Relationship of Depression to Death or Hospitalization in Patients With Heart Failure

Aggiornamento ADR febbraio ’07 II

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1: Arch Intern Med. 2007 Feb 26;167(4):367-73. Related Articles, Links

Relationship of depression to death or hospitalization in patients with heart failure. Sherwood A, Blumenthal JA, Trivedi R, Johnson KS, O'connor CM, Adams KF Jr, Dupree CS, Waugh RA, Bensimhon DR, Gaulden L, Christenson RH, Koch GG, Hinderliter AL. Departments of Psychiatry, Duke University Medical Center, Durham, NC; Department of Medicine, School of Medicine, and Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill. BACKGROUND: Depression is widely recognized as a risk factor in patients with coronary heart disease. However, patients with heart failure (HF) have been less frequently studied, and the effect of depression on prognosis, independent of disease severity, is uncertain. METHODS: Two hundred four outpatients having a diagnosis of HF, with a ventricular ejection fraction of 40% or less, underwent baseline assessments including evaluation of depressive symptoms using the Beck Depression Inventory and of HF severity determined by plasma N-terminal pro-B-type natriuretic peptide. Cox proportional hazards regression analyses were used to examine the effects of depressive symptoms on a combined primary end point of death and hospitalizations because of cardiovascular disease (hereafter referred to as cardiovascular hospitalization) during a median follow-up of 3 years. RESULTS: Symptoms of depression (Beck Depression Inventory score) were associated with risk of death or cardiovascular hospitalization (P<.001) after controlling for established risk factors including HF disease severity, ejection fraction, HF etiology, age, and medications. Clinically significant symptoms of depression (Beck Depression Inventory score >/=10) were associated with a hazard ratio of 1.56 (95% confidence interval, 1.07-2.29) for the combined end point of death or cardiovascular hospitalization. Contrary to our expectation, antidepressant medication use was associated with increased likelihood of death or cardiovascular hospitalization (hazard ratio, 1.75; 95% confidence interval,1.14-2.68, P =.01) after controlling for severity of depressive symptoms and for established risk factors. CONCLUSIONS: Symptoms of depression were associated with an adverse prognosis in patients with HF after controlling for HF severity. The unexpected association of antidepressant medications with worse clinical outcome suggests that patients with HF requiring an antidepressant medication may need to be monitored more closely. PMID: 17325298 [PubMed - in process]

2: Anesth Analg. 2007 Mar;104(3):563-8. Related Articles, Links

Reversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane. Vanacker BF, Vermeyen KM, Struys MM, Rietbergen H, Vandermeersch E, Saldien V, Kalmar AF, Prins ME.


Department of Anesthesiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. [email protected] In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. NMB was monitored using acceleromyography. At reappearance of the second twitch of the train-of-four ratio, sugammadex 2.0 mg/kg was administered by IV bolus. The primary end-point was time from start of sugammadex administration to recovery of train-of-four ratio to 0.9. Mean recovery time was 1.8 min after both propofol and sevoflurane anesthesia. The 95% confidence interval for the difference in recovery time between the 2 groups (-0.5 to +0.4 min) was well within the predefined equivalence interval (-1 to +1 min), indicating that recovery from NMB was unaffected by maintenance anesthesia. Thirteen patients (propofol n = 4; sevoflurane n = 9) experienced adverse events; these were treatment-related in 4 patients (propofol n = 3; sevoflurane n = 1). There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia. Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 17312209 [PubMed - in process]

3: Anesth Analg. 2007 Mar;104(3):555-62. Related Articles, Links

A randomized, dose-finding, phase II study of the selective relaxant binding drug, Sugammadex, capable of safely reversing profound rocuronium-induced neuromuscular block. Groudine SB, Soto R, Lien C, Drover D, Roberts K. Department of Anesthesiology, Albany Medical Center, Albany, New York 12208-34798, USA. [email protected] BACKGROUND: The reversal of a deep neuromuscular blockade remains a significant clinical problem. Sugammadex, a modified gamma-cyclodextrin, encapsulates steroidal neuromuscular blocking drugs, promoting their rapid dissociation from nicotinic receptors. Sugammadex is the first drug that acts as a selective relaxant binding agent. METHODS: We enrolled 50 patients into a Phase II dose-finding study of the efficacy and safety of sugammadex. Subjects, anesthetized with nitrous oxide and propofol, were randomized to one of two doses of rocuronium (0.6 or 1.2 mg/kg) and to one of five doses of sugammadex (0.5, 1.0, 2.0, 4.0, or 8.0 mg/kg). Neuromuscular monitoring was performed using the TOF Watch SX acceleromyograph. Recovery was defined as a train-of-four ratio > or =0.9. Sugammadex was administered during profound block when neuromuscular monitoring


demonstrated a posttetanic count of one or two. RESULTS: Reversal of neuromuscular block was obtained after administration of sugammadex in all but the lowest dose groups (0.5-1.0 mg/kg) where several subjects could not be adequately reversed. At the 2 mg/kg dose all patients were reversed with sugammadex, but there was significant variability (1.8-15.2 min). Patient variability decreased and speed of recovery increased in a dose-dependent manner. At the highest dose (8 mg/kg), mean recovery time was 1.2 min (range 0.8-2.1 min). No serious adverse events were reported during this trial. CONCLUSIONS: Sugammadex was well tolerated and effective in rapidly reversing profound rocuronium-induced neuromuscular block. The mean time to recovery decreased with increasing doses. Profound rocuronium-induced neuromuscular block can be reversed successfully with sugammadex at doses >/=2 mg/kg. Publication Types:



4: N Engl J Med. 2007 Feb 15;356(7):748-9; author reply 749-50. Related Articles, Links

Comment on:

• N Engl J Med. 2006 Oct 5;355(14):1419-31. • N Engl J Med. 2006 Oct 5;355(14):1432-44.

Ranibizumab for neovascular age-related macular degeneration. Gillies MC, Wong TY. Publication Types:

• Comment • Letter

PMID: 17310523 [PubMed - indexed for MEDLINE]

5: Ann Intern Med. 2007 Feb 20;146(4):278-88. Related Articles, Links

Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada. BACKGROUND: Underutilization of anticoagulant prophylaxis may be due to lack of evidence that prophylaxis prevents clinically important outcomes in hospitalized medical


patients at risk for venous thromboembolism. PURPOSE: To assess the effects of anticoagulant prophylaxis in reducing clinically important outcomes in hospitalized medical patients. DATA SOURCES: MEDLINE, EMBASE, and Cochrane databases were searched to September 2006 without language restrictions. STUDY SELECTION: Randomized trials comparing anticoagulant prophylaxis with no treatment in hospitalized medical patients. DATA EXTRACTION: Any symptomatic pulmonary embolism (PE), fatal PE, symptomatic deep venous thrombosis, all-cause mortality, and major bleeding. Pooled relative risks and associated 95% CIs were calculated. For treatment effects that were statistically significant, the authors determined the absolute risk reduction and the number needed to treat for benefit (NNT(B)) to prevent an outcome. DATA SYNTHESIS: 9 studies (n = 19 958) were included. During anticoagulant prophylaxis, patients had significant reductions in any PE (relative risk, 0.43 [CI, 0.26 to 0.71]; absolute risk reduction, 0.29%; NNT(B), 345) and fatal PE (relative risk, 0.38 [CI, 0.21 to 0.69]; absolute risk reduction, 0.25%; NNT(B), 400), a nonsignificant reduction in symptomatic deep venous thrombosis (relative risk, 0.47 [CI, 0.22 to 1.00]), and a nonsignificant increase in major bleeding (relative risk, 1.32 [CI, 0.73 to 2.37]). Anticoagulant prophylaxis had no effect on all-cause mortality (relative risk, 0.97 [CI, 0.79 to 1.19]). LIMITATIONS: 2 of 9 included studies were not double-blind. CONCLUSIONS: Anticoagulant prophylaxis is effective in preventing symptomatic venous thromboembolism during anticoagulant prophylaxis in at-risk hospitalized medical patients. Additional research is needed to determine the risk for venous thromboembolism in these patients after prophylaxis has been stopped. Publication Types:

• Meta-Analysis • Research Support, Non-U.S. Gov't


6: Ann Intern Med. 2007 Feb 20;146(4):I53. Related Articles, Links

Original report in:

• Ann Intern Med. 2007 Feb 20;146(4):266-9.

Summaries for patients. Tolerability of meropenem in patients with penicillin allergy. [No authors listed] Publication Types:

• Patient Education Handout


7: BMJ. 2007 Feb 17;334(7589):329. Related Articles, Links


Dying woman seeks backing for dose of morphine to hasten death. Dyer C. Publication Types:

• News


8: N Engl J Med. 2007 Feb 15;356(7):753; author reply 753. Related Articles, Links

Comment on:

• N Engl J Med. 2006 Nov 2;355(18):1903-11.

Hyperglycemia in the hospital setting. Nabhan FA. Publication Types:



9: JAMA. 2007 Feb 14;297(6):586-7; author reply 587-8. Related Articles, Links

Comment on:

• JAMA. 2006 Oct 4;296(13):1633-44.

