Raloxifene (Evista) is a selective estrogen receptor modulator (SERM) because it has estrogen type effects on bones and lipids, but anti-estrogen effects on the breast and uterus. Unfortunately, its use in post-menopausal women is still unclear because of the lack of adequate research. For now, these authors suggest that estrogen remains the medication of choice for post-menopausal women to help prevent both osteoporosis and cardiovascular disease.(Khovidhunkit W, Shoback DM. Ann Intern Med 2-March-1999;130:431)

This study of sixty newborn children found those fed a casein-hydrosylate formula (Nutramigen) had less jaundice than those fed a whey predominant formula (Enfamil) or breast milk. While breast milk is recommended for nearly all neonates, if severe jaundice develops it may be helpful to give a casein-hydrosylate formula until the jaundice resolves. (Gourley GR et al. Arch Pediatr Adolesc Med 1999(Feb);153:184)

A second attempt at microsurgical reversal of a vasectomy is often successful. In this study of 41 men (mean age of 39) who underwent a second reversal procedure after a failed initial attempt, the postprocedure patency rate was 79% and mean total sperm count was 38 million. The pregancy rate overall was 31%. (Hernandez J, Sabanegh ES. 1999;161:1153)

This study of 183 patients with sciatic demonstrated that two weeks of bed rest was no more effective than an early return to routine activity. This confirms previous research recommending that acute low back pain is usually best treated with an early return to light duty and routine activities. (Vroomen PC et al. New Engl J Med 1999;340:418)

This study comparing inhaled beclomethasone (Beclovent) with oral montelukast (Singulair) in the treatment of asthma found a similar efficacy for both. This suggests that some asthmatics may benefit from an oral leukotriene receptor inhibitor like montelukast as the initial second-line therapy to albuterol. (Malmstrom K et al. Ann Intern Med 16-March 1999;130:531)

This Canadian review of the medical literature concluded that in patients over 65 years old complaining of fatigue lasting less than six months, screening for anxiety, depression, trauma and abuse needs to be done. Blood tests should include a hemoglobin, sedimentation rate, thyroid-stimulating hormone, glucose, and white blood cell count. They authors found considerable evidence that physical causes of fatigue were more common in the elderly. (Canadian Fam Physician, Feb 1999;373)

This study of orlistat (Xenical) found that it was more effective than placebo in achieving and maintaining weight loss over a two year period. Although the differences were small in all categories, the patients on orlistat also had greater reductions in total cholesterol, LDL cholesterol, waist circumference, and fasting glucose. (Davidson MH et al. JAMA 20-Jan 1999;281(3):235)

Since streptococcus pneumoniae (S. pneumoniae) is the most common bacterial cause of such infections, antibiotic resistant S. pneumoniae is complicating the treatment of ear infections in children. This CDC working group concluded that amoxicillin remains the first line treatment, at standard dosing for low risk patients (40 mg/kg/d) and high dosing for high risk patients (80 to 90 mg/kg/d). When there is no improvement at three days, consider amoxicillin-clavulanate (Augmentin), IM ceftriaxone (Rocephin), or cefuroxime. Consider clindamycin as second line therapy in patients recently treated with antibiotics. (Dowell SF et al. Ped Infect Dis J 1999;18(1):1)

This British study of 12,592 military men attempted to find out whether or not there was a unique Gulf War Syndrome. Three groups were compared: personnel deployed to the Gulf, Bosnia, or somewhere else. The authors state that their research should be interpreted with caution, however, their findings do not support the existance of a unique Gulf War syndrome. Ismail K et al. (Lancet 1999;353(9148):179)

Why don't men seek medical attention as often as women? This study from the University of Toronto concluded that barriers to treatment men face include the feeling that asking for help is not an acceptable male behavior, a sense of immunity, and a requirement that he disclose the reason for the visit to the receptionist. Female partners were thought to be the primary motivator when men do seek help. Tudiver F et al. J Fam Pract 1999;48(1):47.