Randy Frey

Red Hot Chile Seniors?

When it comes to entitlement programs, who can beat Lo Prado, a working-class suburb of Chile's capital city, Santiago? There, the mayor is handing out free 50-mg Viagra pills to senior citizens who are doctor certified as suffering from erectile dysfunction. No health insurance coverage is needed, but the afflicted age-60-plus citizens do have to register with the Lo Prado health service. Mayor Gonzalo Navarrete, who is a physician and former director of Chile's Institute of Public Health, said that he started the program because “an active sexuality improves the overall quality of life,” and that other mayors in the Santiago area have told him they plan similar programs. The Bureau of Indications' South American office will monitor next year's birth rates in the region.

Bread Mold for Better Health

Certain mold cells have a nifty mechanism that protects the mold organism from genetic abnormalities. Seems some University of Missouri researchers have isolated this “meiotic silencing” device, and see potential for its application in us higher life forms to protect against nasties like the HIV virus. When one chromosome in a pair has an extra gene not found in its partner chromosome, it is a good indication of an intruder, and the fungus will “turn off” all copies of that gene during the sexual process known as meiosis. For this “show me” breakthrough, the Missouri scientists received the Beadle and Tatum Award (named after Nobel Prize-winning geneticists George Beadle and Edward Tatum) for outstanding and original research by a scientist using Neurospora, a type of bread mold. So, the next time you find mold on your sandwich, don't say “Eeeww!” Say “Eureka!”

Hypertension: Stink-Bomb It Away

British researchers (at King's College London and Peninsula Medical School, Exeter) have created a drug that pumps up the volume of hydrogen sulfide gas in the body. Testing on laboratory rats showed that the pungent gas is good at widening arteries, hence significantly lowering blood pressure. Although the scientists' article in Circulation proclaimed the potential of “an entirely new therapeutic approach for the treatment of hypertension,” we are grateful that the authors also foresee the need for much more research, including safety tests. After all, if the gas responsible for rotten-egg odors were to run rampant in some patients and escape, the environmental side effects might again evoke that Hindenberg hydrogen-type disaster cry, “Oh, the humanity!”

Immunity? It's a Swamp Thing

Louisiana biochemists are working not on gaseous cures but on proteins from alligator blood to help fight the infectious ills of humanity. With MRSA-like complications in burns and diabetic ulcers gaining resistance to antibiotics, “The goal of our project is to find the proteins that lead to the exceptionally strong innate immune system in alligators,” said one of the researchers, Kermit Murray, Ph.D., a chemistry professor at Louisiana State University, Baton Rouge. In lab studies, gator white-blood-cell extracts killed not only MRSA but several strains of Candida albicans, and showed considerable promise as well against HIV. The unanswered research question: How long does a scientist have to wrestle the gator before it consents to give blood?

Is It Sport, or Is It Research?

Now, we know that early-morning fun runs aren't for everyone, but when a bunch of emergency docs pick dodgeball as the extracurricular sport at their annual meeting, are they looking for exercise or for professional practice? The Society for Academic Emergency Medicine held its meeting in Washington last month, and no fewer than 16 teams signed up for the SAEM dodgeball tournament—the proceeds of which, it is noted, are donated to the SAEM Research Fund. The requisite waiver form states, “I assume all risk of injury to my person and property that may be sustained in connection with any activity including the tournament or pickup games.” No word on whether damaged limbs or concussed craniums are considered the property of the Research Fund.

Red Hot Chile Seniors?

When it comes to entitlement programs, who can beat Lo Prado, a working-class suburb of Chile's capital city, Santiago? There, the mayor is handing out free 50-mg Viagra pills to senior citizens who are doctor certified as suffering from erectile dysfunction. No health insurance coverage is needed, but the afflicted age-60-plus citizens do have to register with the Lo Prado health service. Mayor Gonzalo Navarrete, who is a physician and former director of Chile's Institute of Public Health, said that he started the program because “an active sexuality improves the overall quality of life,” and that other mayors in the Santiago area have told him they plan similar programs. The Bureau of Indications' South American office will monitor next year's birth rates in the region.

Bread Mold for Better Health

Certain mold cells have a nifty mechanism that protects the mold organism from genetic abnormalities. Seems some University of Missouri researchers have isolated this “meiotic silencing” device, and see potential for its application in us higher life forms to protect against nasties like the HIV virus. When one chromosome in a pair has an extra gene not found in its partner chromosome, it is a good indication of an intruder, and the fungus will “turn off” all copies of that gene during the sexual process known as meiosis. For this “show me” breakthrough, the Missouri scientists received the Beadle and Tatum Award (named after Nobel Prize-winning geneticists George Beadle and Edward Tatum) for outstanding and original research by a scientist using Neurospora, a type of bread mold. So, the next time you find mold on your sandwich, don't say “Eeeww!” Say “Eureka!”

