Journal Watch Direct sampler for Friday, June 13 
Author Message
 Journal Watch Direct sampler for Friday, June 13

  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
journals. We post the top two summaries,
along with the complete table of contents,
to selected news groups in sci.med.
  To receive the complete complement of stories
*via email* please send your snail-mail address

mailing list immediately and mail you an invoice
(the cost is $US60 a year).
                    *********
  Contents copyright 1997, Mass. Medical Society.

Journal Watch Summaries for Friday, June 13, 1997.

ARE CELLULAR PHONES DANGEROUS NEAR PACEMAKERS?.
  N Engl J Med 1997 May 22; 336:1473-9.

THALIDOMIDE TREATS APHTHOUS ULCERS IN AIDS.
  N Engl J Med 1997 May 22; 336:1487-93.

CONVENTIONAL VS. LAPAROSCOPIC HERNIA SURGERY.
  N Engl J Med 1997 May 29; 336:1541-7.
  N Engl J Med 1997 May 29; 336:1596-7.

PREDICTING THE RESPONSE TO SPLENECTOMY IN ITP.
  N Engl J Med 1997 May 22; 336:1494-8.

EPIDURAL STEROIDS OF LITTLE BENEFIT FOR SCIATICA.
  N Engl J Med 1997 Jun 5; 336:1634-40.

CYCLOSPORIASIS OUTBREAK LINKED TO IMPORTED
RASPBERRIES.
  N Engl J Med 1997 May 29; 336:1548-56.

DEPRESSED ELDERLY PATIENTS CONSUME MORE HEALTH CARE
RESOURCES.
  JAMA 1997 May 28; 277:1618-23.
DT.-970613.

AN.-1.
HL.-ARE CELLULAR PHONES DANGEROUS NEAR PACEMAKERS?.
NS.-Cellular telephones generate electromagnetic
interference that may affect cardiac pacemakers. This study
from three U.S. medical centers examined the interaction
between five types of cellular phones and the pacemakers
implanted in 980 patients. Testing was conducted while
technicians monitored the patients' ECGs.
   The incidence of interference was higher with digital
than with analog telephones (24 vs. 3 percent) and when the
telephone was held directly over the pacemaker rather than
over the ear (13 vs. 0.2 percent). Interference was more
common with dual-chamber than single-chamber devices (25 vs.
7 percent) and varied greatly depending on the brand of
pacemaker.
   Interference was deemed definitely clinically significant
in 2 percent of tests, probably significant in 5 percent,
and probably not significant in 13 percent. Patients
reported symptoms (most commonly palpitations or dizziness)
in 7 percent of tests, but symptoms occurred only when the
telephone was placed directly over the pacemaker.
   Comment: This study documents that cellular phones pose
potential problems for patients with pacemakers. However,
clinically important interference is unlikely if the phone
is not held over the pacemaker; nor is it likely among
patients who are not dependent on the pacemaker or have
analog phones. --AS Brett.
AU.-Hayes DL et al.
TI.-Interference with cardiac pacemakers by cellular
telephones.
SO.-N Engl J Med 1997 May 22; 336:1473-9.

AN.-2.
HL.-THALIDOMIDE TREATS APHTHOUS ULCERS IN AIDS.
NS.-Although AIDS-associated giant aphthous ulcers can
sometimes be treated with topical or systemic steroids, the
relapse rate is high and the additional immunosuppressive
effects are undesirable. This double-blind,
placebo-controlled study confirms that the notorious drug
thalidomide is an excellent treatment alternative.
   Researchers randomized 60 people with AIDS to 200 mg of
thalidomide or placebo daily; 50 men and 7 women were
included in the final analysis. All were severely
immunosuppressed, with median CD4 counts of less than 30
cells per cubic millimeter and {*filter*}ulcers measuring about 2
by 1 cm and causing substantial pain. After four weeks'
treatment, ulcers were completely or partially resolved in
90 percent of thalidomide recipients versus 25 percent of
placebo recipients. Weight increased and quality of life
measurements improved significantly with thalidomide.
   Adverse events ascribed to thalidomide included
somnolence and rash, each occurring in 24 percent of
recipients. No pregnancies occurred. Interestingly, although
thalidomide is an inhibitor of TNF-alpha in vitro and should
thus suppress HIV replication, plasma HIV-RNA levels
actually rose slightly with thalidomide, by a median factor
of 0.42 log copies/ml.
   Comment: Thalidomide is clearly an effective treatment
for AIDS-associated aphthous ulcers. But its use is
complicated by several considerations, including the
absolute prohibition against pregnancy, and the possibility
that it may significantly enhance HIV replication through a
still unclear mechanism. --A Zuger.
AU.-Jacobson JM et al.
TI.-Thalidomide for the treatment of {*filter*}aphthous ulcers
in patients with HIV infection.
SO.-N Engl J Med 1997 May 22; 336:1487-93.



Mon, 29 Nov 1999 03:00:00 GMT
 
 [ 1 post ] 

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