Cyclooxygenase inhibitors and cardiovascular risk. Andersohn F, Suissa S, Garbe E. Publication Types:




10: JAMA. 2007 Feb 14;297(6):573-4. Related Articles, Links

FDA panel seeks to balance risks in warnings for antidepressants. Kuehn BM. Publication Types:

• News


11: Neurology. 2007 Feb 13;68(7):515-21. Related Articles, Links

Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, Kelly ME, Rowbotham MC, Petersen KL. Community Consortium, Positive Health Program, San Francisco General Hospital, San Francisco, CA 94110, USA. [email protected] OBJECTIVE: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model. METHODS: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model. RESULTS: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported. CONCLUSION: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain. Publication Types:

• Research Support, N.I.H., Extramural



12: J Urol. 2007 Mar;177(3):1030-5. Related Articles, Links

Phase I/II Examination of Transurethral Ethanol Ablation of the Prostate for the Treatment of Symptomatic Benign Prostatic Hyperplasia. Plante MK, Marks LS, Anderson R, Amling C, Rukstalis D, Badlani G, Getlin L, Vang E. University of Vermont College of Medicine, Burlington, Vermont. PURPOSE: We assessed the safety of transurethral ethanol ablation of the prostate as a treatment for men with symptomatic benign prostatic hyperplasia and determined the efficacy of this procedure. MATERIALS AND METHODS: We performed a multicenter randomized trial on 79 men, 50 to 79 years old, who had drug refractory voiding symptoms (International Prostate Symptom Score greater than 12) and prostate volumes of 30 to 80 cc. Ethanol was injected transurethrally into the prostate with a curved cystoscopic needle in men randomly assigned to 1 of 3 doses: 15%, 25% or 40% of prostate volume by transrectal ultrasound. Followup evaluations were performed 1, 3 and 6 months later. Postoperative cystoscopy was performed on all patients to evaluate ablation extent and extraprostatic effects. Transrectal ultrasound volume determinations were obtained before and 6 months after transurethral ethanol ablation of the prostate. RESULTS: Adverse events were generally mild or moderate, and included hematuria (42.9%), irritative voiding symptoms (40.3%), pain/discomfort (25.6%) and urinary retention (22.1%). No serious adverse events were reported. Statistically significant improvements were seen in International Prostate Symptom Score, quality of life, maximum flow rate and prostate volume reduction (p <0.05). Improvements were consistently observed across the 3 groups without an apparent dose effect. CONCLUSIONS: In this randomized clinical trial transurethral ethanol ablation of the prostate was safe and effective at 6-month followup. No serious adverse events were encountered. Although ethanol can safely ablate prostatic tissue, further studies will be necessary before widespread clinical application. PMID: 17296405 [PubMed - in process]

13: Lancet. 2007 Feb 10;369(9560):465-73. Related Articles, Links

Comment in:

• Lancet. 2007 Feb 10;369(9560):439-40.

Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP; MEDAL Steering Committee.


Division of Gastrointestinal and Liver Diseases, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA. [email protected] BACKGROUND: Upper gastrointestinal safety of cyclo-oxygenase (COX)-2 selective inhibitors versus traditional non-steroidal anti-inflammatory drugs (NSAIDs) has not been assessed in trials that simulate standard clinical practice. Our aim was to assess the effects of these drugs on gastrointestinal outcomes in a population that includes patients taking gastrointestinal protective therapy. METHODS: A prespecified pooled intent-to-treat analysis of three double-blind randomised comparisons of etoricoxib (60 or 90 mg daily) and diclofenac (150 mg daily) in 34 701 patients with osteoarthritis or rheumatoid arthritis was done for upper gastrointestinal clinical events (bleeding, perforation, obstruction, or ulcer) and the subset of complicated events (perforation, obstruction, witnessed ulcer bleeding, or significant bleeding). We also assessed such outcomes in patients who were taking concomitant proton pump inhibitors (PPIs) or low-dose aspirin. These trials are registered with , with the numbers , , and . FINDINGS: Overall upper gastrointestinal clinical events were significantly less common with etoricoxib than with diclofenac (hazard ratio [HR] 0.69, 95% CI 0.57-0.83; p=0.0001). There were significantly fewer uncomplicated gastrointestinal events with etoricoxib than there were with diclofenac (0.57, 0.45-0.74; p<0.0001); there was no difference in complicated events (0.91, 0.67-1.24; p=0.561). PPIs were used concomitantly for at least 75% of the study period by 13 862 (40%) and low-dose aspirin by 11 418 (33%) patients; treatment effects did not differ significantly in these individuals. INTERPRETATION: There were significantly fewer upper gastrointestinal clinical events with the COX-2 selective inhibitor etoricoxib than with the traditional NSAID diclofenac due to a decrease in uncomplicated events, but not in the more serious complicated events. The reduction in uncomplicated events with etoricoxib is maintained in patients treated with PPIs and is also observed with regular low-dose aspirin use. Publication Types:

• Comparative Study • Meta-Analysis • Research Support, Non-U.S. Gov't



Comment on:

• Lancet. 2006 Dec 23;368(9554):2195-6.

Safety of recommended doses of paracetamol. Ahmad SR. Publication Types:





Comment on:

• Lancet. 2007 Feb 10;369(9560):482-90.

Attention prescribers: be careful with antibiotics. Dancer SJ. Department of Microbiology, Southern General Hospital, Glasgow G51 4TF, UK. [email protected] Publication Types:

• Comment



Comment on:

• Lancet. 2007 Feb 10;369(9560):465-73.

Do COX-2 inhibitors give enough gastrointestinal protection? Drenth JP, Verheugt FW. Department of Gastroenterology and Hepatology, Heart Lung Centre, Radboud University Nijmegen, Medical Centre, 6500 HB Nijmegen, Netherlands. [email protected] Publication Types:

• Comment


17: BMJ. 2007 Feb 10;334(7588):312-5. Related Articles, Links


Pitfalls of testing and summary of guidance on safety monitoring with amiodarone and digoxin. Smellie WS, Coleman JJ. Clinical Laboratory, General Hospital, Bishop Auckland DL14 6AD. [email protected] Publication Types:

• Review


18: Mayo Clin Proc. 2007 Jan;82(1):61-8. Related Articles, Links

Twelve-month tolerability and safety of sumatriptan-naproxen sodium for the treatment of acute migraine. Winner P, Cady RK, Ruoff GE, Frishberg BM, Alexander WJ, Zhang Y, Kori SH, Lener SE. Palm Beach Headache Center, 4631 N Congress Ave, Suite 200, West Palm Beach, FL 33407, USA. [email protected] OBJECTIVES: To evaluate the long-term safety and tolerability of sumatriptan-naproxen sodium for the treatment of moderate to severe acute migraines and to assess the safety of administration of an optional second dose. PATIENTS AND METHODS: A 12-month, multicenter, open-label safety study was conducted in adults treated for migraine attacks of moderate to severe intensity from April 14, 2004, to August 18, 2005. Safety evaluations included adverse events and laboratory tests. RESULTS: Of 600 patients enrolled, 565 (94%) were treated for at least 1 migraine. Of treated patients, 414 (73%) and 362 (64%) completed 6 and 12 months of treatment, respectively. Of the 24,485 attacks treated, 17,144 (70%) were treated with only 1 dose. On average, patients treated 5 migraine attacks per month, with a median of 6 days between attacks. The most common treatment-related adverse events were nausea, muscle tightness, and dizziness. Fourteen patients reported 1 or more serious adverse event with only 1 judged probably related to treatment. No deaths occurred. Eight percent of patients discontinued participation in the study because of adverse events or pregnancy. The rates of adverse events reported were no higher after treatment with 2 tablets (at least 2 hours apart) compared with 1 tablet. CONCLUSIONS: In this 12-month data set of more than 24,000 migraine attacks in 565 patients, sumatriptan-naproxen sodium formulated in a single tablet was well tolerated when used episodically for the treatment of acute migraine. The adverse events did not differ from those expected for the individual components alone, and no new or unexpected findings occurred. Publication Types:




19: Neurology. 2007 Feb 6;68(6):472; author reply 472-3. Related Articles, Links

Comment on:

• Neurology. 2005 Nov 8;65(9):1370-5.

Oxcarbazepine adjunctive therapy in infants and young children with partial seizures. Kruszewski SP, Klotz SG. Publication Types:



20: Neurology. 2007 Feb 6;68(6):414. Related Articles, Links

Acute parkinsonism with corresponding lesions in the basal ganglia after heroin abuse. Matzler W, Nagele T, Gasser T, Kruger R. Center of Neurology and Hertie-Institute for Clinical Brain Research, University of Tubingen, Hoppe-Seyler-Str. 3, 72076 Tubingen, Germany. Publication Types:

• Case Reports



Sexual sequelae of general medical disorders. Basson R, Schultz WW. University of British Columbia, Department of Psychiatry, BC Centre for Sexual Medicine,


Vancouver General Hospital, Canada. [email protected] That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of sexual response could help to identify the pathophysiology of sexual dysfunction from disease and medical interventions, and also to ameliorate or prevent some dysfunctions. Many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex. Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Current approaches to assessment of sexual dysfunction are based on models that combine psychological and biological aspects. Publication Types:

• Research Support, Non-U.S. Gov't • Review



Comment in:

• Lancet. 2007 Feb 3;369(9559):346-50.

Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Phrommintikul A, Haas SJ, Elsik M, Krum H. NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia. BACKGROUND: Recombinant human erythropoietin is commonly used for treatment of anaemia. Our aim was to determine whether targeting different haemoglobin concentrations with such treatment is associated with altered all-cause mortality and cardiovascular events in patients with anaemia caused by chronic kidney disease. METHODS: We did a meta-analysis of randomised controlled clinical trials that were identified in medical databases and trial registration websites. Trials were eligible for inclusion if they assessed the effects of targeting different haemoglobin concentrations in patients with anaemia caused by chronic disease who were randomly assigned to treatment with recombinant human erythropoietin, recruited at least 100 patients, and had a minimum follow-up of 12 weeks. FINDINGS: We analysed nine randomised controlled trials that enrolled 5143 patients. There was a significantly higher risk of all-cause mortality (risk ratio 1.17, 95% CI 1.01-1.35; p=0.031) and arteriovenous access thrombosis (1.34, 1.16-1.54; p=0.0001) in the higher haemoglobin target group than in the lower haemoglobin target group in the fixed


effects model without heterogeneity between studies. There was a significantly higher risk of poorly controlled blood pressure (1.27, 1.08-1.50; p=0.004) in the higher haemoglobin target group than in the lower target haemoglobin group with the fixed effects model; however, this was not significant in the random effects model (1.31, 0.97-1.78; p=0.075). The incidence of myocardial infarction was much the same in the two groups. INTERPRETATION: To target higher haemoglobin concentrations when treating patients with anaemia caused by chronic kidney disease with recombinant human erythropoietin puts such patients at increased risk of death. Current guidelines do not include an upper limit for the target haemoglobin concentration; such an upper limit should be considered in future recommendations. Publication Types:

• Meta-Analysis



When the book is wrong. Leclercq P, Betz R, Lambermont B, Leonard P, Frippiat F. Publication Types:

• Case Reports • Letter


24: Lancet. 2007 Feb 3;369(9559):366; author reply 366-7. Related Articles, Links

Comment on:

• Lancet. 2006 Aug 12;368(9535):556-7.

Methadone and QTc prolongation. Byrne A, Stimmel B. Publication Types:





Comment on:

• Lancet. 2007 Feb 3;369(9559):381-8.

Haemoglobin targets: we were wrong, time to move on. Strippoli GF, Tognoni G, Navaneethan SD, Nicolucci A, Craig JC. Cochrane Renal Group and Centre for Kidney Research and NHMRC Centre for Clinical Research Excellence in Renal Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia. [email protected] Publication Types:

• Comment


26: Am J Med. 2007 Feb;120(2):180-4. Related Articles, Links

Risk of mortality with vitamin E supplements: the Cache County study. Hayden KM, Welsh-Bohmer KA, Wengreen HJ, Zandi PP, Lyketsos CG, Breitner JC; Cache County Investigators. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. [email protected] PURPOSE: A recent meta-analysis reported increased mortality in clinical trial participants randomized to high-dose vitamin E. We sought to determine whether these mortality risks with vitamin E reflect adverse consequences of its use in the presence of cardiovascular disease. METHODS: In a defined population aged 65 years or older, baseline interviews captured self- or proxy-reported history of cardiovascular illness. A medicine cabinet inventory verified nutritional supplement and medication use. Three sources identified subsequent deaths. Cox proportional hazards methods examined the association between vitamin E use and mortality. RESULTS: After adjustment for age and sex, there was no association in this population between vitamin E use and mortality (adjusted hazard ratio [aHR] 0.93; 95% confidence interval [CI], 0.74-1.15). Predictably, deaths were more frequent with a history of diabetes, stroke, coronary artery bypass graft surgery, or myocardial infarction, and with the use of warfarin, nitrates, or diuretics. None of these conditions or treatments altered the null main effect with vitamin E, but mortality was increased in vitamin E users who had a history of stroke (aHR 3.64; CI, 1.73-7.68), coronary bypass graft surgery (aHR 4.40; CI, 2.83-6.83), or myocardial infarction (aHR 1.95; CI, 1.29-2.95) and, independently, in those taking nitrates (aHR 3.95; CI, 2.04-7.65), warfarin (aHR 3.71; CI, 2.22-6.21), or diuretics (aHR 1.83; CI, 1.35-2.49). Although not definitive, a


consistent trend toward reduced mortality was seen in vitamin E users without these conditions or treatments. CONCLUSIONS: In this population-based study, vitamin E use was unrelated to mortality, but this apparently null finding seems to represent a combination of increased mortality in those with severe cardiovascular disease and a possible protective effect in those without. Publication Types:

• Research Support, N.I.H., Extramural


27: Am J Med. 2007 Feb;120(2):165-71. Related Articles, Links

The association of methamphetamine use and cardiomyopathy in young patients. Yeo KK, Wijetunga M, Ito H, Efird JT, Tay K, Seto TB, Alimineti K, Kimata C, Schatz IJ. Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA. [email protected] PURPOSE: Methamphetamine is the most widespread illegally used stimulant in the United States. Previously published case reports and series suggest a potential association between methamphetamine exposure and cardiomyopathy. The objective of this study is to demonstrate an association between methamphetamine use and cardiomyopathy. SUBJECT AND METHODS: Case-control study based on chart review of discharges from a tertiary care medical center from January 2001 to June 2004. Patients were < or =45 years old. Cases included patients with a discharge diagnosis of either cardiomyopathy or heart failure. Controls included hospitalized patients who had an echocardiographic assessment of left ventricular function with ejection fraction > or =55% and no wall motion abnormalities. RESULTS: One hundred and seven cases and 114 controls were identified. Both groups had similar gender distribution, length of hospital stay, rates of health insurance, prevalence of coronary artery disease, diabetes mellitus, hypertension, cigarette smoking, alcohol abuse, and marijuana and cocaine use. Cases were older than controls (mean age: 38 vs 35 years; P=.008), had higher body mass index (BMI) (mean BMI: 37 vs 30 kg/m2; P<.001), and higher prevalence of renal failure (13% vs 4.4%; P=.03). Methamphetamine users had a 3.7-fold increased odds ratio [95% confidence interval, 1.8-7.8] for cardiomyopathy, adjusting for age, body mass index, and renal failure. CONCLUSIONS: Methamphetamine use was associated with cardiomyopathy in young patients. Publication Types:




28: N Engl J Med. 2007 Feb 1;356(5):527-8; author reply 528-9. Related Articles, Links

Comment on:

• N Engl J Med. 2006 Oct 19;355(16):1715-22.

Case 32-2006: a girl with fever after a visit to Africa. Blazes DL, Sanders JW, Riddle MS. Publication Types:



29: Pediatrics. 2007 Feb;119(2):e426-34. Related Articles, Links

Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study. Sayal K, Heron J, Golding J, Emond A. Centre for Child and Adolescent Health, Department of Community-Based Medicine, University of Bristol, Hampton House, Cotham Hill, Bristol BS6 6JS, United Kingdom. [email protected] OBJECTIVES: High levels of alcohol use during pregnancy can lead to adverse physical and neurodevelopmental outcomes in children. It remains uncertain whether there is a safe level of drinking during pregnancy. In this study we investigate whether very low levels of alcohol consumption (<1 drink per week) are independently associated with childhood mental health problems (assessed at 3 time points between ages 4 and 8 years) and whether these effects are moderated by gender. We expected that only higher levels of alcohol consumption would be associated with later mental health problems and that any associations might be more readily detectable in boys. METHODS: This prospective, population-based study used data from the Avon Longitudinal Study of Parents and Children. We investigated the relationship between self-reports of the amount and frequency of alcohol use in the first trimester and the presence of clinically significant mental health (behavioral and emotional) problems at 47 and 81 months (parental report: n = 9086 and 8046, respectively) and at 93 to 108 months (teacher report: n = 5648). RESULTS: After controlling for a range of prenatal and postnatal factors, the consumption of <1 drink per week during the first trimester was independently associated with clinically significant mental health problems in girls at 47 months. This gender-specific association persisted at 81 months and was confirmed by later teacher ratings. CONCLUSIONS: Very low levels of alcohol consumption during early pregnancy may have a negative and persistent effect on mental health outcomes. Given the lack of a clear dose-response relationship and unexpected gender effects, these findings should be considered preliminary and need


additional investigation. Publication Types:



30: BMJ. 2007 Feb 3;334(7587):220. Related Articles, Links

Allergy to hair dye. McFadden JP, White IR, Frosch PJ, Sosted H, Johansen JD, Menne T. Publication Types:

• Editorial


31: BMJ. 2007 Feb 3;334(7587):217-8. Related Articles, Links

Leprosy after starting antiretroviral treatment. Lawn SD, Lockwood DN. Publication Types:

• Editorial


32: N Engl J Med. 2007 Feb 1;356(5):530-1. Related Articles, Links

Intoxication of a hospitalized patient with an isopropanol-based hand sanitizer. Emadi A, Coberly L. Publication Types:





Intoxication of a prison inmate with an ethyl alcohol-based hand sanitizer. Doyon S, Welsh C. Publication Types:




Prepubertal gynecomastia linked to lavender and tea tree oils. Henley DV, Lipson N, Korach KS, Bloch CA. Receptor Biology Section, Laboratory of Reproductive and Developmental Toxicology, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA. Most cases of male prepubertal gynecomastia are classified as idiopathic. We investigated possible causes of gynecomastia in three prepubertal boys who were otherwise healthy and had normal serum concentrations of endogenous steroids. In all three boys, gynecomastia coincided with the topical application of products that contained lavender and tea tree oils. Gynecomastia resolved in each patient shortly after the use of products containing these oils was discontinued. Furthermore, studies in human cell lines indicated that the two oils had estrogenic and antiandrogenic activities. We conclude that repeated topical exposure to lavender and tea tree oils probably caused prepubertal gynecomastia in these boys. 2007 Massachusetts Medical Society Publication Types:

• Case Reports • Research Support, N.I.H., Intramural


35: Obstet Gynecol. 2007 Feb;109(2 Pt2):490-2. Related Articles, Links

Comment in:


• Obstet Gynecol. 2007 Feb;109(2 Pt2):481-2.

