This is a NEJM case report.  Take a look at the photo of the urine.  Looks more like pea soup.
http://omniphysicians.com/2008/03/13/the-case-of-the-green-urine/
Inhalant abuse among adolescents is on the upswing.  We’re talking about products ranging from “shoe polish, glue, aerosol air fresheners, [and] hair sprays,” to “nail polish, paint solvents, degreasers, gasoline, and lighter fluid.”  Keep this in mind when kids are brought in acting “strange.”
http://omniphysicians.com/2008/03/14/inhalants-among-kids/
Do you remember that an FDA panel was going to meet Thursday and vote on what to do about anemia drugs that are often used adjunctively in the treatment of cancer patients?  Well, they met.  First, they all burnt their Emperors Club membership cards and then they voted to restrict the use of these drugs because of the risk of worsening the cancer.
http://omniphysicians.com/2008/03/14/fda-places-restrictions-on-anemia-drugs/
The Journal of Clinical Pharmocology published a study concluding that ibuprofen counteracts the anti-platelet potential of aspirin. 
http://omniphysicians.com/2008/03/14/ibuprofen-aspirin/
This is a news report about a study published in Lancet.  A small series showed that using absorbable stents instead of metallic stents in the coronary arteries work.  Apparently, re-stenosis occurs within 6 months and so, in theory, the use of a stent should be temporary.  Obviously, multiple larger series are needed in the future and they are now underway.
http://omniphysicians.com/2008/03/14/absorbable-stents/
Across Europe and here, there is an overuse of antibiotics in the treatment of sinusitis.  Prescribing antibiotics is one easy way of getting these patients out of the ER early, but is it good medicine? 
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As per HealthDay (3/13, Reinberg), a report released by the National Inhalant Prevention Coalition indicates that “[i]nhalants are being used more often than marijuana or prescription painkillers by kids on the brink of being teenagers.”  The survey, which includes data collected between 2002 and 2006, revealed that “[i]n the past year, 3.4 percent of 12-year-olds report using an inhalant, while only 1.1 percent tried marijuana, and 2.7 percent took prescription painkillers.”  Children abused products ranging from “shoe polish, glue, aerosol air fresheners, [and] hair sprays,” to “nail polish, paint solvents, degreasers, gasoline, and lighter fluid.”

        Overall, the “combined data showed that an annual average of 593,000 adolescents had used inhalants for the first time in the year before the survey,” added WebMD (3/13, Colihan).  The report also suggests that as they aged, children “chose inhalants as a ‘gateway’ drug to other illicit drugs.”  Still, H. Westley Clark, M.D., the director of the Substance Abuse and Mental Health Statistics’s Center for Substance Abuse Treatment, said that “[i]nhalants are a health hazard that can damage the brain, heart, liver, or kidneys,” and can “even [result in] death.”

MedPage Today (3/13, Smith) reported that according to a study published in the Mar. issue of the Journal of Clinical Pharmacology (JCP), “[f]or secondary stroke prophylaxis, ibuprofen nearly cancels out the antiplatelet benefit of aspirin.” Francis Gengo, Pharm.D., of the University of Buffalo, and colleagues, found that “[t]he combination markedly reduces aspirin’s antiplatelet effect to the point that patients taking both may have essentially normal platelet aggregation for up to 20 hours a day.” In an earlier issue of the JCP, the researchers reported that “[t]aking both drugs together ‘can have clinical consequences for patients taking aspirin.’” In the new study, Gengo and colleagues “found that among patients who had a recurrent cerebral ischemic event, 66 percent were non-responsive to aspirin.” The researchers “found that taking a non-selective non-steroidal anti-inflammatory drug along with aspirin significantly increased the odds (P=0.001) of a recurrent event.”

THURSDAY, March 13 (HealthDay News) — A polymer stent that is quietly absorbed by the body after it has done its job of keeping a coronary artery open has worked well in an international trial, researchers report.

The stent was successfully implanted in 29 of 31 attempts, the report said. In a one-year follow-up, none of the arteries in which the bio-absorbable stent had been implanted had closed again. One of the 30 people given the stent had a heart attack during that time, but no other adverse events were reported, according to the report in the March 15 issue of The Lancet.

A major clinical trial of the experimental stent is under way in several countries, said Karin Bauer, a spokeswoman for Abbott Laboratories, the company that developed the device. Plans for a U.S. trial are in the preliminary stages, she said.

“We currently are looking at the safety and feasibility of using the bio-absorbable stent platform in patients here,” Bauer said. “Once we have completed the international trial, we will look at the feasibility of bringing such a trial to the United States, but we haven’t made any decision as to when that might be.”

The new stent has a backbone of lactic acid. It also is coated with everolimus, a drug that prevents formation of scar tissue.

