Date: Fri, 29 Aug 1997 14:31:25 -0400
From: Medscape's MedPulse <news@xu1.medscape.COM>
Subject: Medscape's MedPulse 08.29.97
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=====================MEDSCAPE's MedPulse(R)===================
What's new on Medscape, the world's leading medical Web site.
READ THE FULL-TEXT ARTICLES ON THE WORLD WIDE WEB at:
http://www.medscape.com/
Links to articles featured below may be found at:
http://www.medscape.com/Home/MedPulse/MedPulse.html
===============================================================
________
CONTENTS
o Tidbits:
- 371,664 members as of 8/29/97
- 4,944 new members
this week
o Feature Articles
- Gynecology Case Challenge
- Spotting and Abnormal
Cervix in a Young
Woman on Oral Contraceptives
- Metabolic Bioactivation Can
Cause Idiosyncratic Drug
Reactions
- New Orleans Citywide Rounds
- Skin Lesions and
Pulmonary Infiltrates
in a Patient With AIDS
- Improving Oxygen Utilization
in Septic Patients
- Prolonged Magnesium Sulfate
Infusion in the Treatment
of Ventricular
Tachycardia in Acquired Long QT
Syndrome
- Evolving Infectious Complications
in Patients With
Hemophilia
- Chromosomal Abnormalities
and Bipolar Affective
Disorder: Velo-Cardio-Facial
Syndrome
- Furuncular Myiasis of the
Scrotum
- Issues in Drug Benefit Management
- Are Rebates Going Away?
- Pneumonia in the Elderly:
Diagnostic and Therapeutic
Challenges
- Ventricular Pacing With a
Novel Gastroesophageal
Electrode: A Comparison
With External Pacing
- Prepregnancy Counseling for
Primary Care Physicians
- Prompt Control of Asthma
Essential: The Emphasis From
the New US and
UK Guidelines
- Assessing Effects of
Potent Combination Therapy on
Tissue Viral Load
- What Should a Doctor Do?
- Grand Rounds - A 51-Year-Old
Man With Dysphagia
- Offset Acetabular Components
in Total Hip Arthroplasty
- Mechanisms of Food Allergy
- Polycystic Kidney Disease:
An Unrecognized Emerging
Infectious Disease?
- Drug Information Services
in the Managed Care Setting
o Articles and Columns
- Clinical Characteristics
and Long-Term Outcome of
Patients in Whom
Congestive Heart Failure Develops After
Thrombolytic Therapy
for Acute Myocardial Infarction:
Development of
a Predictive Model
- Charting the New Oncology
Landscape
- Current Abstracts - Viral
Vectors in Cystic Fibrosis Gene
Therapy
- Comparison of the Plasma,
Urine and Blister Fluid
Pharmacokinetics
of Clarithromycin and Azithromycin in
Normal Subjects
- How to Explain Fees to Speed
Up Payment
- Current Abstracts - Incidence
and Prevalence of Alzheimer's
Disease
- Current Abstracts - Osteomyelitis
of the Spine
- No Effect of Miglitol on
the Oral Bioavailability of
Single-Dose Phenytoin
in Healthy Males
- Current Abstracts - Biochemical
Markers for Disease
Progression in
Dilated Cardiomyopathy
- Allograft Aortopathy: An
In Vivo Study of Donor Aorta
Involvement in
Cardiac Allograft Vaculopathy
- Current Abstracts - Effect
of Policy Guidelines on
Breast Cancer Management
o Exam Room
- Sinusitis
- Refractory Angina Pectoris
o User Support
==========================
________________________________
FEATURE ARTICLES ADDED THIS WEEK
Medscape's Feature Articles include links to related
clinical
information on the World Wide Web.
o Gynecology Case Challenge - Spotting and Abnormal Cervix in a
Young Woman on Oral Contraceptives
-------------------------------------------------------------
A 22-year-old primiparous woman on oral contraceptives is
referred to you for "spotting after intercourse" and an
"abnormal-appearing cervix." What is your diagnosis and
treatment plan? [Medscape Women's Health 1(8), 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#1>
o Metabolic Bioactivation Can Cause Idiosyncratic Drug Reactions
-------------------------------------------------------------
Evidence suggests that bioactivation of drugs to form toxic
reactive metabolites is one mechanism by which idiosyncratic
drug reactions may be mediated. Identification of these active
metabolites could allow for the development of safer
therapeutic agents, and also might help target which patients
are at high risk. [Drugs & Ther. Perspect. 9(10): 11-13,
1997]
<http://www.medscape.com/Home/MedPulse/082997.html#2>
o New Orleans Citywide Rounds - Skin Lesions and Pulmonary
Infiltrates in a Patient With AIDS
-------------------------------------------------------------
A 43-year-old man with AIDS presented with a one-week history
of nonproductive cough and subjective fever. The patient
also
noted nodular skin lesions. [Infect Med 14(8): 596-605, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#3>
o Improving Oxygen Utilization in Septic Patients
-------------------------------------------------------------
Therapeutic oxygen can play an important role in the treatment
of septic patients. Although empiric guidelines are available,
actual needs are difficult to assess. This article focuses
on
the methods used to assess tissue and organ oxygen needs.