Ethylene vinyl alcohol copolymer erosions after use as a urethral bulking agent. Erekson EA, Sung VW, Rardin CR, Myers DL. Brown Medical School, Providence, Rhode Island 02903, USA. [email protected] BACKGROUND: Ethylene vinyl alcohol copolymer was approved for use by the U.S. Food and Drug Administration (FDA) in December 2004 for the treatment of stress urinary incontinence. CASE: We report on two patients who underwent injection with ethylene vinyl alcohol copolymer who were later found to have urethral erosions. CONCLUSION: Information regarding complications after ethylene vinyl alcohol copolymer urethral injections is currently limited. We performed a search of the FDA labeling information, Manufacturer and User Facility Device Experience database, and abstracts presented at scientific meetings regarding complications with this material. Symptomatic and asymptomatic erosions of ethylene vinyl alcohol copolymer in the urethra, bladder, and vaginal mucosa are possible complications after this procedure. Publication Types:

• Case Reports



Maternal death related to misoprostol overdose. Henriques A, Lourenco AV, Ribeirinho A, Ferreira H, Graca LM. Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal. [email protected] BACKGROUND: Misoprostol is an important drug in obstetrics and gynecology because of its uterotonic and cervical-ripening activities. The side effects are dose-related, usually transitory, and well tolerated. The toxic dosage in humans is unknown, and there is no specific antidote. CASE: An adolescent developed upper gastrointestinal bleeding after self-medication with misoprostol orally (12 mg) to cause abortion. She presented with multiorgan failure, acute abdominal signs, and hemodynamic instability. Emergency laparotomy showed gastric and esophageal necrosis. After several episodes of cardiac arrest, and despite resuscitation efforts, the patient died. CONCLUSION: Temporal relationship (48 hours after the beginning of medication) strongly suggests that misoprostol was the agent directly involved in the maternal death. The mechanism implicating misoprostol in gastrointestinal ischemia and necrosis is unknown. Publication Types:


• Case Reports



Comment on:

• Obstet Gynecol. 2007 Feb;109(2 Pt2):490-2. • Obstet Gynecol. 2007 Feb;109(2 Pt2):493-4.

Things sometimes happen. Rogers RG. Publication Types:

• Comment • Editorial


38: Obstet Gynecol. 2007 Feb;109(2 Pt 1):450-1; author reply 451. Related Articles, Links

Comment on:

• Obstet Gynecol. 2006 Oct;108(4):986-9.

Magnesium sulfate tocolysis: time to quit. Macones G, Hauth JC, Lockwood CJ. Publication Types:



39: Am J Psychiatry. 2007 Feb;164(2):342-5. Related Articles, Links

Lithium in breast milk and nursing infants: clinical implications.


Viguera AC, Newport DJ, Ritchie J, Stowe Z, Whitfield T, Mogielnicki J, Baldessarini RJ, Zurick A, Cohen LS. Perinatal and Reproductive Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital, Simches Research Bldg., Second Fl., Suite 2200, 185 Cambridge St., Boston, MA 02114. [email protected]. OBJECTIVE: Current practice guidelines discourage use of lithium during breast-feeding, despite limited data. This study aimed to quantify lithium exposure in nursing infants. METHOD: In 10 mother-infant pairs, the authors obtained assays of lithium in maternal serum, breast milk, and infant serum and indices of infant renal and thyroid function. RESULTS: Maternal serum, breast milk, and infant serum daily trough concentrations of lithium averaged 0.76, 0.35, and 0.16 meq/liter, respectively, each lithium level lower than the preceding level by approximately one-half. No serious adverse events were observed, and elevations of thyroid-stimulating hormone, blood urea nitrogen, and creatinine were few, minor, and transient. CONCLUSIONS: Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breast-feeding and underscore the importance of close clinical monitoring of nursing infants. PMID: 17267800 [PubMed - in process]

40: J Thorac Cardiovasc Surg. 2007 Feb;133(2):584-5. Related Articles, Links

Lymphoceles in premature infants after congenital diaphragmatic hernia repair: thoracoscopic management. Saxena AK, Haxihja E, Kleinlein B, Hollwarth ME. Department of Pediatric Surgery, Medical University of Graz, Graz, Austria. [email protected] Publication Types:

• Case Reports


41: Am J Nurs. 2007 Feb;107(2):52-9; quiz 59-60. Related Articles, Links

PAIN Control: IV opioid range orders for acute pain management. Pasero C, Manworren RC, McCaffery M. [email protected] Patients have the right to adequate and safe pain relief in hospitals, but many continue to


experience unrelieved pain. Range orders for the delivery of IV opioids give nurses the flexibility needed to treat patients' pain in a timely manner while allowing for differences in patient response to pain and to analgesia. To ensure safety and effectiveness, and to meet the requirements of accreditation agencies, hospitals should develop prescribing guidelines for IV opioid range orders and clear protocols for their implementation. Range orders should, for example, take into consideration the patient's age, pain intensity, and comorbidities; avoid frequency ranges; and prescribe a maximum dose that is at least two times but no more than four times the minimum dose in the range. Publication Types:

• Case Reports • Review


42: Am J Phys Med Rehabil. 2007 Feb;86(2):166-7. Related Articles, Links

Epidural corticosteroid injections precipitating epidural hematomas with spinal paresis. LaBan MM, Kasturi G, Wang IM. Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. Publication Types:

• Case Reports


43: Neurology. 2007 Jan 23;68(4):310. Related Articles, Links

Tiagabine-induced myoclonic status epilepticus in a nonepileptic patient. Vollmar C, Noachtar S. Department of Neurology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. [email protected] Publication Types:

• Case Reports



44: Neurology. 2007 Jan 23;68(4):301-3. Related Articles, Links

Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists. Tippmann-Peikert M, Park JG, Boeve BF, Shepard JW, Silber MH. Mayo Clinic Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. [email protected] Pathologic gambling is an impulse control disorder previously reported to complicate dopamine agonist therapy in patients with Parkinson disease. It has not been described in association with dopamine agonist therapy of other conditions. We report three patients treated in our sleep disorders center who developed pathologic gambling while receiving treatment with dopamine agonists for restless legs syndrome. Publication Types:

• Case Reports


45: Arch Intern Med. 2007 Jan 22;167(2):117-24. Related Articles, Links

Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Dentali F, Douketis JD, Lim W, Crowther M. Department of Medicine, McMaster University, and St Joseph's Healthcare, Hamilton, Ontario, Canada. BACKGROUND: For patients receiving oral anticoagulant (OAC) therapy, deciding whether to add aspirin to their treatment is a common clinical scenario with no clear guidelines to aid practice. We performed a systematic review and meta-analysis of randomized controlled trials comparing these 2 treatment strategies (combined aspirin-OAC therapy vs OAC therapy alone) to assess the therapeutic benefits and risks. DATA SOURCES: Randomized controlled trials published up to June 2005 in MEDLINE, EMBASE, and Cochrane Library databases. STUDY SELECTION: Randomized controlled trials with at least 3 months of follow-up that compared aspirin-OAC therapy with OAC therapy alone, in which OAC was administered to achieve the same target international normalized ratio or was given at the same fixed dose in both treatment arms. DATA EXTRACTION: Two reviewers independently extracted data on study characteristics and outcomes. Pooled odds ratios (ORs) and associated 95% confidence intervals (CIs) were calculated for study outcomes in patients receiving aspirin-OAC therapy and OAC therapy


alone. DATA SYNTHESIS: Ten studies were included, totaling 4180 patients. The risk for arterial thromboembolism was lower in patients receiving combined aspirin-OAC therapy compared with OAC therapy alone (OR, 0.66; 95% CI, 0.52-0.84). However, these benefits were limited to patients with a mechanical heart valve (OR, 0.27; 95% CI, 0.15-0.49). There was no difference in the risk for arterial thromboembolism with these treatments in patients with atrial fibrillation (OR, 0.99; 95% CI, 0.47-2.07) or coronary artery disease (OR, 0.69; 95% CI, 0.35-1.36). There was no difference in all-cause mortality with either treatment (OR, 0.98; 95% CI, 0.77-1.25). The risk for major bleeding was higher in patients receiving aspirin-OAC therapy compared with OAC therapy alone (OR, 1.43; 95% CI, 1.00-2.02). CONCLUSION: Our findings question the current practice of using combined aspirin-OAC therapy except in patients with a mechanical heart valve, given the questionable benefits in reducing thromboembolic events and the increased risk of major bleeding. Publication Types:

• Comparative Study • Meta-Analysis • Research Support, Non-U.S. Gov't • Review


46: Circulation. 2007 Jan 30;115(4):432-41. Epub 2007 Jan 22. Related Articles, Links

Comment in:

• Circulation. 2007 Jan 30;115(4):428-9.

