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
of 25 journals. Twice a month, the summaries
get compiled into newsletter form and mailed
to subscribers.
  To acquaint you with Journal Watch, we will
post the top two stories, along with the table
of contents, twice a week.
  To receive the complete complement of stories
(usually three to five additional summaries)
twice a week *via email* please send payment

(the cost is $US50 a year).
  If you'd like to receive the twice-monthly
*paper* newsletter, which costs $US79 a year,
please call 800-843-6356; international orders:
(49) 30 335 8006.
                    *********
  Contents copyright 1994, Mass. Medical Society.

Journal Watch Summaries for November 11, 1994

PYELONEPHRITIS: IS AN EXTRA HOSPITAL DAY REALLY
NEEDED?.
  J Fam Pract 1994 Oct; 39:337-9.

LOW ALTITUDE IMPROVES OXYGENATION IN ADVANCED LUNG
DISEASE.
  Ann Intern Med 1994 Nov 1; 121:658-62.

SUCCESSFUL SCREENING FOR {*filter*}ISM IN AN URBAN
CLINIC.
  J Gen Intern Med 1994 Oct; 9:550-3.

DO BETA-BLOCKERS IMPAIR MEMORY?.
  Nature 1994 Oct 20; 371:702-4.

ABNORMALITIES OF THE THALAMUS IN SCHIZOPHRENIA.
  Science 1994 Oct 14; 266:294-8.

HIV PROTEIN MAY INDUCE KAPOSI'S SARCOMA.
  Nature 1994 Oct 20; 371:674-80.

GENDER BIAS IN CARDIAC ISCHEMIA: A CLOSER LOOK.
  J Fam Pract 1994 Oct; 39:331-6.

PYELONEPHRITIS: IS AN EXTRA HOSPITAL DAY REALLY
NEEDED?.
   Patients who are hospitalized for intravenous
antibiotic treatment of acute pyelonephritis are typically
observed for 24 hours after being switched to {*filter*}
antibiotics, but there is no scientific evidence to support
this practice. Is this extra hospital day necessary?
   Researchers in Cleveland conducted a retrospective review
of 138 consecutive nonpregnant {*filter*}s who were admitted with
acute pyelonephritis. Ninety-one percent of the patients
were female, and ages ranged from 17 to 65 years (average,
31). The length of stay averaged 6.5 days, and the mean
interval between the last IV antibiotic dose and patient
discharge was 2.6 days. Eighty-three percent of patients
spent at least one night in the hospital after receiving the
last IV dose. During the observation period on {*filter*}
antibiotics, only two patients showed evidence of relapse:
one was found to have a kidney stone and the other had
recurrence of back pain. Five patients had adverse reactions
attributed to the {*filter*}antibiotics, but none were serious.
   Comment: This study supports the notion that the extra
hospital day for observation is clinically unnecessary, and
that patients with uncomplicated pyelonephritis can safely
leave the hospital after being switched from IV to {*filter*}
antibiotics. --JC Puffer.
   Citation: Caceres VM; et al. The clinical utility of a day of
hospital observation after switching from intravenous to {*filter*}
antibiotic therapy in the treatment of pyelonephritis. J Fam
Pract 1994 Oct; 39:337-9.

LOW ALTITUDE IMPROVES OXYGENATION IN ADVANCED LUNG
DISEASE.
   Long-term oxygen supplementation improves functional
status and physiologic parameters in hypoxemic patients with
severe chronic lung disease. These Israeli researchers
assessed the degree to which the "natural" oxygen enrichment
at low altitudes enhances respiratory function.
   Ten patients with end-stage lung disease who required
home oxygen therapy underwent testing in Jerusalem
(altitude, 800 meters above sea level) and at the Dead Sea
(400 meters below sea level). In Jerusalem, the median
daytime arterial oxygen pressure was 52 mm Hg and the median
oxygen saturation during sleep was 85 percent; at the Dead
Sea, these measurements were significantly higher (67 mm Hg
and 90 percent, respectively). Moreover, median maximal
oxygen uptake during exercise increased at the lower
altitude, from 827 to 1056 ml/min, and all patients noted
improvement in general well-being.
   Comment: These fairly impressive differences in
oxygenation occurred after a moderate, 1200-meter descent.
Although longer-term assessments at different altitudes
would be desirable, the results suggest that chronically
hypoxemic patients living substantially above sea level
would benefit from moving to lower altitudes. --AS Brett.
   Citation: Kramer MR; et al. Effect of natural oxygen
enrichment at low altitude on oxygen-dependent patients with end-
stage lung disease. Ann Intern Med 1994 Nov 1; 121:658-62.