Journal Watch Summaries for September 2, 1994 
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 Journal Watch Summaries for September 2, 1994

  This is Journal Watch, a medical-literature
survey produced by the Massachusetts Medical
Society.
  Twice a week, our physician-editors summarize
important new clinical research from a group
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  Contents copyright 1994, Mass. Medical Society.

Journal Watch Summaries for September 2, 1994

LOW-DOSE AMIODARONE FOR HEART FAILURE.
  Lancet 1994 Aug 20; 344:493-8.
   Lancet 1994 Aug 20; 344:489-90.

TREATING HYPERTENSION WITH A MINERAL SALT SUBSTITUTE.
  BMJ 1994 Aug 13; 309:436-40.

TRIPLE THERAPY FOR STEROID-INDUCED BONE LOSS.
  Am J Respir Crit Care Med 1994 Aug; 150:394-7.

MORE ON LOW CHOLESTEROL AND {*filter*} DEATH.
  BMJ 1994 Aug 13; 309:445-7.

OUTCOME OF TRANSPLANTS FOR OBSTRUCTIVE LUNG DISEASE.
  Am J Respir Crit Care Med 1994 Aug; 150:398-402.

AN OUTBREAK OF PNEUMONIA IN TEXTILE WORKERS.
  Lancet 1994 Aug 20; 344:498-501.

LOW-DOSE AMIODARONE FOR HEART FAILURE.
   Attempts to prolong survival of heart-failure patients
by using antiarrhythmic {*filter*} have been disappointing. This
randomized, unblinded study from Argentina, involving 516
patients with moderately severe heart failure, examined the
effects of low-dose amiodarone.
   All patients received standard treatment for heartfailure
(diuretics, digitalis, and ACE inhibitors), and half
were randomized to amiodarone (300 mg daily). Patients with
sustained ventricular arrhythmias were excluded, but one
third had episodes of nonsustained ventricular tachycardia
on Holter monitoring. The study was stopped early after
interim analysis showed lower mortality with amiodarone at
two years (34 vs. 41 percent); the decrease was similar for
sudden and progressive heart-failure deaths. The amiodarone
group also had significantly improved functional capacity
and fewer hospitalizations for heart failure. The incidence
of drug-related side effects was 6 percent.
   Comment: A reduction in sudden deaths with amiodarone may
result from arrhythmia suppression, but the apparent
improvement in functional capacity and the reduction in
deaths from heart failure are surprising and their mechanism
unclear. An editorial notes that the rate of reported side
effects was unusually low and may reflect insufficient
ascertainment. Before amiodarone is used routinely in heart
failure, additional trials with longer follow-up and
monitoring are needed. --B Jarman.
   Citation: Doval HC; et al. Randomised trial of low-dose amiodarone in
severe congestive heart failure. Lancet 1994 Aug 20; 344:493-8.
   Citation: Henderson AH. Amiodarone for chronic heart failure. Lancet 1994
Aug 20; 344:489-90.

TREATING HYPERTENSION WITH A MINERAL SALT SUBSTITUTE.
   Because dietary minerals -- particularly sodium,
potassium, and magnesium -- can influence {*filter*} pressure,
people have tried to correct hypertension by altering
mineral intake. This 24-week Dutch trial manipulated all
three minerals through relatively simple means.
   One hundred previously untreated {*filter*}s (aged 55 to 75)
with {*filter*} pressures above 140 mm Hg systolic or 85 mm Hg
diastolic were randomized to an intervention or control
group. Both groups ate their usual diet, but, in the
intervention group, table and cooking salt were replaced by
a commercially available mineral salt containing 41 percent
potassium chloride, 41 percent sodium chloride and 17
percent magnesium salts. (Subjects were not told which salt
they received.)
   Systolic pressure in the group using mineral salt fell an
average of 7.6 mm Hg, and diastolic pressure fell 3.3 mm Hg
as compared with the control group. Urinary sodium excretion
fell by 28 percent with the mineral salt, and potassium
excretion increased by 22 percent. Subjects felt that the
mineral salt tasted fine.
   Comment: This relatively easy change in diet had a fairly
large impact on {*filter*} pressure as compared with other
trials, perhaps because several minerals were changed
simultaneously. Switching to mineral salt may be a
reasonable first step in controlling mild to moderate
hypertension. --KI Marton.
   Citation: Geleijnse JM; et al. Reduction in {*filter*} pressure with a low
sodium, high potassium, high magnesium salt in older subjects with mild
to moderate hypertension. BMJ 1994 Aug 13; 309:436-40.

