Clinical Pearls, 16-Jan-1998 Ethics hit the forefront of medicine with the announcement of Richard Seed, PhD, a physicist from Chicago, that he planned to clone human beings. The recent skiing deaths of Sonny Bono and Michael Kennedy renewed calls for the mandatory use of ski helmets. For inquiring minds (and bodies), a recent survey found that Americans have sex on average once a week.
Now for the pearls of the week...
Polyunsaturated fats seem to increase the risk of breast cancer, whereas monounsaturated fats actually decrease the risk. Monounsaturated fats are found in olive and canola oils. Arch Intern Med 1998 158:0041.
Breast feeding should be delayed for at least one hour after vigorous exercise; immediately after exercise the antibodies in breast milk fall to low levels, but return to normal within an hour. Med Sci Sports Exercise 1997 029:1596.
Dextromethorphan was found to cause birth defects in an animal study; it is recommended that pregnant women not take this popular over-the-counter cough medicine. Ped Research 1998 043:0001.
The use of quilts as bedding material for infants under age 1 yr old was associated with an increase in the rate of Sudden Infant Death (SIDS). BMJ 1998 316:0125.
In a study of 5,601 patients scheduled for elective surgery, of whom all received a second opinion, it was determined that 9% of the patients did not need the surgery. Implication- a second opinion may help you avoid unnecessary surgery. J Am Coll Surgeons 1997 185:0451.
Physicians supporting the use of calcium channel blockers were more likely to have financial relationships with the pharmaceutical companies making calcium channel blockers than those physicians who supported a neutral or negative view. NEJM 1998 338:0101.
The regular (at least weekly) use of acetaminophen was associated with a decreased risk for ovarian cancer in this study of 1086 women over a 5 year period. Lancet 1998 351:0104.
Medical information on the internet is often faulty. In this study, 41 sites were found discussing the management of fever in children, and of those, only 4 sites closely adhered to standard published guidelines. BMJ 1997 314:1875.
Supplementation with 27 grams of rhubarb fiber a day lowered total cholesterol by 8% and LDL cholesterol by 9% in this study of 10 men. J Am Coll Nutr 1997 016:0600.
The Chinese herbal treatment for menopausal symptoms, Dong Quai, is no better than placebo. It reduced symptoms by 25 - 30 %, comparable to placebo. In contrast, treatment with estrogen is from 60 - 100 % effective. Fertility & Sterility 1997 068:0981.
Green tea contains a powerful antioxidant that kills human cancer cells in-vitro. The ingredient is epigallocatechin-3-gallate. J Nat Cancer Inst 1997 089:1881.
Drinking alcohol outside of mealtimes increased the risk of liver cirrhosis by 5 times; those drinking multiple types of alcohol (corrected for total intake of EtOH) had 23 times the risk for cirrhosis. Gut 1997 041:0845.
Children who own and wear cigarette promotional items such as T-shirts, hats, or jackets were 4 times more likely to smoke than those who don't own such items. Youngsters with friends and/or family who smoked were 30 times more likely to smoke themselves. Arch Ped Adol Med 1997 151:1189.
Amiodarone, taken for one week before heart surgery, can decrease the post operative rate of atrial fibrillation. NEJM 1997 337:1785.
The symptoms of fever, joint pain, and night sweats help identify people with recent HIV infections. JAMA 1997 278:2085.
Postmenopausal hormone replacement therapy protected against age related memory loss in this study of 288 women. Neurology 1997 049:1491.
The use of an electric blanket early in pregnancy increased the risk of miscarriage in this study of 2967 women. Epidemiol 1998 009:0036.
Among male smokers, those who drank chlorinated water versus those who drank nonchlorinated water, for 40 or more years, where more likely to develop bladder and rectal cancers. Epidemiol 1998 009:0021, 0029.
Physician behaviors likely to result in fewer lawsuits: longer visits, asking pts' opinions, checking understanding, using connectors ("go on, tell me more"), humor, and orientation (e.g. "here's what we will do today...). JAMA 1997 277:0553.
People taking long half-life benzodiazepines had an approximately 45% increased risk of having a motor vehicle accident; those taking short half-life benzodiazepines did not have an elevated risk. JAMA 1997 278:0027.
A low-fat, high carbohydrate diet was more effective than a fixed energy maintenance diet in keeping the weight off after dieting; energy intake from fat was 20% to 25% and from carbohydrates at least 55% . BMJ 1997 314:0029.
Vitamin E at 2,000 IU per day given to people with Alzheimer's disease delayed progression of the disease. NEJM 1997 336:1216.
Inhaled ipratropium bromide (ATROVENT) has been shown to help resolve persistent postviral infection coughs. Resp Med 1992 086:0425.
Heparin therapy along with aspirin is more effective in the treatment of unstable angina if it is discontinued prior to 48 hours as compared with a similar group of patients treated for longer than 48 hours. The etiology for this finding is unclear. Am J Cardiol 1997 079:0259.
In this study of 3,187 women aged 25 to 44, the risk of a delayed conception (waiting 9 1/2 months or longer) was increased among heavy ( over 500 mg/d) consumers of caffeine. Am J Epidemiol 1997 145:0324.
When asked about the risks of antiobesity drugs, This assistant professor at Harvard stated that "If appropriately obese persons (those with a body mass index greater than 27) are treated, the risk-benefit ratio favors drug therapy." Consultant 1997 037:1168.
Only 1 of 4 lens types is recommended for kids who wear glasses--those made from polycarbonate plastic. JAMA 1997 .