological data from Jefferson County,
Ala., reported in the Journal of School Health's October issue. Type I
diabetes was less than half that for blacks than in white children.
GUM DISEASE EXPECTED TO RISE:
The American Dental Association will meet this weekend in Honolulu to
discuss the problems dentists will face more often in the next decade.
According to research by Colgate: Of 200 dentists surveyed, 64 percent think
gun disease will be the most serious problem in the 1990s. (From the USA TODAY
Life section.)
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Volume 2, Number 41 November 8, 1989
UC SELECTED FOR TRANSPLANTS:
The Medical Center at UC San Francisco has been named as one of seven
centers nationwide where children can receive allogeneic bone marrow
transplants under the Prudential Insurance Co. "Institutes of Quality"
program. Why: The company routes patients to institutions it deems has
superior track records in performing high-tech medical treatments.
SENIORS OPT TO PULL THE PLUG:
A majority of seniors say they would not want to be kept alive by
artificial means if they were beyond medical help, reports Mark Clements
Research Inc. Thursday. The survey also found most seniors were satisfied with
their lives, financially independent and not afraid of death or dying.
DRUG SLOWS CELL DESTRUCTION:
New animal research shows that an experimental compound -U74006f slows down
the degeneration of nerve cells, reports the drug's producer The Upjohn
Company. Future use: Might be used to treat human diseases such as Parkinson's
and Alzheimer's diseases.
SURGEONS PROBE FOR MOTIVATIONS:
Because more people are looking into plastic surgery, physicians are taking
more precautions before doing surgery, said the American Society of Plastic
and Reconstructive Surgeons. Why: To identify patients who require special
attention such as those experiencing an acute crisis, those with unrealistic
expectations and patients with "minimal" defects.
TEST WILL PREDICT WHO SCARS:
In the near future, it may be possible to detect with a test individuals
who are at risk of developing unsightly scars or other wound-healing problems
after reconstructive surgery, said the American Society of Plastic and
Reconstructive Surgeons. How: Researchers are using the cell production
process to grow skin and study its makeup.
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Volume 2, Number 41 November 8, 1989
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday November 2, 1989
Epidemiologic Notes and Reports
Outbreak of Invasive Pneumococcal Disease in a Jail -- Texas, 1989
Between September 6 and October 2, 1989, invasive pneumococcal disease--
including bacteremic pneumonia, meningitis, and primary septicemia--occurred
in 12 inmates at a county jail in Texas. Two patients died. Five additional
inmates with pneumonia had Streptococcus pneumoniae isolated from sputum
specimens. All isolates from the 17 patients were serotype 12. Four{*filter*}
patients had underlying conditions including {*filter*}ism and intravenous-drug
abuse, cirrhosis, and asplenia. One person reported having previously received
pneumococcal vaccine. All patients were male; their mean age was 30 (range:
19-53) years.
The jail is in a 13-story building that was constructed to hold 3500
inmates but houses a daily average of 6900 inmates (84% male). Cases occurred
on seven of 10 floors used to house inmates. No cases occurred among 950 staff
members.
Immunization with the 23-valent pneumococcal polysaccharide vaccine was
recommended for all inmates and staff; 79% of inmates accepted vaccination. In
addition, inmates with underlying medical conditions received a 1-week course
of penicillin or erythromycin prophylaxis following vaccination.
An ongoing investigation is focusing on risk factors for disease,
mechanisms of transmission, further characterization of the isolates, and
distribution of serotypes of invasive pneumococcal isolates from patients in
the surrounding community. Active surveillance for pneumococcal disease has
been initiated within the jail.
Reported by: J Pappas, JE Arradondo, MD, KH Sullivan, PhD, City of Houston
Dept of Health and Human Svcs; MA Canfield, MS, T Hyslop, MD, Harris County
Health Dept, Houston; KA Hendricks, MD, D Simpson, MD, State Epidemiologist,
Texas Dept of Health. Respiratory Diseases Br, Div of Bacterial Diseases,
Center for Infectious Diseases, CDC.
