A safer, more effective treatment may soon be available for the 1 million Americans hospitalized each year with acute congestive heart failure.
In congestive heart failure, the heart pumps inefficiently, and fluid accumulates in various tissues, including the lungs and limbs. Patients usually have difficulty breathing. During an acute episode, symptoms become so severe that patients must be hospitalized. Conventional treatments include dobutamine and miranone, which can produce arrhythmias, and nitroglycerin, which often wears off quickly.
Two new studies indicate that a new drug, nesiritide (trade-named Natrecor), may provide an alternative. Nesiritide is a genetically engineered version of the naturally occurring protein B-type natriuretic peptide, or BNP, which is part of the body's normal response to a failing heart.
In the first study, Dr. Wilson S. Colucci of the Boston University School of Medicine and his colleagues at 23 medical centers studied 127 patients who received either nesiritide or a placebo. They reported in Thursday's New England Journal of Medicine (http://www.nejm.com) that patients receiving the drug showed reduced symptoms and an improved ability to breathe.
In the second study, reported in the same journal, the researchers gave either nesiritide or conventional therapy to 305 patients at 46 medical centers. Again, those receiving BNP showed more improvement. The primary drawback of the drug is that it must be administered intravenously. The principal side effect was low blood pressure, which did not prove to be a problem.
Good Showing From Emphysema Therapy
A controversial emphysema treatment called lung volume-reduction surgery is beneficial for many patients, according to results from the first controlled trial of the technique.
Dr. Duncan Geddes and his colleagues at the Royal Brompton Hospital in London studied 48 patients with severe emphysema. Half received the surgery, which is designed to remove the most severely affected portions of the lung, allowing more space for healthy lung to expand and contract. The other half received conventional medical care.
The team reported in Thursday's New England Journal of Medicine (http://www.nejm.com) that five of the surgery patients died within the first year, compared with three of those receiving conventional drug treatment. But most of the survivors showed improved breathing ability and an increased capacity for exercise, while those receiving conventional treatment only got worse.
Although several thousand patients have received the surgery, Medicare and many private insurers refuse to pay for it because its efficacy has not been demonstrated.
The National Heart, Lung and Blood Institute is conducting a much larger trial of the treatment, with results expected in 2004. Information about that trial is available at http://www.nhlbi.nih.gov/health/prof/lung/nett/lvrsweb.htm.
Human Enzyme Could Relieve Infant Disorder
Four babies with Pompe's disease, a fatal disorder caused by a deficiency of the enzyme alpha-glucosidase, have been successfully treated with a human version of the enzyme that's produced through rabbit milk, according to Dutch researchers.
Pompe's disease is rapidly progressive and is commonly fatal in the first year of life. It is characterized by respiratory and breathing difficulties, lack of muscle strength, and heart muscle disease. Dr. Ans van der Ploeg and associates at Sophia Childrens Hospital in Rotterdam, the Netherlands, reported in Saturday's Lancet (http://www.thelancet.com) that the four infants who received the enzyme had reduced heart size, improved heart function and conditioning, and improved muscle function. The babies are also expected to have a longer life.
Researchers have been exploring techniques to produce vaccines, enzymes and other proteins useful in medicine in the milk of various animals, and the Dutch work is one of the few successes reported to date.
Babies Born at Night Seem More Vulnerable
A new German study appears to confirm an earlier British report that babies born during the night are less likely to survive.
Dr. Gunther Heller and colleagues at the Philipps-University of Marburg Medical School studied 380,000 low-risk births in German clinics between 1990 and 1998. A total of 57 early deaths (occurring during labor or the first seven days of life) were observed, reflecting the overall low risk of these births. But, they reported in Saturday's British Medical Journal (http://www.bmj.com), babies born between 9 p.m. and 7 a.m. were twice as likely to die as those born at other times.
Among potential explanations for the increased risk, they said, were increased physical and mental fatigue of hospital staff during the night and the hospitals' overreliance on less experienced staff during the shifts.
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