Defining the cellular phenotype of "ankyrin-B syndrome" variants: human ANK2 variants associated with clinical phenotypes display a spectrum of activities in cardiomyocytes. Mohler PJ, Le Scouarnec S, Denjoy I, Lowe JS, Guicheney P, Caron L, Driskell IM, Schott JJ, Norris K, Leenhardt A, Kim RB, Escande D, Roden DM. Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA. [email protected] BACKGROUND: Mutations in the ankyrin-B gene (ANK2) cause type 4 long-QT syndrome and have been described in kindreds with other arrhythmias. The frequency of ANK2 variants in large populations and molecular mechanisms underlying the variability in the clinical phenotypes are not established. More importantly, there is no cellular explanation for the range of severity of cardiac phenotypes associated with specific ANK2 variants. METHODS AND RESULTS: We performed a comprehensive screen of ANK2 in populations (control, congenital arrhythmia, drug-induced long-QT syndrome) of different ethnicities to discover unidentified ANK2 variants. We identified 7 novel nonsynonymous ANK2 variants; 4 displayed abnormal activity in cardiomyocytes. Including the 4 new variants, 9 human ANK2 loss-of-function variants have been identified. However, the


clinical phenotypes associated with these variants vary strikingly, from no obvious phenotype to manifest long-QT syndrome and sudden death, suggesting that mutants confer a spectrum of cellular phenotypes. We then characterized the relative severity of loss-of-function properties of all 9 nonsynonymous ANK2 variants identified to date in primary cardiomyocytes and identified a range of in vitro phenotypes, including wild-type, simple loss-of-function, and severe loss-of-function activity, seen with the variants causing severe human phenotypes. CONCLUSIONS: We present the first description of differences in cellular phenotypes conferred by specific ANK2 variants. We propose that the various degrees of ankyrin-B loss of function contribute to the range of severity of cardiac dysfunction. These data identify ANK2 variants as modulators of human arrhythmias, provide the first insight into the clinical spectrum of "ankyrin-B syndrome," and reinforce the role of ankyrin-B-dependent protein interactions in regulating cardiac electrogenesis. Publication Types:

• Research Support, N.I.H., Extramural • Research Support, Non-U.S. Gov't


47: AJR Am J Roentgenol. 2007 Feb;188(2):326-33. Related Articles, Links

Inhalational talc pneumoconiosis: radiographic and CT findings in 14 patients. Akira M, Kozuka T, Yamamoto S, Sakatani M, Morinaga K. Department of Radiology, Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Sakai City, Osaka 591-8555, Japan. OBJECTIVE: The purpose of this study was to evaluate the radiographic and CT findings of inhalational talc pneumoconiosis. CONCLUSION: Large opacities of talc pneumoconiosis progress more often than do small opacities. The CT findings of talc pneumoconiosis overlap those of silicosis and asbestosis. PMID: 17242238 [PubMed - indexed for MEDLINE]

48: Anaesthesia. 2007 Feb;62(2):203-4. Related Articles, Links

Airway obstruction from denture fixative. Ramani S. Publication Types:




49: Anaesthesia. 2007 Feb;62(2):201. Related Articles, Links

Intra-operative bradycardia in a patient with Alzheimer's disease treated with two cholinesterase inhibitors. Jones PM, Soderman RM. Publication Types:




Possible malignant hyperthermia during spinal anaesthesia with tetracaine. Sheu CC, Tsai JR, Hung JY. Publication Types:




Peri-operative atrioventricular block as a result of chemotherapy with epirubicin and paclitaxel. Wheeler DW, Liew TV, Bailey AR. University Department of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. [email protected] A 47-year-old woman presented for mastectomy and immediate latissimus dorsi flap reconstruction having been diagnosed with carcinoma of the breast 6 months previously. In the preceding months she had received neo-adjuvant chemotherapy with epirubicin, paclitaxel (Taxol) and cyclophosphamide. This had been apparently uncomplicated and she had maintained a remarkably high level of physical activity. She was found to be bradycardic at pre-operative assessment but had no cardiac symptoms. Second degree Mobitz type II atrioventricular block was diagnosed on electrocardiogram, and temporary transvenous ventricular pacing instituted in the peri-operative period. We discuss how


evidence-based guidelines would not have been helpful in this case, and how chemotherapy can exhibit substantial cardiotoxicity that may develop over many years. We suggest that patients who have received chemotherapy at any time should have a pre-operative electrocardiogram even if they are asymptomatic. Publication Types:

• Case Reports


52: Am J Cardiol. 2007 Jan 15;99(2):291. Epub 2006 Nov 27. Related Articles, Links

Monday, Wednesday, and Friday dosing of rosuvastatin in patients previously intolerant to statin therapy. Mackie BD, Satija S, Nell C, Miller J 3rd, Sperling LS. Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. Statins are normally administered for the treatment of dyslipidemia on a daily basis. This standard dosing regimen is well tolerated by most patients. Occasionally, patients discontinue therapy secondary to side effects, most commonly myalgias. We describe 2 patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, with resolution of adverse effects. Significant reductions in serum low-density lipoprotein cholesterol levels were observed in the 2 patients despite the alternate-day dosing regimen. Rosuvastatin was chosen because of its long half-life (19 hours) and very high potency. Publication Types:

• Case Reports


53: Am J Cardiol. 2007 Jan 15;99(2):288-90. Epub 2006 Nov 27. Related Articles, Links

Assessment of bleeding events in clinical trials--proposal of a new classification. Serebruany VL, Atar D. Johns Hopkins University, Towson, Maryland, USA. [email protected] Present classifications of bleeding events used in antithrombotic and/or antiplatelet clinical trials are based on the criteria developed by the Thrombolysis In Myocardial Infarction


(TIMI) and Global Use of Strategies to Open Coronary Arteries (GUSTO) groups. Introduced more than a decade ago, the 2 classifications used the criteria to better categorize hemorrhagic events after therapy with thrombolytic agents. Recent advances in interventional cardiology, resulting in a domination of percutaneous intracoronary procedures over systemic drug-induced thrombolysis, have substantially changed the clinical characteristics and magnitude of bleeding complications. Moreover, disturbances of the coagulation cascade, as well as platelet inhibition caused directly by antithrombotic and antiplatelet agents, share very specific and well-recognized clinical features not reflected in the existing classifications. Bleeding events after aspirin or clopidogrel, and especially those after more delicate antiplatelet regimens with dipyridamole used in patients after ischemic stroke or transient ischemic attack, are impossible to classify by the present guidelines, other than categorically triaging them altogether to the "minor" category. Uniting entirely different bleeding events as "minor" under-rates their importance and diminishes affiliated risks, creating an illusion that they do not require monitoring and/or changes in antiplatelet or antithrombotic regimens. In reality, such unrecognized and unreported mild complications may transform into more serious bleeds or lead to noncompliance. Unauthorized withdrawal from antiplatelet agents in turn causes rebound platelet activation and higher risk for secondary vascular events. In conclusion, a new classification of bleeding events is introduced (the BleedScore), based on a point accumulation depending on the severity of hemorrhage, which is believed to be more suitable for the assessment of modern, more delicate antithrombotic and antiplatelet therapies, particularly for their realistic assessment in clinical trials. Publication Types:

• Review


54: J Urol. 2007 Feb;177(2):639-43. Related Articles, Links

High dose zinc increases hospital admissions due to genitourinary complications. Johnson AR, Munoz A, Gottlieb JL, Jarrard DF. Department of Surgery, Division of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA. PURPOSE: Zinc is a common dietary supplement that is widely believed to have beneficial health effects. To assess the impact of high dose supplemental zinc on genitourinary diseases we analyzed a recent randomized trial comparing zinc, antioxidants and their combination to placebo for complications related to the genitourinary tract. MATERIALS AND METHODS: In a further analysis of the recent Age-related Eye Disease Study we examined the data pool for primary International Classification of Diseases, 9th revision codes given for hospital admissions related to urological problems. The Age-Related Eye Disease Study randomized 3,640 patients with age related macular degeneration to 1 of 4 study arms, including placebo, antioxidants (500 mg vitamin C, 400 IU vitamin E and 15 mg beta-carotene), 80 mg zinc and antioxidant plus zinc. Statistical analyses using Fisher's exact test were performed. RESULTS: We found a significant increase in hospital


admissions due to genitourinary causes in patients on zinc vs nonzinc formulations (11.1% vs 7.6%, p = 0.0003). The risk was greatest in male patients (RR 1.26, 95% CI 1.07-1.50, p = 0.008). In the study group of 343 patients requiring hospital admission the most common primary International Classification of Diseases, 9th revision codes included benign prostatic hyperplasia/urinary retention (benign prostatic hyperplasia), urinary tract infection, urinary lithiasis and renal failure. When comparing zinc to placebo, significant increases in urinary tract infections were found (p = 0.004), especially in females (2.3% vs 0.4%, RR 5.77, 95% CI 1.30-25.66, p = 0.013). Admissions for urinary lithiasis approached significance in men on zinc compared to placebo (2.0% vs 0.5%, RR = 4.08, 95% CI 0.87-19.10). There was no increase in prostate or other cancers with zinc supplementation. A significant decrease in prostate cancer diagnoses was seen in patients receiving antioxidants vs placebo (RR = 0.6, 95% CI 0.49-0.86, p = 0.049). Subgroup analysis revealed that this finding was significant in men who smoked but not in nonsmokers. CONCLUSIONS: Zinc supplementation at high levels results in increased hospitalizations for urinary complications compared to placebo. These data support the hypothesis that high dose zinc supplementation has a negative effect on select aspects of urinary physiology. PMID: 17222649 [PubMed - indexed for MEDLINE]

55: J Clin Pathol. 2007 Jan;60(1):80-1. Related Articles, Links

Plasmablastic lymphoma presenting as a paravertebral mass in a patient with Crohn's disease after immunosuppressive therapy. Redmond M, Quinn J, Murphy P, Patchett S, Leader M. Department of Histopathology, Beaumont Hospital, Dublin, Ireland. [email protected] The case of a 32-year-old man with a paravertebral mass and skin nodules, occurring against a background of immunosuppressive therapy for Crohn's disease, is presented. The tumours showed morphological and immunophenotypical features of plasmablastic lymphoma. To our knowledge, this is the first reported case of plasmablastic lymphoma presenting in this location, and also after immunosuppression with infliximab treatment for Crohn's disease. Publication Types:

• Case Reports


56: J Clin Endocrinol Metab. 2007 Jan;92(1):42-3. Related Articles, Links

Comment on:

• J Clin Endocrinol Metab. 2007 Jan;92(1):131-6.


Breast cancer and the risk of osteoporotic fracture: A paradox. Eastell R. Publication Types:



57: Anesthesiology. 2007 Jan;106(1):193-4; author reply 194. Related Articles, Links

Comment on:

• Anesthesiology. 2006 Mar;104(3):518-26.

