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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2007;167(18):1921.
Pharmacologic Management of Painful Bladder Syndrome/Interstitial Cystitis
Painful bladder syndrome/interstitial cystitis is a poorly defined clinical condition characterized by 3 key symptoms: pelvic pain, urinary urgency, and frequency. Dimitrakov et al performed a systematic literature review of pharmacological treatments. Data from 21 randomized controlled trials involving 1470 adult patients were analyzed. Pentosan polysulfate appears modestly effective with a relative risk for patient-reported improvement in symptoms of 1.78 (95% confidence interval, 1.34-2.35). While preliminary data suggest that dimethyl sulfoxide and amitriptyline may also be beneficial, more evidence is needed.
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Effect of Pneumococcal Vaccination in Hospitalized Adults With Community-Acquired Pneumonia
The 23-valent polysaccharide pneumococcal vaccine has been available for 25 years, and guidelines recommend it for adults at increased risk of pneumonia. However, the vaccine is underused, perhaps because of the controversy regarding its ability to prevent pneumonia. Johnstone et al hypothesized that the vaccine might still improve outcomes for vaccinated patients who go on to develop pneumonia. In a cohort of 3415 hospitalized patients with pneumonia, they found that previous vaccination was associated with a significant 40% reduction in mortality or intensive care unit admission. Only 9% of eligible patients were vaccinated before discharge. They conclude that their findings further emphasize the importance of adopting current adult pneumococcal vaccination guidelines.
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Body Mass Index and Episodic Headaches
After interviewing 24 000 individuals with headache selected to be representative of the US population, Bigal et al found that obesity was related to increased frequency of attacks in individuals with migraine but not probable migraine or tension-type headache. The disability of individuals with migraine, but not the other headache types, also varied as a function of body mass index. These findings support the concept that obesity is an exacerbating factor for migraine and not for headaches overall.
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Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial
Gheorghiade et al evaluated the prognostic value of hyponatremia, which is relatively common in patients hospitalized for heart failure and known to predict worse outcomes, in the context of the patient's clinical course and changes in serum sodium concentration during hospitalization. They analyzed the data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial conducted to evaluate the utility of a pulmonary artery catheter in guiding therapy in patients hospitalized with New York Hospital Association class IV heart failure due to systolic dysfunction. Their results suggest that persistent hyponatremia is an independent predictor of mortality, rehospitalization, and death or rehospitalization at 6 months despite clinical and hemodynamic improvements that were similar to those in patients without hyponatremia.
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Short- and Long-term Mortality With Localized Prostate Cancer
Randomized clinical trials have not yet determined which treatment gives the best chance of survival for patients with localized prostate cancer. Currently, only results from well-conducted population-based observational studies can fill this gap. This population-based study including 844 patients with localized prostate cancer aims to evaluate the effect of prostatectomy, radiotherapy, watchful waiting, and hormone therapy on long-term cancer mortality after adjusting for treatment determinants and prognostic factors. Treatments slightly influenced 5-year prostate cancer–specific mortality but had an important impact on 10-year mortality. Compared with patients who underwent surgery, those who received radiotherapy or watchful waiting had a 2-fold increased risk to die from disease after accounting for patient selection bias. This study strongly suggests that surgery offers the best chance of long-term prognosis, particularly for young patients and patients with poorly differentiated tumor.
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