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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:1375.
What Killed Mozart?
Wolfgang Mozart had been sick for 2 weeks prior to his death in 1791.
Several people in Vienna at that time had many of the same symptoms as Mozart
(fever, rash, edema without dyspnea, inflamed extremities, all with clear
mentation). Various articles have suggested arsenic poisoning, acute rheumatic
fever, renal failure, Henoch-Schönlein purpura, and infective endocarditis
as possible causes. In this article, Hirschmann suggests
a new theory about Mozart's death.
(SEE ARTICLE)
Consequences of Asymptomatic Bacteriuria in Women With Diabetes Mellitus
In this study of 636 diabetic women with and without asymptomatic bacteriuria, Geerlings et al monitored their tendency to develop urinary
tract infections (UTIs), renal function disturbances, and secondary diabetic
complications during 18 months of follow-up.
(SEE ARTICLE)
Is Patients' Perception of Time Spent With Physician a Determinant
of Ambulatory Patient Satisfaction?
The results of this study by Lin et al showed
that most patients surveyed in an academic primary care clinic spent more
time with their physician than expected. Satisfaction correlated with time
spent. Physicians felt rushed in 10% of visits although this was rarely detected
by patients.
(SEE ARTICLE)
Endoscopy for Acute Nonvariceal Upper Gastrointestinal Tract Hemorrhage:
Is Sooner Better?
There is a lack of consensus regarding the ideal time to perform upper
endoscopy after a patient presents with nonvariceal upper gastrointestinal
tract hemorrhage (UGTH). Early endoscopy has been advocated for its ability
to provide prompt diagnosis, risk stratification, and therapeutic hemostasis,
yet opponents contend that scant evidence exists to support a mortality benefit,
regardless of timing. They note that a policy of early endoscopy may be difficult
and expensive to implement. In this systemic review of the literature, Spiegel et al found that early endoscopy is safe and effective
for all risk groups, and may reduce the financial burden of hospital length-of-stay.
(SEE ARTICLE)
Use of Statins and the Subsequent Development of Deep Vein Thrombosis
Some of the benefit of statins in preventing cardiovascular disease
may be their antithrombotic properties. Little is known about the effect of
these drugs on the development of deep vein thrombosis (DVT). Ray et al conducted a retrospective cohort study of 125 862 men
and women aged 65 years and over. They found that prescribed statins were
associated with a 22% relative reduction in the risk for DVT compared to control
subjects. This benefit appeared to be only significant in women. Prescription
of nonstatin lipid-lowering agents was not associated with a decrease in DVT
risk. A randomized clinical trial might optimally evaluate the efficacy of
statins for the primary and secondary prevention of DVT.
(SEE ARTICLE)
Echocardiographic Examination of Women Previously Treated With Fenfluramine:
Long-term Follow-up of a Randomized, Double-blind, Placebo-Controlled Trial
In this study by Davidoff et al, the authors
studied 619 women previously randomized to fenfluramine or placebo as part
of a smoking cessation study. Echocardiograms were performed up to 4.9 years
after fenfluramine therapy of 3 months' duration. There were no significant
differences in the prevalence of aortic or mitral regurgitation, or in aortic
or mitral mobility or thickening. There were also no differences in clinical
cardiovascular status. There was no evidence of drug-related heart disease
up to 4.9 years after anorexigenic therapy in patients randomly assigned to
receive fenfluramine at the recommended dose for up to 3 months.
(SEE ARTICLE)
Postmenopausal Estrogen Use, Type of Menopause, and Lens Opacities:
The Framingham Studies
In this study, Worzala et al used the Framingham
Heart and Eye Study data to examine the relationship between postmenopausal
estrogen use and the occurrence of age-related lens opacities (nuclear, cortical,
and posterior subcapsular). The study included 529 women aged 66 to 93 years.
Longer duration of postmenopausal estrogen therapy was inversely associated
with the presence of nuclear lens opacities. Women who had estrogen for 10
years or longer had a 60% reduction in risk compared with nonusers. The risk
of posterior subcapsular opacities was significantly increased for women who
had undergone surgical menopause compared with women who had natural menopause.
Age at menopause was not associated with the occurrence of lens opacities.
(SEE ARTICLE)
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