Safety of parecoxib and valdecoxib after noncardiac surgery: lack of demonstration. Engelman E, Salengros JC. Publication Types:



58: Anesthesiology. 2007 Jan;106(1):186-8. Related Articles, Links

An early example of evidence-based medicine: hypoxemia due to nitrous oxide. Cheney FW. Department of Anesthesiology, University of Washington, Seattle 98195, USA. [email protected] Diffusion anoxia. By Bernard Raymond Fink. Anesthesiology 1955; 16:511-14.In 1955, Dr. Bernard Raymond Fink published his findings that described the mechanism by which hypoxemia occurred when nitrous oxide-oxygen anesthesia was discontinued and room air breathing commenced. Using an ear oximeter and brachial artery blood gases, he measured oxygen saturation in eight healthy patients who had received 75% nitrous oxide-25% oxygen for gynecologic surgery. He showed that oxygen saturation decreased from 5% to 10% and often reached a value below 90% when the patient began room air breathing after


the nitrous oxide-oxygen was discontinued. The effect was seen over a 10-min period. He concluded that "anoxia arises because the outward diffusion of nitrous oxide lowers the alveolar partial pressure of oxygen." This phenomenon can become a causative factor of cardiac arrest in patients with impaired pulmonary or cardiac reserves. PMID: 17197861 [PubMed - indexed for MEDLINE]

59: Am J Respir Crit Care Med. 2007 Jan 1;175(1):4-5. Related Articles, Links

Comment on:

• Am J Respir Crit Care Med. 2007 Jan 1;175(1):40-4.

Reverse phenotyping in sarcoidosis. Iannuzzi MC, Baughman RP. Publication Types:



60: J Oral Maxillofac Surg. 2007 Jan;65(1):154. Related Articles, Links

Tooth extraction: Is it inciting event or sequela of osteonecrosis of the jaws associated with intravenous bisphosphonates? Altundag K, Bulut N, Tezcan E, Ozen M, Purnak T. Publication Types:

• Letter


61: J Oral Maxillofac Surg. 2007 Jan;65(1):122-7. Related Articles, Links

The perioperative management of metformin for the oral and maxillofacial surgery patient: risks and recommendations. Blyer SM, Yelon JA. Department of Oral and Maxillofacial Surgery, Long Island Jewish Hospital, New Hyde


Park, NY, USA. [email protected] PMID: 17174776 [PubMed - indexed for MEDLINE]

62: Am J Phys Med Rehabil. 2007 Feb;86(2):158-60. Related Articles, Links

Spinal cord infarction secondary to cocaine use. Schreiber AL, Formal CS. Thomas Jefferson University Hospital, Department of Rehabilitation, Philadelphia, Pennsylvania 19107, USA. A 27-yr-old woman recreationally inhaled cocaine. Several hours later, she noted chest tightness, back and neck pain, and later bilateral upper-extremity weakness. Physical examination revealed flaccid paresis of the upper extremities. Spasticity at 2 mos after injury, but no detectable weakness, developed in the lower extremities. Cocaine was detected in her urine. Magnetic resonance imaging showed hyperintensity in the anterior cervicothoracic spinal cord. Electrodiagnostic studies of the upper extremities were consistent with anterior horn cell death. Cocaine abuse is associated with cerebrovascular events; spinal cord effects are rarely reported. The patient seems to have an infarct in the anterior spinal artery distribution, with clinical, imaging, and electrodiagnostic findings of upper-extremity lower-motor neuron injury, accompanied by spasticity of the lower extremities. Gray matter has increased susceptibility to ischemia compared with white matter, producing flaccid weakness in the cervical region with isolated arm weakness. Although uncommon, cocaine abuse can cause spinal cord infarction. Publication Types:

• Case Reports • Research Support, U.S. Gov't, Non-P.H.S.


63: BMJ. 2007 Feb 3;334(7587):242. Epub 2006 Dec 12. Related Articles, Links

Comment in:

• BMJ. 2007 Feb 17;334(7589):327. • BMJ. 2007 Feb 3;334(7587):215-6.

Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study. Rubino A, Roskell N, Tennis P, Mines D, Weich S, Andrews E. RTI Health Solutions, Manchester Science Park, Manchester M15 6SE. [email protected]


OBJECTIVE: To compare the risk of suicide in adults using the antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. DESIGN: Retrospective cohort study. SETTING: UK General Practice Research Database. PARTICIPANTS: 219,088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005. MAIN OUTCOME MEASURES: Completed suicide and attempted suicide. RESULTS: Venlafaxine users had a higher burden of risk factors for suicide, including previous suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios. CONCLUSIONS: Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk. Publication Types:



64: Anaesthesia. 2007 Jan;62(1):99-100. Related Articles, Links

Anaesthetic gas monitoring devices--the new gadget for the motorhome owner. Park G, Shelly M. Publication Types:

• Letter


65: Anaesthesia. 2007 Jan;62(1):94. Related Articles, Links

Comment on:

• Anaesthesia. 2006 Jun;61(6):580-3.

Methylene blue for parathyroid localisation.


Appadurai IR, Scott-Coombes D. Publication Types:



66: Anaesthesia. 2007 Jan;62(1):75-8. Related Articles, Links

Treatment of the first known case of king cobra envenomation in the United Kingdom, complicated by severe anaphylaxis. Veto T, Price R, Silsby JF, Carter JA. Department of Anaethetics and Intensive Care, Frenchay Hospital, Beckspool Road, Frenchay, Bristol BS16 1JE, UK. We report the first known case of envenomation following snake bite by a king cobra in the UK. The patient required tracheal intubation and ventilation. Treatment with king cobra antivenom resulted in anaphylaxis (bronchospasm and hypotension), requiring adrenaline infusion. The patient's trachea was extubated 11 h after administration of antivenom. Publication Types:

• Case Reports • Review


67: Am J Psychiatry. 2006 Dec;163(12):2194; author reply 2194-5. Related Articles, Links

Comment on:

• Am J Psychiatry. 2006 Apr;163(4):594-8.

Comments on "prescription drug dependence and evolving beliefs about chronic pain management". Fishbain DA, Gallagher RM. Publication Types:




68: Am J Psychiatry. 2006 Dec;163(12):2134-40. Related Articles, Links

Predictors of marijuana use in adolescents before and after licit drug use: examination of the gateway hypothesis. Tarter RE, Vanyukov M, Kirisci L, Reynolds M, Clark DB. Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, PA 15261, USA. [email protected] OBJECTIVE: The authors investigated whether the transition from licit drug use to marijuana use is determined by particular risk factors, as specified by the gateway hypothesis. They also evaluated the accuracy of the "gateway sequence" (illicit drug use following licit drugs) for predicting a diagnosis of substance use disorder. METHOD: Boys who consumed licit drugs only (N=99), boys who consumed licit drugs and then transitioned to marijuana use (gateway sequence) (N=97), and boys who used marijuana before using licit substances (alternative sequence) (N=28) were prospectively studied from ages 10-12 years through 22 years to determine whether specific factors were associated with each drug use pattern. The groups were compared on 35 variables measuring psychological, family, peer, school, and neighborhood characteristics. In addition, the utility of the gateway and alternative sequences in predicting substance use disorder was compared to assess their clinical informativeness. RESULTS: Twenty-eight (22.4%) of the participants who used marijuana did not exhibit the gateway sequence, thereby demonstrating that this pattern is not invariant in drug-using youths. Among youths who did exhibit the gateway pattern, only delinquency was more strongly related to marijuana use than licit drug use. Specific risk factors associated with transition from licit to illicit drugs were not revealed. The alternative sequence had the same accuracy for predicting substance use disorder as the gateway sequence. CONCLUSIONS: Proneness to deviancy and drug availability in the neighborhood promote marijuana use. These findings support the common liability model of substance use behavior and substance use disorder. Publication Types:

• Comparative Study • Research Support, N.I.H., Extramural



Comment on:

• Am J Psychiatry. 2006 Dec;163(12):2072-9.


Gaining: pediatric patients and use of atypical antipsychotics. Towbin KE. Publication Types:

• Comment • Editorial • Research Support, N.I.H., Intramural



Comment on:

• Am J Psychiatry. 2006 Dec;163(12):2080-9.

The costs of drugs for schizophrenia. Freedman R, Carpenter WT Jr, Davis JM, Goldman HH, Tamminga CA, Thomas M. Publication Types:

• Comment • Editorial • Research Support, Non-U.S. Gov't


71: J Pediatr. 2006 Dec;149(6):833-6. Related Articles, Links

Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNFalpha agents. Saurenmann RK, Levin AV, Feldman BM, Laxer RM, Schneider R, Silverman ED. Division of Rheumatology, the Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. [email protected] OBJECTIVE: To determine whether treatment with tumor necrosis factor alpha (TNFalpha)-blocking agents alters the incidence of new-onset uveitis in patients with juvenile idiopathic arthritis (JIA). STUDY DESIGN: Cohort study based on retrospective chart review. The charts of all 1109 patients with a diagnosis of JIA seen between January 1,


1996, and June 30, 2003, at our clinic were reviewed for diagnosis of uveitis and treatment with TNFalpha inhibitors. Cox regression analysis was performed with anti-TNFalpha treatment as a time-dependent covariate for risk of development of uveitis. RESULTS: We identified 70 patients treated with anti-TNFalpha without a prior diagnosis of uveitis. Two of these 70 patients (2.9%), both treated with etanercept, had development of new-onset uveitis during anti-TNFalpha therapy. One had juvenile psoriatic arthritis diagnosed 4.1 years before onset of uveitis. The other had extended oligoarticular JIA diagnosed 6.4 years before onset of uveitis. We found no statistically significant difference in the risk for development of uveitis between patients with or without anti-TNFalpha treatment. CONCLUSIONS: In our patients with JIA, anti-TNFalpha treatment did not alter the risk for development of new-onset uveitis. However, anti-TNFalpha therapy with etanercept did not prevent the development of uveitis in 2 patients. Publication Types:



