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Old August 8th, 2001, 20:53
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1998.03.20

Clinical Pearls, 20-Mar-1998.  More warnings are coming out for former "phen fen" (phentermine and fenfluramine) diet pill users: there may be a risk before dental procedures. According to a statement from the American Dental Association, the some four and a half million people who used these medications may be at a risk for a cardiac infection after certain dental procedures. If you have taken these medications, you should let your dentist know before having any dental procedures performed. 



The Oscars weren't the only awards given to movies this week. The American Lung Association (ALA) also gave out movie awards. Teenagers throughout California made up the selection committee for the ALA, and awarded HACKADEMY awards. "Thumbs Down" awards were given to movies such as "Titanic," "My Best Friend's Wedding," and "Men in Black" because these movies portrayed smoking in a positive light. "Thumbs Up" awards were given to "Liar, Liar," "The Lost World," "Tomorrow Never Dies," and "As Good As It Gets." These movies featured characters who did not glamorize smoking, or who were anti-smoking. 



The hazards of road rage include the transmission of HIV. In an article published in the Lancet, after a car accident the 2 drivers got into a fight. The assailant, who was infected with HIV and hepatitis B, head butted the other driver, who was wearing metal framed glasses. Both started bleeding, and by 3 months later the previously healthy driver had both HIV and hepatitis B.



Recommended reading this week is Diet and Disease by Emanuel Cheraskin, MD, DMD. This is an excellent, easy to read book about the role of your diet in the etiology, prevention, and treatment of disease. This is full of references, and is written by a well regarded professor at the University of Alabama at Birmingham. Full of useful information.



Another good diet book is Diet for a New America by John Robbins. Although this book was published a decade ago, it is still relevent today. It has a compelling argument for vegetarianism, and contains suprising information about what goes into the meat you get from the grocery story. This book is a classic.



Now for the pearls of the week---



In male smokers, supplementation with vitamin E (50 mg/d) lowered the rate of prostate cancer by 30% in this Finnish study. Heinonen OP … J National Cancer Inst, 1998, 090:0414.



Antibiotics are not effective in the treatment of a cough in adults. Fahey T et al. BMJ, 21-MAR 1998, 316:0906.



Hormone replacement therapy in this meta-analysis study was associated with a 30% decreased risk of Alzheimer's disease. JAMA, 1998, 279:0668.



This review notes that anal sphincter trauma occurs in up to a 3rd of all deliveries; women have 8 times the risk of fecal incontinence later in life. Recommended that women with 3rd degree tears from delivery be referred for colorectal surgical followup. Brit J Surgery, 1998, 085:0293.



In this placebo controlled study of 309 patients, the use of ginko biloba stabilized dementia and in some cases improved mental performance over a 1 year period. Le Bars et al. JAMA, 1997, 278:1327.



In this study of 789 children, 70.5% had received at least 1 antibiotic by 200 days of life (about 6 months of age), even though too much exposure to antibiotics has been associated with more antimicrobial resistance. Bergus GR et al. Arch Fam Med, 1996, 005:0523.



In this study of 7925 men and 7977 women, leisure time activity was associated with a lower death rate. After correcting for several predictors of mortality; there was a 30% reduced mortality rate in occasional exercisers vs sedentary people. Kujala UM et al. JAMA, 11-FEB 1998, 279:0440.



Syncope is more likely to be cardiac related in men than women; in this study of 109 consecutive patients hospitalized for syncope, 49% of the men vs 25% of the women had a cardiac etiology. Freed LA et al. Am J Cardiol, 1997, 080:1183.



CT scans predicted a good response to tPA in ischemic stroke. tPA helped pts with small (<33%) hypoattenuation in the MCA region. Those with none or large (>33%) parenchymal hypoattenuation had a higher risk of cerebral bleeding; tPA did not help them. von Kummer R et al. Radiology, 1997, 205:0327



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