TRIPLE THERAPY FOR STEROID-INDUCED BONE LOSS.
   Osteoporosis is a serious consequence of chronic {*filter*}
steroid use. This trial in Germany evaluated whether the
combination of calcium, vitamin D, and the diphosphonate
EHDP (which blocks bone resorption) prevents secondary
osteoporosis in {*filter*}s using long-term systemic steroids for
asthma.
   Forty patients were randomized to either a treatment
group, which received calcium (1 g/d), vitamin D (1000 IU),
and EHDP (7.5 mg/kg), or a control group given calcium only.
During six months of treatment, bone density (assessed by
dual photon absorptiometry of the lumbar spine) increased by
5 percent in the treated group and declined by 4 percent in
the control group, a significant difference. New vertebral
crush fractures were seen in 4 of 19 controls but in none of
the 14 treated patients who completed the study. Three
treated patients, but no controls, withdrew because of
nausea.
   Comment: This small study suggests that a triple-drug
regimen that includes a diphosphonate agent to prevent bone
resorption can prevent steroid-induced bone loss. Larger and
longer studies in broader populations will better establish
the acceptability, benefits, costs, and ideal duration of
this regimen. --CD Mulrow.
   Citation: Worth H; et al. Therapy of steroid-induced bone loss in {*filter*}
asthmatics with calcium, vitamin D, and a diphosphonate. Am J Respir Crit Care
Med 1994 Aug; 150:394-7.

MORE ON LOW CHOLESTEROL AND {*filter*} DEATH.
   Several clinical trials have linked {*filter*} cholesterol
reduction with a rise in {*filter*} deaths ({*filter*},
accidents, and suicide). A recent review of cohort studies
(see Journal Watch accession number 940318005) reported a
link between low cholesterol and {*filter*} death in community
cohorts but not in employed men. This prospective Finnish
study revisited the issue in two randomly chosen cohorts
(10,898 men and 11,534 women) who were born between 1913 and
1947 and examined in 1972 and 1977.
   During follow-up, according to the national death
registry, 193 men and 43 women died from accidents, suicide,
or {*filter*}. A multiple regression model assessed the
relation between these deaths and several predictors. The
key finding was that serum cholesterol level did not predict
{*filter*} death. However, in both sexes, people who died
{*filter*} deaths were more likely to have been smokers than
those dying from other causes. In men, {*filter*} deaths were
associated with both abstention from {*filter*} and use of
{*filter*} more than monthly.
   Comment: These findings add to the growing body of
epidemiologic data showing little or no relation between
{*filter*} death and low cholesterol levels. However, the
epidemiologic studies by definition don't necessarily exclude an effect
of active cholesterol-lowering on these causes of death. --KI Marton.
   Citation: Vartiainen E; et al. Serum cholesterol concentration and
mortality from accidents, suicide, and other {*filter*} causes. BMJ 1994 Aug 13;
309:445-7.

OUTCOME OF TRANSPLANTS FOR OBSTRUCTIVE LUNG DISEASE.
   Is single-lung transplantation a viable option for
patients with end-stage obstructive lung disease? This study
followed the clinical course of 28 people who underwent this
procedure. All were under age 60 and had lung disease
secondary to alpha-1-antitrypsin deficiency, emphysema due
to tobacco use, or bronchiolitis obliterans.
   Six transplant recipients died within a year (including
two who died soon after the operation). The remaining 22
patients were followed for at least one year and 10 for at
least two years, during which 6 more patients died (5 deaths
were related to original lung pathology or possibly to
immunocompromise after transplantation). Patients who
survived for at least one year had significant, sustained
improvements in FEV1 and arterial oxygenation as compared
with pretransplant values. They were able to perform daily
activities unimpaired and did not need home oxygen. Exercise
testing showed no ventilatory limitations.
   Comment: This small study suggests that single-lung
transplants may be successful in some patients with end-
stage lung disease, but that mortality risks are still high.
Before we routinely consider this costly procedure, we need
more data on its benefits and risks and which patients are
likely to be successful recipients. --CD Mulrow.
   Citation: Levine S; et al. Medium term functional results of single-lung
transplantation for endstage obstructive lung disease. Am J Respir Crit Care
Med 1994 Aug; 150:398-402.

AN OUTBREAK OF PNEUMONIA IN TEXTILE WORKERS.
   This report documents a 1992 outbreak of organizing
pneumonia in Valencia, Spain that led to six deaths and one
lung transplant among factory textile workers. The outbreak
coincided with a change in the formulation of an aerosol
dye.
   Initial epidemiologic investigation linked two cases of
severe pulmonary insufficiency and interstitial lung disease
to a fatal case of acute respiratory failure at the same
factory. Consequently, investigators interviewed and
examined all 257 employees at eight nearby textile factories
that used spray-printing techniques. Seventy-one workers (28
percent) had abnormal respiratory features, and 22 had chest
X-rays, CT scans, and lung biopsies that showed nodular
opacities or confluent patchy consolidation consistent with
a diagnosis of organizing pneumonia. All 71 affected workers
were treated with {*filter*}corticosteroids; after one year of
follow-up, 6 had died and 1 had required a lung transplant.
The overall attack rate was 9 percent.
   Comment: There have been other reports of respiratory disease caused
by reformulated aerosol products. Often such
products are reformulated in an effort to eliminate ozone-
depleting solvents. This study emphasizes the need to
carefully test these reformulations for adverse health
effects. --B Jarman.
   Citation: Moya C; et al. Outbreak of organizing pneumonia in textile
printing sprayers. Lancet 1994 Aug 20; 344:498-501.



Tue, 18 Feb 1997 23:10:52 GMT
 
 [ 1 post ] 

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