Hypertension: Stink-Bomb It Away

British researchers (at King's College London and Peninsula Medical School, Exeter) have created a drug that pumps up the volume of hydrogen sulfide gas in the body. Testing on laboratory rats showed that the pungent gas is good at widening arteries, hence significantly lowering blood pressure. Although the scientists' article in Circulation proclaimed the potential of “an entirely new therapeutic approach for the treatment of hypertension,” we are grateful that the authors also foresee the need for much more research, including safety tests. After all, if the gas responsible for rotten-egg odors were to run rampant in some patients and escape, the environmental side effects might again evoke that Hindenberg hydrogen-type disaster cry, “Oh, the humanity!”

Immunity? It's a Swamp Thing

Louisiana biochemists are working not on gaseous cures but on proteins from alligator blood to help fight the infectious ills of humanity. With MRSA-like complications in burns and diabetic ulcers gaining resistance to antibiotics, “The goal of our project is to find the proteins that lead to the exceptionally strong innate immune system in alligators,” said one of the researchers, Kermit Murray, Ph.D., a chemistry professor at Louisiana State University, Baton Rouge. In lab studies, gator white-blood-cell extracts killed not only MRSA but several strains of Candida albicans, and showed considerable promise as well against HIV. The unanswered research question: How long does a scientist have to wrestle the gator before it consents to give blood?

Is It Sport, or Is It Research?

Now, we know that early-morning fun runs aren't for everyone, but when a bunch of emergency docs pick dodgeball as the extracurricular sport at their annual meeting, are they looking for exercise or for professional practice? The Society for Academic Emergency Medicine held its meeting in Washington last month, and no fewer than 16 teams signed up for the SAEM dodgeball tournament—the proceeds of which, it is noted, are donated to the SAEM Research Fund. The requisite waiver form states, “I assume all risk of injury to my person and property that may be sustained in connection with any activity including the tournament or pickup games.” No word on whether damaged limbs or concussed craniums are considered the property of the Research Fund.

Red Hot Chile Seniors?

When it comes to entitlement programs, who can beat Lo Prado, a working-class suburb of Chile's capital city, Santiago? There, the mayor is handing out free 50-mg Viagra pills to senior citizens who are doctor certified as suffering from erectile dysfunction. No health insurance coverage is needed, but the afflicted age-60-plus citizens do have to register with the Lo Prado health service. Mayor Gonzalo Navarrete, who is a physician and former director of Chile's Institute of Public Health, said that he started the program because “an active sexuality improves the overall quality of life,” and that other mayors in the Santiago area have told him they plan similar programs. The Bureau of Indications' South American office will monitor next year's birth rates in the region.

Bread Mold for Better Health

Certain mold cells have a nifty mechanism that protects the mold organism from genetic abnormalities. Seems some University of Missouri researchers have isolated this “meiotic silencing” device, and see potential for its application in us higher life forms to protect against nasties like the HIV virus. When one chromosome in a pair has an extra gene not found in its partner chromosome, it is a good indication of an intruder, and the fungus will “turn off” all copies of that gene during the sexual process known as meiosis. For this “show me” breakthrough, the Missouri scientists received the Beadle and Tatum Award (named after Nobel Prize-winning geneticists George Beadle and Edward Tatum) for outstanding and original research by a scientist using Neurospora, a type of bread mold. So, the next time you find mold on your sandwich, don't say “Eeeww!” Say “Eureka!”

Hypertension: Stink-Bomb It Away

British researchers (at King's College London and Peninsula Medical School, Exeter) have created a drug that pumps up the volume of hydrogen sulfide gas in the body. Testing on laboratory rats showed that the pungent gas is good at widening arteries, hence significantly lowering blood pressure. Although the scientists' article in Circulation proclaimed the potential of “an entirely new therapeutic approach for the treatment of hypertension,” we are grateful that the authors also foresee the need for much more research, including safety tests. After all, if the gas responsible for rotten-egg odors were to run rampant in some patients and escape, the environmental side effects might again evoke that Hindenberg hydrogen-type disaster cry, “Oh, the humanity!”

