Quote of the Week

Vitamin B
Jeffrey A. Toice, M.D., et al reported in the August 22 issue of JAMA on the cost effectiveness of low dose Vitamin B preparations for the prevention of Coronary Heart disease. This comes from the premise that homocysteine can be an etiologic agent for Coronary heart disease and that Vitamin B preparations, particularly Folic Acid and cyanocobalamin, lower homocysteine levels in the human body. They studied grain fortification with Folic acid and concluded that it's effectiveness may be preventative and would result in fewer cardiac deaths and therefore lower health care costs.
     Ed. This is certainly easy to accomplish and can be achieved by a daily multivitamin in addition to eating the fortified grain products.

Passive Smoking
Another report from the JAMA by some Osaka Japan physicians outlined the acute effects of passive smoking on the coronary circulation in healthy young adults. They calculated the coronary artery flow velocity reserve and determined that passive smoking reduced the flow velocity in healthy young adult non-smokers and proposed that this could cause endothelial (artery lining) dysfunction.
     Ed. Passive smoking has been suspect in pulmonary disease, now this is good evidence that growing up in a smokers house can be hazardous to one's heart also.

Statin Therapy
It has been shown that elevated levels of C-reactive protein, even without high blood lipid levels, are related to a higher risk of coronary artery disease in humans. Paul M. Redker, M.D., et al reported in the June 28,2001 issue of The New England Journal of Medicine that statin therapy may be effective in the prevention of coronary artery events in people with elevated levels of C-reactive protein. This protection occurred even if their blood lipid levels were relatively low.
     Ed. More and more we see benefits associated with statin therapy. Lovastatin was the drug used in this study, but it's effectiveness should be comparable to all that are on the market.

Common Cough
At a recent Journal Club meeting, Dr. Lazarus Loeb reported on an article by Joseph A. Bellanti, M.D. et al published in the Allergy and Asthma Proceedings. The authors stated that a cough was the fifth most common symptom complex that stimulated patient medical office visits. They estimated that there were more than 30 million doctor visits per year for this annoying complaint. A table in their article listed the most common causes of a persistent cough: 1) nasal rhinitis (post nasal drip). 2) sinusitis. 3) asthma-cough equivalent. 4) gastro-esophageal reflux. (GERD). 5) post viral inflammation. 6) smoking and other irritants. 7) medication related (ACE inhibitors and BETA blockers).
     Ed. Smokers may also have 1, 2, 3, & 4 and this would intensify the problem.

Serum Sickness
Another report by Dr. Loeb listed 3 cases of serum sickness like reaction to oral penicillin drugs. Serum sickness was reported in humans by von Pirquet and Schick in 1901. It usually occurs as a complication of the administration of horse serum. The common symptoms are fever, joint pain, skin eruptions, and lymph node enlargement.
     Ed. This is not the usual penicillin reaction that can consist of just hives or a life threatening acute medical event after the penicillin injection or oral dose.

CVD in Diabetics
Another report from our Journal Club was a review article by James R. Sowers, M.D. on the subjects of diabetus, hypertension, and cardiovascular disease. His opening statement was "---cardiovascular diseases (CVD) are the major cause of mortality in persons with Diabetus mellitus and many factors including hypertension contribute to the high prevalence of CVD in diabetics."
     Ed. This is a lethal combination. Life style modification can influence and often prevent these outcomes.

An article in The Journal of the American College of Surgeons by Michael D. Holzman M.D., et al was interesting. They conducted a retrospective study of Tennessee Medicaid (Tenn care) patients and found that surgical treatment caused a 64% reduction in GERD medication use when the patients were followed for one year.
     Ed. GERD is an ever-increasing problem in the United States. Laparoscopic surgery has made the procedure much more popular. It is good to see its effectiveness. Dr. Tom DeMeester has also shown that surgery reduces the incidence of gastro-esophageal cancer in patients who have esophageal mucosal changes as a result of GERD.

Cellular Phones
Here it is again. Do hand held cellular phones increase the risk of brain tumors? Peter D. Inskip, ScD, et al studied 782 patients with brain tumors and reported their study and conclusions in the January 11,2001 issue of The New England Journal of Medicine. The data they collected did not support the hypothesis that cellular telephones cause brain tumors when they are held next to the head; however, they could not evaluate long term and frequent users.
     Ed. These devices were introduced in the US about 20 yrs. Ago and the numbers and frequency of use have been progressively increasing. There is a need to determine the results of long-term exposure and frequency of use. This will require ongoing monitoring and periodic data analysis. Currently there is no valid medical reason not to use these phones. The major risk is from automobile drivers who are distracted by the use of hand held phones.




Take care until next time,
RJT, Editor.

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