Editorial Note: In the pre-antibiotic period, epidemic pneumococcal disease
was observed in a variety of settings including military training centers,
psychiatric hospitals, and correctional institutions (1,2). Pneumococcal
outbreaks are rarely reported now, although two epidemics have occurred in
shelters for homeless men (3,4).
Crowding and the medical status of the inmates may have been contributing
factors in the jail outbreak in Texas. Underlying conditions that increase the
risk for pneumococcal disease in {*filter*}s include chronic cardiovascular and
pulmonary diseases, diabetes mellitus, {*filter*}ism, cirrhosis, asplenia,
Hodgkin disease, lymphoma, multiple myeloma, chronic renal failure, nephrotic
syndrome, organ transplantation, human immunodeficiency virus (HIV) infection,
age greater than or equal to 65 years, and other conditions associated with
immunosuppression (5). Of these factors, {*filter*}ism and trauma (po ssibly
predisposing to splenectomy) are common among inmates of correctional
facilities (6). In addition, HIV seroprevalence rates among inmates of
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Volume 2, Number 41 November 8, 1989
correctional facilities are higher than in the general population (7). The
epidemiology of pneumococcal disease in institutional settings is poorly
understood. However, because this disease has been associated with
overcrowding (2,3), overcrowded correctional facilities may be at risk for
pneumococcal outbreaks.
Correctional facilities' staff have the opportunity to immunize high-risk
inmates for pneumococcal disease during medical screening at time of
incarceration. However, in facilities with high rates of recidivism among
inmates, a policy of routine immunization may increase the likelihood of early
revaccination. To prevent unnecessary revaccination, immunization programs in
correctional facilities need to include a means of identifying inmates
vaccinated during a previous incarceration.
Further efforts are needed to delineate the epidemiology of pneumococcal
infections in institutional environments such as jails and prisons. State
health departments are requested to notify the Respiratory Diseases Branch
(RDB), Division of Bacterial Diseases, Center for Infectious Diseases, CDC, of
clusters of cases of pneumococcal disease in these and other settings.
Information on pneumococcal disease is available from RDB at (404) 639-3021.
References
1. Hodges RG, MacLeod CM, Bernhard WG. Epidemic pneumococcal pneumonia. Am J
Hyg 1946;44:183-236.
2. Heffron R. Pneumonia with special reference to pneumococcus lobar
pneumonia. Cambridge, Massachusetts: Harvard University Press, 1939, 1979.
3. DeMaria A Jr, Browne K, Berk SL, Sherwood EJ, McCabe WR. An outbreak of
type 1 pneu mococcal pneumonia in a men's shelter. JAMA 1980;244:1446-9.
4. Nguyen J, Grosset J, Dautzenberg B, Hubert B, Vaccarie M, Geslin P. Type 1
pneumococcal diseases: two successive outbreaks in men's shelters in Paris,
France (Abstract). In: Program and abstracts of the 29th Interscience
Conference on Antimicrobial Agents and Chemotherapy. Houston: American
Society for Microbiology, 1989:145.
5. ACIP. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64-8,73-6.
6. Salive ME, Brewer TF. Medical care behind bars: Maryland prison system.
Maryland Med J 1989;38:246-9.7. CDC. AIDS and human immunodeficiency virus
infection in the United States: 1988 update. MMWR 1989;38(no.S-4).
*The ISRA was a cooperative effort by many hospital personnel and by the
study's sponsors, the Iowa Governor's Traffic Safety Bureau (supported by the
National Highway Traffic Safety Administration) and the Iowa Traffic Safety
Now.
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Volume 2, Number 41 November 8, 1989
Safety-Restraint Assessment -- Iowa, 1987-88
From November 1987 to March 1988, the Iowa Safety Restraint Assessment
(ISRA)* study gathered data on injuries to and hospital charges for persons
who survived motor vehicle crashes and presented for emergency medical care at
one of 16 hospitals in Iowa. The par ticipating hospitals (seven rural and
nine urban) rep resented all levels of trauma care and all geographic
quadrants of the state (Figure 1).
