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Inhaled Steroid Helped Lung Patients in Study

May 15, 2000|THOMAS H. MAUGH II

Inhaled steroids, such as Fluticasone propionate, can sharply slow the general health decline of patients with chronic obstructive pulmonary disease, according to British physicians.

The study provides strong support for the current practice of using the drugs in patients with moderate to severe forms of the disease, a generally fatal loss of lung function caused primarily by smoking, the researchers concluded.

Dr. Peter S. Burge of Birmingham Heartlands Hospital and his associates enrolled 751 current and former smokers at 18 hospitals in the United Kingdom. Half were treated with Fluticasone propionate and half with a placebo. The team reported in Saturday's British Medical Journal (http://www.bmj.com) that the steroid treatment reduced the decline in general health status by half. It didn't, however, halt the deterioration of lung function as measured by forced expiratory volume, the amount of air that can be forced out of the lungs during breathing. The use of the drug also reduced the number of exacerbations, a worsening of respiratory symptoms requiring additional treatment.

New View of Rewarming Body After Heart Surgery

The mental impairment that often follows open-heart surgery might be minimized by slowing the rate at which bodies, cooled during surgery, are rewarmed, suggests new research from Duke University Medical Center in Durham, N.C.

Patients undergoing the surgery are chilled to reduce their oxygen requirements and to protect the brain and other organs from damage. Previous studies have shown that as many as one-third of such patients later exhibit permanent mental impairment.

Dr. Alina M. Grigore and her colleagues at Duke studied 100 patients who were rewarmed at the normal rate, which takes about 15 to 20 minutes, and 65 who were rewarmed over a period of 20 to 30 minutes. Various tests of mental functioning were performed on all the patients before, and six weeks after, the surgery.

Grigore reported Tuesday at a meeting of the Society of Cardiovascular Anesthesiologists that the patients rewarmed slowly scored much better on the tests and that the results were particularly dramatic in the case of diabetic patients. She speculated that the more rapid rewarming may allow the brain to overheat or to regain functioning before it receives adequate oxygen.

Drug From Pit Viper's Venom Used for Stroke Treatment

A drug isolated from the venom of the Malaysian pit viper has proved successful in treating strokes, according to a new international study.

The drug, called ancrod, reduces clotting of the blood by depleting fibrinogen, a crucial chemical in the clotting process. Although ancrod is not presently marketed in the United States, it has been used in Europe and Canada since the 1970s for treating patients with peripheral vascular disease and blood clots in the legs.

A team headed by Dr. David G. Sherman of the University of Texas Health Science Center in San Antonio enrolled 500 stroke patients at 48 centers in the U.S. and Canada. Half were given ancrod within three hours of the onset of the stroke, and half were given a placebo. The trial was begun before the clot-buster tPA was approved for general use, and an obvious need now is to test it directly against tPA.

The team reported in Wednesday's Journal of the American Medical Assn. (http://jama.ama-assn.org) that about 42% of the patients receiving ancrod had a significant recovery from their stroke, as measured by conventional tests of functional ability, compared with roughly 34% of those receiving the placebo. Only about 12% of those receiving ancrod were severely disabled by their strokes, compared with about 20% of those receiving the placebo. There were no differences in death rates, however.

C-Sections More Likely to Lead to Rehospitalization

Women who undergo a caesarean section are nearly twice as likely to be readmitted to a hospital within 60 days as those who undergo a normal vaginal delivery, according to Washington researchers.

About 22% of the 3.9 million births in the United States in 1996 were by caesarean section, roughly 64% were by spontaneous vaginal delivery and about 14% were assisted vaginal deliveries, in which vacuum extraction or forceps were used.

Epidemiologist Mona Lydon-Rochelle and her colleagues at the University of Washington in Seattle used data from 256,795 Washington births involving single infants between 1987 and 1996. They reported in Wednesday's Journal of the American Medical Assn. (http://jama.ama-assn.org) that women undergoing a caesarean section were 80% more likely to be rehospitalized and those undergoing an assisted vaginal birth were 30% more likely to be readmitted than women undergoing normal vaginal deliveries. The most common cause for readmission was complications of the surgical wound.

Even so, only about 1% of new mothers overall were readmitted, the researchers found.

Indoor Hot Tubs Can Foster Bacteria Causing Lung Disease

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