[Comp Surg, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#4>
o Prolonged Magnesium Sulfate Infusion in the Treatment of
Ventricular Tachycardia in Acquired Long QT Syndrome
-------------------------------------------------------------
The anti-arrhythmic agent magnesium sulfate is known to be
effective in suppressing Torsade de Pointes (TdP). Slow
infusion rates may reduce the adverse effects and negative
inotropy while maintaining efficacy.
[Clin. Drug. Invest 13(5): 229-236, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#5>
o Evolving Infectious Complications in Patients With Hemophilia
-------------------------------------------------------------
Technologic advances have changed the spectrum of infections
faced by people with hemophilia. These include complications
of worsening HIV-immunosuppression, central line infections,
and infections with parvovirus B19 and hepatitis A virus.
[Infect Med 14(8):619,623,624,631-633, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#6>
o Chromosomal Abnormalities and Bipolar Affective Disorder:
Velo-Cardio-Facial Syndrome
-------------------------------------------------------------
A majority of patients with velo-cardio-facial syndrome
(VCFS) -- a genetic disorder with distinctive facial
dysmorphology and other physical abnormalities -- also have
bipolar disorder or other serious psychiatric disorders.
By
studying the genetic defects in these patients, it is possible
we may gain insight into one or more of the genes underlying
a
common psychiatric illness. [Medscape Mental Health 2(8),
1997]
<http://www.medscape.com/Home/MedPulse/082997.html#7>
o Furuncular Myiasis of the Scrotum
-------------------------------------------------------------
A 32-year-old man presented with a unique case of genital
myiasis, a condition that very rarely originates within the
US. [Infect Urol 10(4):102-104, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#8>
o Issues in Drug Benefit Management - Are Rebates Going Away?
-------------------------------------------------------------
"Are rebates going away?" is the question posed by Debi
Reissman, PharmD. She thinks probably not, but that
the game
surrounding the negotiation and final contract is ever
changing -- and the players are getting more skeptical.
[Drug Benefit Trends 9(8): 12-13, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#9>
o Pneumonia in the Elderly: Diagnostic and Therapeutic
Challenges
-------------------------------------------------------------
Pneumonia is the fourth leading cause of death in the elderly.
The development of pneumonia in the elderly differs from
that
in younger patients, requiring an organized approach to
assessment and treatment. [Infect Med 14(8):643-654, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#10>
o Ventricular Pacing With a Novel Gastroesophageal Electrode:
A Comparison With External Pacing
-------------------------------------------------------------
Now -- due to the development of a novel gastroesophageal
electrode -- stable ventricular pacing can be reliably achieved
without the technically-demanding placement of endocardial
electrodes, and without the damaging effects of the high
current requirements of transcutaneous pacing. This
gastroesophageal electrode may be useful in the emergency
management of acute bradyarrhythmias.
[Am Heart J 133(6): 674-680, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#11>
o Prepregnancy Counseling for Primary Care Physicians
-------------------------------------------------------------
By the time a woman realizes she is pregnant, the fetus may
already have been subjected to deleterious genetic,
environmental, and lifestyle influences. Thus, women
contemplating pregnancy should receive counseling that covers
such topics as genetic risks, appropriate and inappropriate
drug use, proper nutrition, and immunizations.
[Hospital Medicine 33(6):28-35,38-40, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#12>
o Prompt Control of Asthma Essential: The Emphasis From the
New US and UK Guidelines
-------------------------------------------------------------
The use of aggressive therapy to establish prompt control
at
the onset of asthma is one of the key recommendations in
new
asthma guidelines released in the US and UK recently.
[Drugs & Ther. Perspect. 9(8):6-8, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#13>
o Assessing Effects of Potent Combination Therapy on Tissue
Viral Load
-------------------------------------------------------------
Can HIV be eradicated from an individual? Four experts discuss
the background, rationale, and feasibility of HIV eradication
in articles adapted from an AmFAR symposium held at Georgetown
University Medical Center in Washington, DC, on January 23,
1997. [AIDS Reader 7(4):123-125,129, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#14>
o What Should a Doctor Do?