The 1454 persons injured in motor vehicle crashes who were studied during
the 5-month period represented approximately 20% of all persons who were
injured and who presented for emergency medical care in Iowa during the same
period. Safety- restraint status was determined through questions to the
patient or ambulance personnel. Of the 1454 injured persons, 697 (48%) were
wearing safety restraints at the time of the crash (belted), and 757 (52%)
were not (unbelted). Unbelted persons were more likely than belted persons to
be male, be younger, have higher reported {*filter*} use at the time of the
crash, and report motor vehicle crash speeds greater than or equal to 55 mph
(Table 1).
Twenty-seven percent of unbelted persons were admitted to a hospital
(Table 2). Unbelted persons were three times more likely than belted persons
to be hospitalized, 8.4 times more likely to sustain a head injury with loss
of consciousness, 2.7 times more likely to sustain a fracture, and 2.8 times
more likely to sustain a laceration. Strains or sprains were reported more
frequently among belted than among unbelted persons.
The average hospital bill was significantly higher for unbelted ($2462)
than for belted persons ($753) (p less than 0.01). The average hospital stay
was 2.6 times longer for unbelted (16.9 days) than for belted persons (6.6
days).
Most injuries were minor and external (e.g., abrasions, contusions, and
lacerations)--391 (51.7%) among unbelted and 296 (42.5%) among belted persons.
Based on the Abbreviated Injury Scale (AIS)--for which severity scores range
from 1 (minor) to 6 (most critical) for each anatomic region (1)--injuries
were more severe in all anatomic regions for unbelted than for belted persons.
These differences were statistically significant (p less than 0.01) for all
areas except the face and the abdomen and pelvis. For head injuries, the
average AIS score was 1.6 for belted persons and 2.6 for unbelted persons; for
injuries to the thorax, the average score was 1.8 for belted persons and 2.3
for unbelted persons. Overall, the average AIS score was 1.2 for belted and
1.5 for unbelted persons.
At both low- and high-impact speeds, unbelted occupants were more likely
to incur head injuries, fractures, and lacerations. At low-impact speeds (less
than or equal to 30 mph), 1.1% of belted persons received head injuries; 3.7%,
fractures; and 8.8%, lacerations. For unbelted persons, 7.8% incurred head
injuries; 9.5%, fractures; and 26.6%, lacerations. At high-impact speeds
(greater than 30 mph), 2.5% of belted persons received head injuries; 11.9%,
fractures; and 16.3%, lacerations. For unbelted persons, 20.3% received head
injuries; 29.8%, fractures; and 41.3%, lacerations.
Reported by: TD Peterson, MD, KM Royer, Iowa Methodist Medical Center, Des
Moines, Iowa. Biometrics Br, Div of Injury Epidemiology and Control, Center
for Environmental Health and Injury Control, CDC.
Editorial Note: This statewide hospital evaluation of motor vehicle crash
morbidity, which is modeled after a 1986 pilot study in Keokuk, Iowa (2),
serves as a model for future injury surveillance.
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Volume 2, Number 41 November 8, 1989
Since July 1986, Iowa has had a primary enforcement safety-restraint law.
Observational studies conducted by the Iowa Department of Transportation found
that safety-restraint compliance was 56% in September 1987 and 55% in
September 1988 (3,4). In the ISRA, 48% of injured persons were belted, which
may suggest that belted persons have fewer motor vehicle crashes and/or are
less likely to have injuries requiring emergency care.
Most injuries reported were minor, especially for belted persons. Minor
injuries can be a source of temporary disability and medical expense but are
seldom reported in case studies. Soft-tissue injuries, such as strains and
sprains, may be underreported among unbelted persons because seriously injured
patients are less likely (or unable) to complain about soft-tissue injury, and
trauma teams are less likely to address these injuries when life-threatening
injuries are present.
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HICN241 News Part 1/2