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Imj 1997 3
1. Clinical Pearls 1997 #3
These one sentence summaries of recent articles in the medical literature are intended to direct the
reader to the source article. They provide medical information NOT ADVICE. Please consult with your
physician before making any changes in your lifestyle based upon the information contained in these
web pages
After 2 years of treatment, amenorrhea (i.e. no periods or spotting) was achieved in 90% of
women on continuous combined hormone replacement therapy. (Am J Obstet Gynecol 1995 ;
173:1446)
In this study, the nicotine patch did help smokers quit; only minimal counseling was necessary as
adjunctive therapy (i.e. intensive counseling was not superior to a physician's advice to quit).
(JAMA 1995 ;274:1347)
Fish oil at a daily dose of 4 g per day was effective in lowering blood pressure and triglyceride
levels in this study of 78 non-diabetics. (Ann Intern Med 1995 ;123:0911)
Full implementation of the 2-dose schedule of measles vaccination is essential for community-
wide protection. (Pediatr Infect Dis J 1996 ;015:0031)
Women with a prior c-section and a lower uterine segment thickness of less than 3.5 mm at 37
weeks gestation are at high risk of uterine rupture during a trial of labor after c-section. (Lancet
1996 ;347:0281)
Vitamin D deficiency is highly prevalent among homebound and community-dwelling elderly
patients. (JAMA 1995 ;274:1683)
The results of skin testing for tuberculosis (PPD testing) should be interpreted by health care
professionals; self reporting is highly inaccurate. (Pediatr Infect Dis J 1996 ;015:0090)
Famotidine (pepcid) at a dose of 40 mg twice daily significantly decreased the rate of gastric and
duodenal ulcer formation in patients with arthritis require long term nonsteroidal anti-
inflammatory drug (e.g. ibuprofen) therapy. (NEJM 1996 ;334:1435)
In addition to the ECG and CK-MB level, it is helpful to look at the relative lymphocyte count:
pts with a differential of less than 20.3% lymphocytes were much more likely to have an acute
myocardial infarction. (Ann Intern Med 1996 ;122:0335)
In a study of 336 people with adult onset diabetes, 52% of men had impotence, nearly half had
vascular injury, and more than a third had mental problems such as forgetfulness, depression,
and blurred vision. (Arch Fam Med 1996 ;005:0135)
In 18 patients with chronic low back pain, 13 were found to have major depression, suggesting
the need to rigorously look for depression in those with chronic (more than 6 months) low back
pain. (Gen Hosp Psychiatr 1995 11/01;017:0399)
In this study of pregnant Indonesian women, once a week supplementation with iron was as
effective as daily supplementation. (Am J Clin Nutr 1996 06/01;063:0884)
Low thyroid homone levels were found in this group of recently obese (now normal weight)
women compared with a similar group of never obese women, suggesting that mild
hypothyroidism plays a role in the obese and obese-prone. (Am J Clin Nutr 1996 06/01;063:0879)
2. Chromum supplementation has no benefitial effects on strength gain or body composition in this
study of 36 men. (Am J Clin Nutr 1996 06/01;063:0897)
In Alzheimer's Disease, the average age of onset is 72, average age of diagnosis is 75; most
patients institutionalized at age 77, with death occuring at an average age of 80 1/2 years old in
this study of 100 patients with Alzheimer's. (J Am Geriatr Soc 1995 ;043:1248)
Requiring vision testing as part of a driver's license renewal increases road safety; given a 4 year
renewal interval, adding vision testing is estimated to prevent 7% of all fatal crashes. (JAMA
1995 ;274:1026)
In this study of 46 black men, regular moderate aerobic exercise significantly decreased blood
pressure, left ventricular hypertrophy, and medication requirements. (NEJM 1995 ;333:1462)
In this study of 1,957 randomly selected Oregon high school students, 31% reported being
physically abused; these students were more likely to carry weapons, use cocaine, smoke, have
multiple sexual partners, and have suicidal thoughts. (Arch Pediatr Adolesc Med 1995 ;149:1254)
A useful screening tool for cardiovascular risks is the waist circumference: above 37.6 inches for
men and 32 inches for women indicates a need for more in depth evaluation, and most likely a
need for weight loss. (BMJ 1995 ;311:1401)
The use of an epidural for anesthesia during labor was associated with a 2 fold increase in the
likelihood of c-section, when compared with the use of intravenous meperidine; also, labor was
prolonged and evidence of infection (chorioamnionitis) increased (Obstet Gynecol 1995 ;086:0783)
The use of selegiline in patients with new onset mild Parkinson's Disease is associated with an
increased mortality and no clinical benefit. (BMJ 1995 ;311:1602)
The induction of labor in women who have premature rupture of membranes at term was
associated with shorter labors and less maternal infection. (NEJM 1996 ;334:1005)