-------------------------------------------------------------
An ethicist could not have thought up a greater challenge:
A critically injured, underage patient needs spinal surgery.
She is also pregnant and anemic, and refuses a blood
transfusion on religious grounds. One hospital's approach
to
this complex ethical dilemma is discussed.
[Hippocrates 11(7): 34-38, 40-42, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#15>
o Grand Rounds - A 51-Year-Old Man With Dysphagia
-------------------------------------------------------------
Recent weight loss and difficulty swallowing prompted this
patient to seek medical evaluation. The differential diagnosis
list was long, but a thorough history and physical
examination helped these clinicians get to the source of
the
problem quickly. [Clin. Review 7(7): 175-181, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#16>
o Offset Acetabular Components in Total Hip Arthroplasty
-------------------------------------------------------------
The primary indication for offset implants is to restore
the
center of rotation of the reconstructed hip to the true
acetabular region or anatomic hip center. This variation
of
the acetabular component adds a level of complexity and
versatility to primary and revision arthroplasty.
[Medscape Orthopedics 1(8), 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#17>
o Mechanisms of Food Allergy
-------------------------------------------------------------
Today's generation of studies in the field of food allergy
examine not only signs and symptoms, but also allergens and
mediators. This research has spawned a new generation of
diagnostic tests and resolved the spectrum of adverse food
reactions into discrete phenomena with similar clinical
presentations but significantly different etiologies at the
level of molecular biology.
[Medscape Respiratory Care 1(8), 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#18>
o Polycystic Kidney Disease: An Unrecognized Emerging
Infectious Disease?
-------------------------------------------------------------
Polycystic kidney disease (PKD) is one of the most common
genetic diseases in humans. It may also be an emerging
infectious disease or microbial toxicosis that expresses
itself in a vulnerable human subpopulation.
[Emerging Infectious Diseases 3(2):113-127, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#19>
o Drug Information Services in the Managed Care Setting
-------------------------------------------------------------
The shift toward managing costs associated with quality care
in the healthcare system has expanded the role of the
pharmacist as a Drug Information specialist.
[Drug Benefit Trends 9(8): 33-40, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#20>
==========================
____________________________________
ARTICLES AND COLUMNS ADDED THIS WEEK
o Clinical Characteristics and Long-Term Outcome of Patients in
Whom Congestive Heart Failure Develops After Thrombolytic
Therapy for Acute Myocardial Infarction: Development of a
Predictive Model
-------------------------------------------------------------
Ischemic heart disease is the most common cause of congestive
heart failure, which often begins after acute myocardial
infarction. To better delineate the clinical characteristics
and outcomes of patients in whom congestive heart failure
develops after acute myocardial infarction in the thrombolytic
era, we prospectively evaluated patients enrolled in six
of
the TAMI trials. [Am Heart J 133(6): 663-673, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#21>
o Charting the New Oncology Landscape
-------------------------------------------------------------
The ACCC's 23rd Annual National Meeting, held March 19-22,
1997 offered 500 physicians, cancer program administrators,
nurses, and medical directors expert presentations about
the
transformations taking place within healthcare and the
far-reaching effects these changes will have on hospitals,
oncology practices, and cancer patients. This new landscape
features dramatic attempts to cut costs and threats to patient
access to quality cancer care.
[Oncology Issues 12(3): 28-33, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#22>
o Current Abstracts - Viral Vectors in Cystic Fibrosis Gene
Therapy
-------------------------------------------------------------
What's new in the use of viral vectors in cystic fibrosis
gene therapy? Find out in this easy-to-navigate collection
of recent MEDLINE abstracts compiled by the editors
at
Medscape Respiratory Care.
[Medscape Respiratory Care 1(8), 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#23>
o Comparison of the Plasma, Urine and Blister Fluid
Pharmacokinetics of Clarithromycin and Azithromycin in
Normal Subjects
-------------------------------------------------------------
Macrolide antibiotics have a relatively low degree of
ionization and are highly lipid soluble. Both of these
characteristics contribute to their extensive tissue
penetration. This study was undertaken to estimate and compare
the plasma/serum and urinary pharmacokinetic parameters of
clarithromycin, its active metabolite 14-OH clarithromycin,
and azithromycin, as well as the effect of inflammation on
drug delivery to a tissue site.
[Clin. Drug. Invest 13(3): 152-161, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#24>
o How to Explain Fees to Speed Up Payment
-------------------------------------------------------------
As employers look for more cost-effective ways to provide
health insurance coverage for their employees, they are
changing insurance coverage more frequently. Five years ago,
patients retained the same insurance coverage for many years.