72: Endocrinology. 2007 Feb;148(2):903-11. Epub 2006 Nov 22. Related Articles, Links

Activation of peroxisome proliferator-activated receptor gamma (PPARgamma) by rosiglitazone suppresses components of the insulin-like growth factor regulatory system in vitro and in vivo. Lecka-Czernik B, Ackert-Bicknell C, Adamo ML, Marmolejos V, Churchill GA, Shockley KR, Reid IR, Grey A, Rosen CJ. St. Joseph Hospital, Maine Center for Osteoporosis Research and Education, 360 Broadway, Bangor, Maine 04401, USA. Rosiglitazone (Rosi) belongs to the class of thiazolidinediones (TZDs) that are ligands for peroxisome proliferator-activated receptor gamma (PPARgamma). Stimulation of PPARgamma suppresses bone formation and enhances marrow adipogenesis. We hypothesized that activation of PPARgamma down-regulates components of the IGF regulatory system, leading to impaired osteoblast function. Rosi treatment (1 microm) of a marrow stromal cell line (UAMS-33) transfected with empty vector (U-33/c) or with PPARgamma2 (U-33/gamma2) were analyzed by microarray. Rosi reduced IGF-I, IGF-II, IGFBP-4, and the type I and II IGF receptor (IGF1R and IGF2R) expression at 72 h in U-33/gamma2 compared with U-33/c cells (P < 0.01); these findings were confirmed by RT-PCR. Rosi reduced secreted IGF-I from U-33/gamma2 cells by 75% (P < 0.05). Primary marrow stromal cells (MSCs) extracted from adult (8 months) and old (24 months) C57BL/6J (B6) mice were treated with Rosi (1 microm) for 48 h. IGF-I, IGFBP-4, and IGF1R transcripts were reduced in Rosi-treated MSCs compared with vehicle (P < 0.01) and secreted IGF-I was also suppressed (P < 0.05). B6 mice treated with Rosi (20 mg/kg.d) for short duration (i.e. 4 d), and long term (i.e. 7 wk) had reduced serum IGF-I; this was accompanied by markedly suppressed IGF-I transcripts in the liver and peripheral fat of treated animals. To determine whether Rosi affected circulating IGF-I in humans, we measured serum IGF-I, IGFBP-2, and IGFBP-3 at four time points in 50 postmenopausal


women randomized to either Rosi (8 mg/d) or placebo. Rosi-treated subjects had significantly lower IGF-I at 8 wk than baseline (-25%, P < 0.05), and at 16 wk their levels were reduced 14% vs. placebo (P = 0.15). We conclude that Rosi suppresses IGF-I expression in bone and liver; these changes could affect skeletal acquisition through endocrine and paracrine pathways. Publication Types:



73: Endocrinology. 2007 Feb;148(2):538-47. Epub 2006 Nov 9. Related Articles, Links

Selective activation of estrogen receptor-beta transcriptional pathways by an herbal extract. Cvoro A, Paruthiyil S, Jones JO, Tzagarakis-Foster C, Clegg NJ, Tatomer D, Medina RT, Tagliaferri M, Schaufele F, Scanlan TS, Diamond MI, Cohen I, Leitman DC. University of California, San Francisco, MS 1258, P.O. Box 0556, San Francisco, California 94143-0556, USA. [email protected] Novel estrogenic therapies are needed that ameliorate menopausal symptoms and have the bone-sparing effects of endogenous estrogens but do not promote breast or uterine cancer. Recent evidence suggests that selective activation of the estrogen receptor (ER)-beta subtype inhibits breast cancer cell proliferation. To establish whether ERbeta-selective ligands represent a viable approach to improve hormone therapy, we investigated whether the estrogenic activities present in an herbal extract, MF101, used to treat hot flashes, are ERbeta selective. MF101 promoted ERbeta, but not ERalpha, activation of an estrogen response element upstream of the luciferase reporter gene. MF101 also selectively regulates transcription of endogenous genes through ERbeta. The ERbeta selectivity was not due to differential binding because MF101 binds equally to ERalpha and ERbeta. Fluorescence resonance energy transfer and protease digestion studies showed that MF101 produces a different conformation in ERalpha from ERbeta when compared with the conformations produced by estradiol. The specific conformational change induced by MF101 allows ERbeta to bind to an estrogen response element and recruit coregulatory proteins that are required for gene activation. MF101 did not activate the ERalpha-regulated proliferative genes, c-myc and cyclin D1, or stimulate MCF-7 breast cancer cell proliferation or tumor formation in a mouse xenograft model. Our results demonstrate that herbal ERbeta-selective estrogens may be a safer alternative for hormone therapy than estrogens that nonselectively activate both ER subtypes. Publication Types:




74: Anaesthesia. 2006 Dec;61(12):1226-7. Related Articles, Links

Comment on:

• Anaesthesia. 2005 Dec;60(12):1235-6.

Transient paralysis after administration of cyclizine. Marr R, Orwin A. Publication Types:

• Case Reports • Comment • Letter


75: Anaesthesia. 2006 Dec;61(12):1225; author reply 1225. Related Articles, Links

Comment on:

• Anaesthesia. 2006 Feb;61(2):107-9.

Lipid emulsions for local anaesthetic toxicity. Dawson JS. Publication Types:



76: Anaesthesia. 2006 Dec;61(12):1208-10. Related Articles, Links

Accidental intracerebroventricular injection of anaesthetic drugs during induction of general anaesthesia.


Tiefenthaler W, Tschupik K, Hohlrieder M, Eisner W, Benzer A. Department of Anaesthesia and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. A 51-year-old patient scheduled for surgery under general anaesthesia was accidentally given remifentanil 150 microg and propofol 1% 10 ml through an intracerebroventricular totally implantable access port placed in the right infraclavicular region, which was mistakenly thought to be an intravenous line. Severe pain in the head and neck caused the mistake to be discovered rapidly, and 20 ml of a mixture of cerebrospinal fluid and the anaesthetic drugs were aspirated from the implantable access port. The patient suffered no apparent adverse neurological sequelae. Publication Types:

• Case Reports


77: Rheumatology (Oxford). 2006 Dec;45(12):1458-60. Epub 2006 Oct

31. Related Articles,

Links

Non-steroidal anti-inflammatory drugs--changes in prescribing may be warranted. Madhok R, Wu O, McKellar G, Singh G. Publication Types:

• Editorial


78: Am J Respir Crit Care Med. 2007 Jan 1;175(1):40-4. Epub 2006 Oct


Links

Comment in:


Sex-specific manifestations of Lofgren's syndrome. Grunewald J, Eklund A. Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet Lung Research Laboratory L4:01, Karolinska University Hospital Solna, S-171 76 Stockholm,


Sweden. [email protected] MOTIVATION: It has been debated whether patients need to have erythema nodosum to be classified as having Lofgren's syndrome. In this study, we have therefore in detail evaluated and compared a large number of patients with an acute onset of sarcoidosis and bilateral hilar lymphadenopathy (BHL), with or without erythema nodosum (EN). This study is important because it may lead to a more accurate definition of Lofgren's syndrome, and an exact phenotype of patients is crucial in modern medical research. BACKGROUND: Lofgren's syndrome is commonly regarded as a distinct clinical entity. METHODS: We have in detail evaluated a large group of patients (n = 150) with an acute onset of sarcoidosis with BHL, in most cases with fever, EN, and/or bilateral ankle arthritis or periarticular inflammation. Within this group, 87 patients had EN (EN positive), whereas 63 were without EN (EN negative), though with distinct symmetric ankle inflammation. RESULTS: EN-positive and EN-negative patients were identical in every aspect except that there were significantly more women in the EN-positive group: 58 women (67%) in the EN-positive group compared with only 17 (27%) women in the EN-negative group (p < 0.0001). In all other aspects, such as age, smoking habits, seasonal clustering of disease onset, rate of positive biopsies, chest radiography, pulmonary function, bronchoalveolar lavage cell distributions including the typically increased CD4/CD8 ratio, and clinical development of the disease, the EN-positive and EN-negative groups were close to identical. The two groups were also identically strongly associated with HLA-DRB1*0301/DQB1*0201, with 60 (69.0%) and 44 (69.8%) patients having this particular HLA type in the EN-positive and EN-negative groups, respectively. Such patients recovered to the same degree-that is, at almost 100%. CONCLUSIONS: We conclude that manifestations of Lofgren's syndrome differ between men and women, with EN found predominantly in women, whereas a marked periarticular inflammation of the ankles or ankle arthritis without EN is seen preferentially in men. Publication Types:



79: Am J Respir Crit Care Med. 2007 Jan 1;175(1):45-54. Epub 2006 Sep


Links

Comment in:


Gene expression profiling of familial and sporadic interstitial pneumonia. Yang IV, Burch LH, Steele MP, Savov JD, Hollingsworth JW, McElvania-Tekippe E, Berman KG, Speer MC, Sporn TA, Brown KK, Schwarz MI, Schwartz DA. Laboratory of Respiratory Biology, National Institute of Environmental Health Sciences, P.O. Box 12233, MD B3-08, Research Triangle Park, NC 27909, USA.