Nicotine nasal spray, soon due on the market for prescription use, has been associated with quit
rates of 33% at 6 months; this compares with rates for the patch of 22% and placebo of 12-15%
at 6 months. (Physicians Clin Digest 1996 07/01;007:0053)
Late whiplash syndrome--neck pain, headaches, and mental impairment after a motor vehicle
accident--causes significant disability in the US, however, this international study suggests the
cause of late whiplash syndrome is purely economic and/or legal. (Lancet 1996 ;347:1207)
Elevated blood homocysteine levels appear to increase the risk of heart disease, fortunately
lowering the level is easy- just take a multivitamin or B-Complex vitamin pill with folate daily;
recommended dose is unknown, 1 mg/d probably sufficient. (Your Patient & Fitness 1996 ;
10(4):0006)
It is estimated that 650,000 to 900,000 persons in the US were infected with HIV in 1992,
approximately 0.3% of the population. (JAMA 1996 07/10;276:0126)
Failure to achieve the target heart rate on exercise treadmill testing was shown to be an
independent predictor of coronary heart disease, with the risk of a cardiac event increased by
75% over the average 7.7 years of follow-up. (Circulation 1996 ;093:1520)
In this study of 333 patients with an ischemic stroke, those given thrombolytic therapy with t-PA
were at least 30% more likely to have a favorable outcome at 3 months after the stroke;
treatment was given within 3 hours of the onset of symptoms. (NEJM 1995 12/14;333:1581)
Nearly 50% of participants in a 4 community wide sample of patients with a history of
3. myocardial infarction did not take aspirin regularly indicating a servere underutilization of
aspirin in the prevention of subsequent myocardial infarctions. (Am Heart J 1996 ;131:0915)
In this study of 11178 people aged 67 - 105 years, the use of vitamin E supplementation reduced
the risk of all cause mortality by 34%; simultaneous use of vitamin C reduced the risk by 42%.
(Am J Clin Nutr 1996 ;064:0190)
According to the HALT trial of 851 patients studied for 16 weeks, doxazosin effectively lowered
blood pressure while also lowering total cholesterol by 2.7%, LDL cholesterol by 2.4%, and
significantly reducing the ratio of total to HDL cholesterol. (Am Heart J 1996 ;131:0966)
In a study of 411 patients, compliance with advice to exercise was increased if their doctor was of
an appropriate weight, exercised regularly, and didn't smoke. (Clin J Sport Med 1996 ;6(2):0112)
The treatment of asymptomatic bactiuria in older women is not helpful; in this study of 50
women, antibiotic treatment did not lower the rate of symptoms during the following 6 months; it
is recommended that antibiotic treatment not be given. (J Am Geriatr Soc 1996 ;044:0293)
Eradication of H. Pylori is useful not only in patients with ulcers, but also in those with
dyspepsia. Treatment with pepto-bismol, Flagyl, and amoxicillin lead to a 75% eradication, and
overall improvement in symptoms. (Am J Gastroenterol 1996 ;091:0441)
The use of calcium channel blockers is associated with an increased risk of gastrointestinal
bleeding compared with beta-blockers and ace-inhibitors. (Lancet 1996 ;347:1061)
Transdermal estrogen is helpful in the treatment of postpartum depression. (Lancet 1996 ;
347:0930)
In a study of 307 pts presenting with symptoms and complaints of a common cold, approximately
20% had bacterial colonization and benefitted from antibiotics; the other 80% did not benefit
from antibiotics and were more likely to experience side-effects. (Lancet 1996 ;347:1507)
The initiation of early feeding after a cesarean section (sips of water immediately after surgery
and pudding within 6 hours) was associated with a more rapid return of gastrointestinal function.
(Obstet Gynecol 1996 ;087:1006)
In this study of 500, treatment of deep venous thrombosis can be safely treated with outpatient
enoxaparin, 1 mg per kg body weight twice daily. (NEJM 1996 ;334:0677)
In this study of 400, treatment of deep venous thrombosis can be safely treated with outpatient
enoxaparin. (NEJM 1996 ;334:0682)
In this meta-analysis of 2459 women, calcium supplementation of 1.5 g to 2.0 g per day during
pregnancy decreased blood pressure and the rate of preeclampsia; the mean number needed to
treat to prevent 1 case of preeclampsia was estimated to be 23. (JAMA 1996 ;275:1113)
Membrane stripping of the woman at term promoted the onset of labor in this study of 120; the
mean time to onset of labor was 12.7 d for controls and 8.2 d for those receiving stripping. (Obstet
Gynecol 1996 ;087:0767)
Results from a 6 year study indicates that that both aspirin and nonsteroidal anti-inflammatory
drugs can lead to a significant reduction in risk for colorectal neoplasia, possibly as much as a
50% reduction in risk. (Dig Dis Sci 1996 ;041:1319)
Postmenopausal estrogen use was associated with a decreased risk and delayed onset of
Alzheimer's disease in this study of 1124 elderly women. (Lancet 1996 ;348:0429)
Results of a 7-year study of over 475,000 people indicate that passive smoking is associated with