Now it's common in some areas for patients to change coverage
as frequently as every two years.
[Medical Practice Communicator 4(4):5, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#25>
o Current Abstracts - Incidence and Prevalence of Alzheimer's
Disease
-------------------------------------------------------------
What's new in the incidence of Alzheimer's disease? Find
out
in this easy-to-navigate collection of recent MEDLINE abstracts
compiled by the editors at Medscape Mental Health.
[Medscape Mental Health 2(8), 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#26>
o Current Abstracts - Osteomyelitis of the Spine
-------------------------------------------------------------
What's new in osteomyelitis of the spine? Find out
in this
easy-to-navigate collection of recent MEDLINE abstracts
compiled by the editors at Medscape Orthopedics and Sports
Medicine. [Medscape Orthopedics & Sports Medicine, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#27>
o No Effect of Miglitol on the Oral Bioavailability of
Single-Dose Phenytoin in Healthy Males
-------------------------------------------------------------
A study designed to determine whether multiple doses of
miglitol 100mg affected the oral bioavailability of a single
dose of phenytoin 400mg when concomitantly administered to
healthy volunteers. [Clin. Drug. Invest 13(3): 171-174, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#28>
o Current Abstracts - Biochemical Markers for Disease
Progression in Dilated Cardiomyopathy
-------------------------------------------------------------
What's new in biochemical markers for disease progression
in
dilated cardiomyopathy? Find out in this easy-to-navigate
collection of recent MEDLINE abstracts compiled by the editors
at Medscape Cardiology. [Medscape Cardiology, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#29>
o Allograft Aortopathy: An In Vivo Study of Donor Aorta
Involvement in Cardiac Allograft Vaculopathy
-------------------------------------------------------------
Limited histopathologic studies of failed cardiac allografts
have demonstrated that cardiac allograft vasculopathy extends
into the donor aorta; however, no study has examined the
development of allograft aortic intimal proliferation in
vivo
in conjunction with coronary intimal hyperplasia.
[Am Heart J 133(6): 698-702, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#30>
o Current Abstracts - Effect of Policy Guidelines on Breast
Cancer Management
-------------------------------------------------------------
In this regular feature, members of the editorial board at
Medscape Oncology scan MEDLINE to provide a brief list of
recent abstracts on a specific topic. This week's focus
is
the effect of policy guidelines on breast cancer management.
[Medscape Oncology, 1997]
<http://www.medscape.com/Home/MedPulse/082997.html#31>
==========================
_________
EXAM ROOM
Check into Medscape's "Exam Room"
and test yourself with
dozens of challenging self-assessment
features, including
Today's Question and PicTours (click
on an image, and make
a diagnosis today).
o Today's Question -- Questions posted this week
-------------------------------------------------------------
? What is the clinical presentation of sinusitis?
<http://www.medscape.com/Home/MedPulse/082997.html#32>
? What is the recommended treatment for medically and
surgically refractory angina pectoris?
<http://www.medscape.com/Home/MedPulse/082997.html#33>
==========================
_______________
CONTENT SOURCES
o Medscape compiles articles and medical news from the following
sources:
-------------------------------------------------------------
American Heart Journal; The AIDS Reader; CareNotes; Clinical
Drug Investigations; Clinician News; Clinician Reviews;
Complications in Orthopedics; Complications in Surgery;
Consumer Health USA; Drug Benefit Trends; Drugs & Therapy
Perspectives; Emerging Infectious Diseases; European
Menopause Journal; Hippocrates; Hospital Medicine; Infections
in Medicine; Infections in Urology; Medical Practice
Communicator; Medical Tribune: Family Practice; Medical
Tribune: Internist & Cardiologist; Medical Tribune:
Obstetrician & Gynecologist; Morbidity & Mortality
Weekly
Report; Oncology Issues; Pediatric Pharmacotherapy Newsletter;
Medscape Electronic Journals: Mental Health, Women's Health,
Orthopedics & Sports Medicine, Respiratory Care, Oncology,
Cardiology
o Contributing Publishers include:
-------------------------------------------------------------
SCP Communications, Inc.; MICROMEDEX, an International
Thomson Co.; Clinicians Publishing Group; Healthcare Media
International; Medscape, Inc.; Mosby-Year Book, Inc.; Oryx
Press; PMSI; Quadrant; Time Inc, Health; Jobson Publishing;
University of Virginia; Association of Community Cancer
Centers; Adis International; US Centers for Disease Control
and Prevention
==========================
____________
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