This is Journal Watch Direct, 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 50
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  Contents copyright 1997, Mass. Medical Society.

Journal Watch Summaries for Friday, January 24, 1997.

GLYCERYL TRINITRATE OINTMENT HEALS {*filter*}FISSURES.
  Lancet 1997 Jan 4; 349:11-14.

HRT MAY IMPROVE OUTCOMES AFTER ANGIOPLASTY.
  J Am Coll Cardiol 1997 Jan 1; 29:1-5.

GENDER DIFFERENCES IN HEALTH CARE UTILIZATION.
  J Fam Pract 1996 Dec; 43:567-76.

DRUNK DRIVING: COMMON ENOUGH TO DISCUSS WITH PATIENTS.
  JAMA 1997 Jan 8; 277:122-5.

BIKE HELMETS: EVIDENCE OF BENEFIT MOUNTS.
  JAMA 1996 Dec 25; 276:1968-73.
  JAMA 1996 Dec 25; 276:1974-5.

PROSTATE CANCER TRANSMITTED VIA HEART TRANSPLANTATION.
  JAMA 1997 Jan 8; 277:133-7.

JOURNAL WATCH 1996 READER SURVEY RESULTS.
DT.-970124.

AN.-1.
HL.-GLYCERYL TRINITRATE OINTMENT HEALS {*filter*}FISSURES.
NS.-Glyceryl trinitrate (GTN) ointment has been shown to
reduce maximum {*filter*}resting pressure, producing a "chemical
sphincterotomy." Researchers in this prospective study
randomized 80 consecutive patients with chronic {*filter*}
fissures to 0.2 percent GTN ointment or placebo ointment
applied twice daily by the patient to the lower {*filter*}canal.
   At eight weeks, the fissure had healed in 26 of 38
patients (68 percent) with GTN and 3 of 39 (8 percent) with
placebo, a significant difference. GTN users also had
significantly lower maximum {*filter*}resting pressure and
increased anodermal {*filter*} flow compared with baseline, but
there was no change with placebo. Both groups had some pain
reduction initially, but this reduction was sustained at
four weeks only with GTN. Fifty-eight percent of GTN users
had headaches at some point, but only one had to stop
treatment because of this side effect.
   Comment: GTN ointment effectively healed chronic {*filter*}
fissures in most patients. These patients might otherwise
have required surgery, which can cause long-term continence
problems. GTN ointment may become the treatment of choice
for {*filter*}fissures. --B Jarman.
AU.-Lund JN; Scholefield JH.
TI.-A randomised, prospective, double-blind,
placebo-controlled trial of glyceryl trinitrate ointment in
treatment of {*filter*}fissure.
SO.-Lancet 1997 Jan 4; 349:11-14.

AN.-2.
HL.-HRT MAY IMPROVE OUTCOMES AFTER ANGIOPLASTY.
NS.-Hormone replacement therapy has a variety of potential
cardiovascular benefits. This retrospective study raises the
possibility that HRT is especially helpful for women who
have undergone coronary angioplasty.
   Subjects included 337 postmenopausal women who underwent
PTCA in Kansas City, Missouri: 137 had used HRT at the time
of angioplasty and during follow-up, and the remaining 200
had not (the two groups were matched by age and
cardiovascular characteristics); none had undergone prior
PTCA or had a recent acute myocardial infarction. Average
length of follow-up was 65 months.
   Actuarial 7-year survival was 93 percent among HRT users
versus 75 percent among nonusers. The cardiac death rate was
lower in those who used HRT (4 vs. 15 percent), as was the
overall cardiovascular event rate (death, MI, or stroke; 12
vs. 35 percent). Multivariate analysis indicated that HRT
use led to a 62 percent reduction in risk for MI or cardiac
death. The need for subsequent revascularization procedures
was similar in the two groups (about 50 percent).
   Comment: These observational data indicate that HRT is
associated with better outcomes after PTCA, but do not prove
a cause-and-effect relation. If HRT did play a causal role,
the mechanism is unclear, given the similar rate of
subsequent revascularization in the two groups. --TH Lee.
AU.-O'Keefe JH; et al.
TI.-Estrogen replacement therapy after coronary
angioplasty in women.
SO.-J Am Coll Cardiol 1997 Jan 1; 29:1-5.