Traditional stents are wire metal mesh tubes used to prop open an artery during angioplasty, a procedure done to clear blockages from the blood vessel.

An absorbable stent has many potential advantages, said Dr. Patrick W. Serruys, a professor of medicine and interventional cardiology at Erasmus Medical Center in Rotterdam, the Netherlands, one site of the international trial. Other sites are located in Denmark, Poland and New Zealand.

“The so-called restenosis process takes place in the first six months, so there is no need to have a permanent scaffolding device,” Serruys explained. Restenosis is the reclosing of an artery, which can occur after a metal stent is implanted.

The polymer of which the Abbott stent is made breaks down to form carbon dioxide and water, “so you don’t have a permanent foreign body in the blood vessel,” he said. “That gives you more flexibility in the vessel. And some metallic stents are breaking, and the fracture of the metal creates some unpleasant reactions.”

Because the polymer stent disappears, “many years later you are still able to work on the vessel,” Serruys added. “You don’t have a metallic cage that limits expansion of the vessel.”

But there is a need for long-term follow-up of the experimental stent, he said, adding, “probably five or seven years down the road. Whenever you have a long-term follow-up, you can make a second attempt with the design. It will be a long process.”

Still, Serruys said he was “impressed and amazed by the fact that the first attempt was so successful.”

A second trial of a new version of the stent is in the planning stage, said study co-investigator Dr. John A. Ormiston, one of New Zealand’s top interventional cardiologists and president of the Asia-Pacific Society of Interventional Cardiology. It will be done at the same sites as the first study, and will also have 30 stent recipients.

“There have been important design modifications,” Ormiston said of the stent in the new trial. “The scaffold will be different so that it will be stronger. We think we might get even better results than we’ve had so far.”

The trial could begin later this year. If it succeeds, it would be the prelude to a larger international trial that could lead to approval of the new stent for medical use, Ormiston said.

Reuters, 3/14/08:  Doctors are overprescribing antibiotics for common sinus infections and related conditions, possibly in the false belief they may help in cases where symptoms are protracted, researchers reported on Friday.Bacteria can cause rhinosinusitis — an inflammation of the sinuses — but a virus such as the common cold is often a more likely culprit so antibiotics seldom work, the researchers reported in the journal Lancet.

Yet doctors still dole out the drugs more than they should. In the United States, for instance, 80 percent of sinus patients are prescribed an antibiotic while the proportion ranges from 72 percent to 92 percent in Europe.

“What tends to happen in practice is when patients have had symptoms for a while and go see their family doctor, the doctor assumes they have a bacterial infection and gives them antibiotics,” said James Young, a statistician at the University Hospital Basel, who led the study.

“Our results show that is not a very good strategy.”

Moderating antibiotics, which are useless against viruses, is critical because overuse of drugs is contributing to the rapid rise of drug-resistant bacteria, he added.

“The underlying idea is the increasing resistance of bacteria to antibiotics,” Young said in a telephone interview. “That is fundamentally the problem, which means we need to limit the use of antibiotics to when they are really needed.”

Analysis of nine previous studies did not show why doctors are overpresribing, but a false belief that antibiotics may help if symptoms are long-lasting may be influencing doctors, he added.

“What we can show is that the length of symptoms reported by the patient does not reliably distinguish between viral and bacterial infection, Young said.

Instead doctors should watch and wait for longer to see if antibiotics are truly needed, because viral infections — as well as bacterial ones — can last for weeks, the researchers said.

In their analysis, the researchers looked at more than 2,500 people with sinus infection-type complaints who had been treated with an antibiotic or a placebo.

Then they set a statistical model using that data to show that doctors would have to give 15 people the drugs before an additional patient was cured. This showed the drugs were not likely to help fight sinus infection-type symptoms, Young said.

“Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days,” the researchers said.

HealthDay (3/13) reported that “U.S. health officials are no longer recommending the combination MMRV (measles, mumps, rubella, and varicella) vaccine over the MMR vaccine and a separate varicella vaccine for kids.”

The move “comes after new data show[ed] that the MMRV shot increase[d] the risk for febrile seizure[s],” which “are convulsions brought on by fever” in “children aged 12 to 23 months,” according to a report published in the Mar. 14 issue of the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. But, Paul A. Offit, M.D., director of the Vaccine Education Center and chief of infectious diseases at the Children’s Hospital of Philadelphia, said, “The attributable risk of fever is still quite low.” Another reason for the change is the fact that due to “manufacturing difficulties, the MMRV shot, made by Merck, won’t really be available until about this time next year.”

NY Times, 3/14/08: A federal advisory panel, in response to mounting safety concerns, called Thursday for additional restrictions on the use of anemia drugs by cancer patients.

