1. Clinical Pearls 1997 #4
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
It is possible to decrease the development of allergies in children by breastfeeding and reducing
the child's exposure to dust mites. (Allergy 1996 ;051:0089)
Over 40% of 4- to 11-year-olds are exposed to secondhand smoke at home according to a survey
of over 10,000 people. Nearly 90% of nonsmokers exposed to secondhand smoke were found to
have detectable levels of cotinine, the major metabolite of nicotine. (JAMA 1996 ;275:1233)
The combination of estrogen replacement therapy AND cyclical etidronate disodium is more
effective at increasing bone mass in postmenopausal women than either therapy alone. (Am J Med
1995 ;099:0036)
Increased anxiety was associated with an increased risk of fatality from coronary heart disease in
this study of male physicians; relative risk of sudden death was 6.1 . (Circulation 1994 ;089:1992)
Oral clindamycin when used to treat bacterial vaginosis reduced by 50% the risk of preterm
rupture of membranes. (Obstet Gynecol 1995 ;173:0157)
Preterm infants have improved cognitive outcomes when the father was involved with the infant.
(J Am Acad Child Adolesc Psychiatry 1995 ;034:0058)
Calcium supplementation in postmenopausal women resulted in a decreased amount of bone
mass loss and fewer fractures as compared with women treated with placebo. (Am J Med 1995 ;
098:0331)
Vitamin E supplementation was associated with a 34% reduced rate of heart disease in women.
(NEJM 1993 ;328:1444)
A pelvic examination may increase the risk of a subsequent urinary tract infection. (Arch Fam
Med 1996 ;005:0357)
Prolonged stress appears to be related to brain damage. (Science 1996 ;273:0749)
Despite normal tests of cardiac status, many patients still have lingering anxiety about their
heart. (BMJ 1996 ;313:0315)
Long acting calcium antagonists, such as amlodipine (Norvasc) and diltiazem (Cardizem SR),
achieve persistent 24-hour blood pressure control and lead to an eventual decrease in left
ventricular mass. (Am J Cardiol 1996 ;078:0203)
Aspirin continues to be under utilized in the treatment of acute myocardial infarction. Ideally,
you should take an aspirin (NOT enteric coated) at the onset of symptoms suggestive of a heart
attack. (Arch Intern Med 1996 ;)
Induction of women at 41 weeks gestational age was associated with a decreased rate of c-section
and equivalent morbidity and mortality to monitoring alone in the Canadian Multicenter Post-
term Pregnancy Trial of 3407 women. (NEJM 1992 ;326:1587)
A rapid rule-out myocardial infarction protocol performed on clinically low risk patients with a

2. nondiagnostic EKG: get enzymes at 0,3,6, & 9 hrs; EKG at 0,9 hrs; treadmill test at 12 hrs. If any
tests positive, a longer hospital stay is warranted. (JACC 1996 ;028:0025)
900 mg of garlic per day with 12 g fish oil per day (providing 3.6 g n-3 fatty acids/d) lowered total
cholesterol, LDL, and triacylglycerol; the combo improved the total to HDL ratio as well. (Am J
Clin Nutr 1997 ;065:0445)
Waiting until the umbilical cord stops pulsating before clamping (about 1 minute after birth)
decreases the rate of anemia in infants at 2 months of age. (Am J Clin Nutr 1997 ;065:0425)
Use of aspartame in the diet instead of sugar was associated with both a greater short-term and
long-term weight loss than controls, even after going back to a regular diet. (Am J Clin Nutr 1997 ;
065:0409)
ST depression in V1 or V2 has a high sensitivity (~90%) and high specificity (~90%) for
identifying the LCA as the infarct-related artery in acute inferior myocardial infarction. (Am J
Cardiol 1997 ;79(2):182)
A high carbohydrate meal preceeding exercise is associated with an earlier onset of myocardial
ischemia than a high fat meal preceeding exercise. (JACC 1997 ;029:0302)
A stress treadmill test alone (i.e. without an associated imaging procedure) is not useful in
diagnosing CAD in symptomatic patients, although it is useful in determining functional capacity.
(Circulation 1992 ;123(5):1312)
An ad lib low fat / high complex carbohydrate diet is better than a fixed calorie diet in keeping
the weight off. (BMJ 1997 ;314(1):29)
For the prevention of DVT: 1) Low Risk Pts- stockings. 2) Mod Risk- add low-molecular wt
heparin, e.g. Enoxaparin 2000 U /d. 3) High Risk- increase LMWH, e.g. enox 4000 U/d SQ. (BMJ
1997 ;314(2):123)
Don't use sublingual nifedipine for htn because of the side-effect of an uncontrolled blood
pressure drop causing neurologic and/or cardiac ischemia. (JAMA 1996 ;276:1328)
Ther is no need to reculture or change antibiotics if pyelonephritis with fever persists for up to 2 -
4 days; this is a fairly common duration. (Am J Med 1996 ;101:0277)
Water soluble dietary fiber supplementation at 15 g / d decreased total cholesterol by 6.4% and
LDL by 10.5% . (Am J Cardiol 1997 ;079:0034)
2 grams of vitamin C taken prior to exercise was shown to decrease symptoms of exercise-
induced asthma in 9 out of 20 study participants aged 7 to 28. (Arch Ped Adol Med 1997 ;
151:0367)
In a prospective study of 1605 Finish men, low baseline fasting plasma vitamin C levels were
associated with an increased rate of acute myocardial infarction. (BMJ 1997 1 MAR;314:0634)
Fluoxetine (prozac) was shown to be effective in the treatment of postnatal depression; it was as
good as (but not better than) cognitive-behavioral counselling. (BMJ 1997 29 MAR;314:0932)
The use of calcium antagonists (e.g. nifedipine) increased the need for perioperative transfusion
in this study of older pts; the authors estimate that switching pts to alternative drugs prior to
surgery would reduce by 24% the need for blood transfusions (BMJ 1997 1 MAR;314:0643)
People with atrial fibrillation view quality of life after minor, moderate, and major strokes much
differently; thus, individual preferences must be taken into account when deciding between
warfarin, aspirin, or no stroke prophylaxis in atrial fib. (Arch Intern Med 1996 9 SEPT;156:1829)