[email protected] RATIONALE: Idiopathic interstitial pneumonia (IIP) and its familial variants are progressive and largely untreatable disorders with poorly understood molecular mechanisms. Both the genetics and the histologic type of IIP play a role in the etiology and pathogenesis of interstitial lung disease, but transcriptional signatures of these subtypes are unknown. OBJECTIVES: To evaluate gene expression in the lung tissue of patients with usual interstitial pneumonia or nonspecific interstitial pneumonia that was either familial or nonfamilial in origin, and to compare it with gene expression in normal lung parenchyma. METHODS: We profiled RNA from the lungs of 16 patients with sporadic IIP, 10 with familial IIP, and 9 normal control subjects on a whole human genome oligonucleotide microarray. RESULTS: Significant transcriptional differences exist in familial and sporadic IIPs. The genes distinguishing the genetic subtypes belong to the same functional categories as transcripts that distinguish IIP from normal samples. Relevant categories include chemokines and growth factors and their receptors, complement components, genes associated with cell proliferation and death, and genes in the Wnt pathway. The role of the chemokine CXCL12 in disease pathogenesis was confirmed in the murine bleomycin model of lung injury, with C57BL/6(CXCR4+/-) mice demonstrating significantly less collagen deposition than C57BL/6(CXCR4+/+) mice. Whereas substantial differences exist between familial and sporadic IIPs, we identified only minor gene expression changes between usual interstitial pneumonia and nonspecific interstitial pneumonia. CONCLUSIONS: Taken together, our findings indicate that differences in gene expression profiles between familial and sporadic IIPs may provide clues to the etiology and pathogenesis of IIP. Publication Types:

• Comparative Study • Research Support, N.I.H., Extramural • Research Support, N.I.H., Intramural


80: MMWR Morb Mortal Wkly Rep. 2007 Feb 23;56(7):137-41. Related Articles, Links

Nephrogenic fibrosing dermopathy associated with exposure to gadolinium-containing contrast agents--St. Louis, Missouri, 2002-2006. Centers for Disease Control and Prevention (CDC). Nephrogenic fibrosing dermopathy (NFD) causes thickening and hardening of the skin, often in the extremities, and occurs in patients with underlying renal disease. The skin lesions can progress rapidly, sometimes leading to joint immobility and the inability to walk. In May 2006, nephrologists at hospital A in St. Louis, Missouri, reported to CDC and the Missouri Department of Health and Senior Services (MoDHSS) a cluster of NFD among patients treated in their dialysis units. CDC and MoDHSS conducted an investigation to determine the number of affected patients and identify risk factors for NFD. Thirty-three patients with NFD were identified in St. Louis, 28 of whom had been treated at hospital A. A matched case-control study was conducted at the hospital. This report summarizes the preliminary results of that study, which indicated that exposure to gadolinium-containing


contrast agents during magnetic resonance imaging (MRI) studies was independently associated with NFD. Clinicians should be aware of the potential for NFD, and when possible, should avoid use of gadolinium-containing contrast agents in patients with advanced renal disease. PMID: 17318112 [PubMed - indexed for MEDLINE]

81: Allergy. 2007 Feb 19; [Epub ahead of print] Related Articles, Links

Ocular manifestations and complications of Stevens-Johnson syndrome and toxic epidermal necrolysis: an Asian series* Yip LW, Thong BY, Lim J, Tan AW, Wong HB, Handa S, Heng WJ. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Background: To describe the acute and late ocular manifestations and complications in toxic epidermal necrosis (TEN) and Stevens-Johnson syndrome (SJS), and identify predictors for development of late complications. Methods: Cases of TEN and SJS during a 9-year period were included. Patients with ocular involvement were reviewed for acute ocular complications. Patients with a minimum 6 months follow-up were reviewed for late complications. Records were reviewed for their demographics, etiology, and severity of ocular involvement. Results: There were 117 patients with a mean age of 52.2 +/- 18.6 years. Eighty-one of these (69%) had acute ocular involvement. This was mild in 40%, moderate in 25% and severe in 4%. Adverse drug reactions were the predominant cause. Patients with thrombocytopenia had more severe acute ocular involvement. Forty-four patients had a minimum 6 months of follow-up and half developed late complications. Severe dry eyes and trichiatic lashes were the commonest late complications. Patients treated with topical antibiotic were more likely to have late complications, particularly dry eyes. There was no difference in the severity of acute eye involvement or late complications when SJS and TEN patients were compared. The severity of the acute ocular disease and abnormal laboratory tests were not found to be the significant risk factors of late complications. Conclusions: Ocular involvement is common in SJS and TEN and can be severe and blinding. The severity of acute ocular complications does not predict late complications. The diagnosis of TEN does not imply a more severe ocular involvement or increased frequency of late ocular complications compared with SJS. Care should be taken even in mild cases. Appropriate intervention during acute ocular disease may prevent late complications. PMID: 17313402 [PubMed - as supplied by publisher]

82: J Exp Clin Cancer Res. 2006 Dec;25(4):607-10. Related Articles, Links

Fatal venous thrombembolism complicating imatinib therapy in a patient with metastatic gastrointestinal stromal tumor. Melichar B, Laco J, Slovacek L, Grossmann P, Vanecek T. Department of Oncology & Radiotherapy, Charles University Medical School & Teaching Hospital, Hradec Kralove, Czech Republic. [email protected]


Imatinib, a tyrosine kinase inhibitor, is currently the therapy of choice for gastrointestinal stromal tumor (GIST). The toxic effects of imatinib treatment are usually mild, and serious adverse events are rare. We report here the case of a patient with peritoneal metastases of GIST involving the pelvis treated by imatinib. Abdominal pain deteriorated early in the course of the therapy along with the enlargement of the tumors. The patient died suddenly, and the autopsy revealed pulmonary embolism originating from the deep vein thrombosis caused by the compression of common iliac vein by the tumor. The possibility of deep vein thrombosis caused by the compression of the veins by necrotic tumor should be considered in patients with abdominal or pelvic metastases of GIST, including patients treated with imatinib. Publication Types:



83: Mayo Clin Health Lett. 2006 Dec;24(12):6. Related Articles, Links

Osteoporosis drugs and jaw problems. Weighing your risks. [No authors listed] PMID: 17304694 [PubMed - indexed for MEDLINE]

84: Pharmacoepidemiol Drug Saf. 2007 Feb 26; [Epub ahead of print] Related Articles, Links

Co-prescriptions with itraconazole and fluconazole as a signal for possible risk of drug-drug interactions: a four-year analysis from Italian general practice. Galatti L, Mazzaglia G, Greco A, Sessa E, Cricelli C, Schito GC, Nicoletti G, Spina E, Caputi AP. Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Torre Biologica-Policlinico Universitario, Via Consolare Valeria-Gazzi, Messina, Italy. PURPOSE: To determine the prevalence of concomitant use of drugs potentially responsible for interactions among itraconazole and fluconazole users in general practice. METHODS: During the years 1999-2002, we obtained information from the 'Health Search Database', (HSD) an Italian general practice research database. Among a total sample of 457 672 eligible patients, we included those aged >16 years, and whose diagnoses could be classified as mycosis. Itraconazole and fluconazole users were then selected. A potentially drug-drug interaction (DDI) occurred when the use of concomitant drugs were recorded within +/-30 days from the date of the first azoles prescription. Interacting drugs were classified according to the summary of product characteristics (SPC) as provided by the Italian Pharmaceutical Repertory (REFI). RESULTS: From 18 323 cases of mycosis, we selected 4843 itraconazole and 1446 fluconazole users. Potentially interacting drugs were prescribed


in 8.7% of itraconazole and 6.1% of fluconazole users. For itraconazole, calcium channel blockers were the most common interacting drugs (3.3%), followed by statins (1.7%) and clarithromycin (1.3%), whereas gestoden + ethynylestradiol (2.5%) and benzodiazepines (1.8%) resulted as the most common interacting drugs among fluconazole users. CONCLUSION: Data indicate a relevant prevalence of concomitant use of medications potentially leading to drug interactions among azoles users. Because of the wide use of these medications in general practice, they should be used with clinical monitoring in view of their known side effects as well as their potential risk for drug interaction. Copyright (c) 2007 John Wiley & Sons, Ltd. PMID: 17323404 [PubMed - as supplied by publisher]

85: J Clin Pharmacol. 2007 Mar;47(3):305-14. Related Articles, Links

Lack of pharmacokinetic interaction between anidulafungin and tacrolimus. Dowell JA, Stogniew M, Krause D, Henkel T, Damle B. Associate Director, Clinical Pharmacology, Pfizer Global Research & Development, 685 3rd Avenue, New York, NY 10017; e-mail: [email protected]. The safety and pharmacokinetics of anidulafungin coadministered with tacrolimus were investigated using a single-sequence, open-label design. Healthy volunteers received 5 mg tacrolimus orally on days 1 and 13 of the study. Anidulafungin (200 mg) was administered intravenously on day 4, followed by 100-mg doses on days 5 through 13. Key pharmacokinetic parameters, including C(max), AUC, t((1/2)), CL, and V(ss), were derived from concentration-time data. The 90% confidence intervals (CIs) of the ratios of mean pharmacokinetic parameters of anidulafungin plus tacrolimus to each drug alone were well within the 80% to 125% bioequivalence range, indicating no pharmacokinetic interaction. This ratio was 101.6 (90% CI: 92.77-111.22) for tacrolimus AUC(0-infinity) and 107.2 (90% CI: 105.1-109.4) for anidulafungin AUC(ss). The 2 drugs were well tolerated, and no drug-related serious adverse events were reported. Because of its lack of pharmacokinetic interaction with key immunosuppressive agents, anidulafungin is an important option for the prevention and treatment of invasive fungal infections in transplant recipients. PMID: 17322142 [PubMed - in process]

Relationship of Depression to Death or Hospitalization in Patients With Heart Failure

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