The recommendation by a committee that advises the Food and Drug Administration could lead to an additional decline in sales for the drugs — Aranesp, made by Amgen, and Procrit by Johnson & Johnson.

But the two companies dodged their worst fear — a recommendation that the drugs not be used by any cancer patients. That probably would have meant the loss of at least $1 billion in sales for each company.

The meeting was held because eight clinical trials have suggested that the drugs might make cancer worse for some patients or even shorten their lives.

The difficulty for the committee was that those studies involved high doses of the drugs. There was very little solid information on whether the drugs are dangerous at doses typically used by cancer doctors.

Faced with that dilemma, the panel voted 13 to 1 that the drugs remain available for use by many patients who suffer anemia because of the chemotherapy they receive to treat cancer.

However, the committee then voted 9 to 5 that the drugs should not be used by patients with either breast cancer or head and neck cancer because of evidence that the drugs’ risks are greatest for those cancers.

The committee also voted 11 to 2, with 1 abstention, to recommend avoiding use of the drug by patients being treated with the intent to cure their cancers. The definition of that category is vague, but it generally refers to patients with early-stage cancer who are undergoing chemotherapy after surgical removal of a tumor, in which the doctors hope the cancer has been eliminated.

The F.D.A. itself is expected to revise the labels of the drugs in consultation with the manufacturers. The agency does not have to adhere to the recommendations of its advisory committees, although it usually does.

Amgen’s shares rose during the meeting and peaked at $48.55 after the committee voted against the prohibition for all cancer use. But then the stock started falling as the committee voted for the other restrictions. Still, the stock closed at $47.18, up nearly 5 percent for the day.

Shares of Johnson & Johnson, which is not as reliant on the drugs, closed up 26 cents, to $62.81.

Sales of the anemia drugs have already been plummeting because of safety concerns and payment restrictions by Medicare and other insurers. Sales of Aranesp fell 12 percent, to $3.6 billion, in 2007, down from $4.1 billion the year before. In the fourth quarter alone, the drop was 25 percent. The sales slump has forced Amgen to cut its work force.

Even with the decline, Aranesp was still a significant part of Amgen’s total 2007 revenue of $14.8 billion.

Amgen has said that $1.55 billion of its Aranesp sales last year were for cancer use in the United States and an additional $550 million for cancer use in other countries. Most of the rest of the use was to treat anemia stemming from kidney disease.

The use of the drugs on kidney patients was not the subject of Thursday’s meeting. Amgen’s other anemia drug, Epogen, is primarily used for kidney dialysis patients.

Johnson & Johnson had sales of $2.9 billion last year for Procrit, an anemia drug it makes under license from Amgen. Amgen and Johnson & Johnson, which made a joint presentation to the committee, argued strenuously that the drugs should remain available because they help chemotherapy patients avoid blood transfusions, which carry their own risks of infections and other side effects. The risk of contracting AIDS or hepatitis from a transfusion has declined significantly in recent years, they said, but other, as yet unknown, pathogens might arise.

“The known risks of blood transfusions are less today than yesterday,” Dr. William Hait, a Johnson & Johnson executive, told the panel. “We do not know if that will be true tomorrow.”

The companies proposed some new changes in the drugs’ labeling that would reduce their use somewhat, but less than if the drugs were barred completely for certain cancers.

One change proposed by the companies was that physicians be advised to wait longer before starting use of the drugs. The label would say that anemia treatment should not start until a patient’s hemoglobin — the oxygen-carrying component of red blood cells — drop to 10 grams per deciliter of blood. Now physicians often start when hemoglobin drops below 11.

The companies also proposed that use of the anemia drugs be halted if patients did not respond to them. And they proposed steps to better inform patients of the risk.

But Dr. Vinni Juneja, an F.D.A. official, said in his presentation that the drugs did not totally eliminate the need for transfusions but only reduced them by about 50 percent. So many patients are being exposed to the possible risks of the drugs while only some patients avoid the transfusions, he said.

The advisory panel meeting was the third the F.D.A. has convened on the risks the anemia drugs may pose to cancer patients. The first was in 2004 and the second last May.

Thursday’s meeting was prompted by two new clinical trials, one for patients with breast cancer and the other for cervical cancer, which suggested risks. But the excess death rate among those who received the anemia drugs in those trials was not statistically significant.

That led one panel member, Dr. Michael Perry of the University of Missouri, to wonder why the F.D.A. was so concerned, because the agency usually ignores data that is not statistically significant.

“I want to make sure that everyone’s tried by the same judge and the same jury,” Dr. Perry said.

F.D.A. officials said they have a lower threshold for concern on safety signals than for data trying to prove a drug works.