3. Elderly people with both hypertension and claudication have an increased risk of abdominal
aortic aneurysm (relative risk versus uncomplicated hypertension is 5.8); screening for AAA may
be helpful. (Arch Intern Med 1996 14 OCT;156:2081)
Postmenopausal estrogen replacement therapy was associated with a decreased risk of
osteoarthritis of the hip in this study of 4366 white women older than 64 years old (OR = 0.62)
(Arch Intern Med 1996 14 OCT;156:2073)
Taking an aspirin early on during an attack of unstable angina or acute myocardial infarction is
recommended; a higher use of aspirin in the prehospital setting is encouraged. (Arch Intern Med
1996 22 JUL;156:1506)
Influenza vaccination is not associated with higher rates of systemic symptoms compared with
placebo injection in this study of 849 healthy adults. (Arch Intern Med 1996 22 JUL;156:1546)
Over half of all women and about a third of men will get osteoporotic fractures during their
lifetime; often the only symptom of osteoporosis disease progression is a bone fracture. (Arch
Intern Med 1996 8 JUL;156:1399)
Weight loss programs have a very poor long term success rate; in this study of 192 people, the
initial wt was 106 kg, after the wt loss program was 84 kg, and after 3 yrs was 103 kg. (Arch
Intern Med 1996 24 JUN;156:1302)
A diet high in antioxidants (e.g. vitamin C) helped prevent fetal malformations in diabetic rats.
(Diabetes 1996 NOV;045:1497)
While eating 1 - 2 servings of fish per week is recommended, the American Heart Association
announced that there's insufficient evidence to promote the use of fish oil supplements.
(Circulation 1996 NOV;094:2337)
Ambulatory blood pressure measurements may be helpful in estimating risk in borderline
hypertensives. (Hypertension 1996 ;028:0641)
Causes of unmet expectations by patients: 30% - not auscultating the heart, 28% - omitting a
cholesterol test, 26% - not asking about specific or medical lifestyle factors, & 19% - not
prescribing pain killers. (Ann Intern Med 1996 ;125:0730)
Postmenopausal estrogen therapy may lower the risk of Alzheimer's Disease: after 10 years of
use, disease risk was lowered by 30%. (Arch Intern Med 1996 ;156:2213)
Smoking during pregnancy increases the risk of placental abruption and placenta previa; it's
estimated that 27% of abruptions and 12% of previas could be avoided if women did not smoke
during pregnancy. (Am J Epidemiol 1996 ;144:0881)
A daily aspirin reduced the rate of cardiovascular mortality over 3 yrs by 40% and all cause
mortality by 35% in this study of 2418 women with coronary artery disease. (Am J Cardiol 1996 ;
078:1215)
After an acute myocardial infarction, enalapril used alone led to a greater survival than enalapril
plus aspirin after 3 months. (Am J Cardiol 1997 ;079:0115)
The prevalence of silent ischemia in a group of 925 noninsulin-dependent diabetics 40 to 65 yrs
old was 6.4% by thallium perfusion scanning; an abnormal rest EKG was the independent risk
with the highest odds ratio (9) of all screening risk factors. (Am J Cardiol 1997 ;079:0134)
Twice daily application of a 0.2% glyceryl trinitrate ointment helped decrease pain and increase
the healing rate of anal fissures. (Lancet 1997 ;349:0011)

4. The use of a cellular phone while driving was associated with an increased motor vehicle accident
rate; the accident rate was similar to driving with a blood alcohol at the legal limit (0.08). (N Engl
J Med 1997 ;336:0453)
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