Immunity? It's a Swamp Thing

Louisiana biochemists are working not on gaseous cures but on proteins from alligator blood to help fight the infectious ills of humanity. With MRSA-like complications in burns and diabetic ulcers gaining resistance to antibiotics, “The goal of our project is to find the proteins that lead to the exceptionally strong innate immune system in alligators,” said one of the researchers, Kermit Murray, Ph.D., a chemistry professor at Louisiana State University, Baton Rouge. In lab studies, gator white-blood-cell extracts killed not only MRSA but several strains of Candida albicans, and showed considerable promise as well against HIV. The unanswered research question: How long does a scientist have to wrestle the gator before it consents to give blood?

Is It Sport, or Is It Research?

Now, we know that early-morning fun runs aren't for everyone, but when a bunch of emergency docs pick dodgeball as the extracurricular sport at their annual meeting, are they looking for exercise or for professional practice? The Society for Academic Emergency Medicine held its meeting in Washington last month, and no fewer than 16 teams signed up for the SAEM dodgeball tournament—the proceeds of which, it is noted, are donated to the SAEM Research Fund. The requisite waiver form states, “I assume all risk of injury to my person and property that may be sustained in connection with any activity including the tournament or pickup games.” No word on whether damaged limbs or concussed craniums are considered the property of the Research Fund.

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires on psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry.

The improvements in abdominal pain were realized without changes in sleep disturbance or psychological distress. The treatment did not significantly change the frequency of defecation or stool type; nor did it change rectal pressures during squeezing, pushing, or resting states (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires on psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry.

The improvements in abdominal pain were realized without changes in sleep disturbance or psychological distress. The treatment did not significantly change the frequency of defecation or stool type; nor did it change rectal pressures during squeezing, pushing, or resting states (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires on psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry.

The improvements in abdominal pain were realized without changes in sleep disturbance or psychological distress. The treatment did not significantly change the frequency of defecation or stool type; nor did it change rectal pressures during squeezing, pushing, or resting states (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Nontoxic Gluten for Celiac Patients

A Dutch study of different wheat varieties has shown that sufficient genetic variation exists to justify continuing the search for wheat with low amounts of the T-cell-stimulatory epitopes that trigger celiac disease, the most common food intolerance in the Western Hemisphere.

Liesbeth Spaenij-Dekking of Leiden (the Netherlands) University Medical Center and her colleagues prepared gluten samples from selected wheat varieties and then tested the gluten for the presence of T-cell-stimulatory epitopes. They used T-cell clones that were generated from small intestine biopsy specimens of celiac disease (CD) patients (Gastroenterology 2005;129:797–806).

The research team found “striking differences” in the clones' responses to individual wheat preparations, independent of the genome background of the accessions. They concluded that “this is promising for future breeding programs aimed at generating new varieties that will be acceptable for the manufacturing of food products for CD patients.”

In an accompanying editorial, Marco Londei of University College, London, and his associates point out that the current CD therapy of a gluten-free diet is neither easy to follow nor foolproof, as gluten can contaminate many foods during processing and preparation (Gastroenterology 2005;129:1111–3).

Reflux-Related Sleep Disorders

Acid suppression therapy significantly reduced the loss of workplace productivity in patients with gastroesophageal reflux disease-related sleep disorder, according to the first large, randomized controlled trial conducted on such therapy.

David A. Johnson, M.D., of Eastern Virginia School of Medicine, Norfolk, and his colleagues concluded that esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances, improving work productivity and sleep quality as measured by the Pittsburgh Sleep Quality Index questionnaire (Am. J. Gastroenterol. 2005;100:1914–22).

The 675 eligible patients were randomized to three treatment groups: esomeprazole 40 mg, esomeprazole 20 mg, and placebo; 650 of the patients were included in the efficacy analyses. Moderate to severe nighttime heartburn was relieved in 53.1% (111/209), 50.5% (111/220), and 12.7% (28/221) of patients receiving esomeprazole 40 mg, esomeprazole 20 mg, and placebo, respectively.

Certolizumab for Crohn's Disease

Certolizumab pegol (CDP870), a polyethylene glycolated Fab' fragment of a humanized anti-tumor necrosis factor-á monoclonal antibody, may be effective at a 400-mg subcutaneous dose and is well tolerated in patients with moderate to severe Crohn's disease, a placebo-controlled, phase II study showed.

Stefan Schreiber of the Hospital for General Internal Medicine and the Institute for Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany, and his colleagues conducted an international study of 292 patients at 58 centers in 10 countries. The researchers concluded that, while ongoing phase III studies are necessary to confirm their finding of clinical efficacy, the treatment had no untoward effects according to serial hematologic and biochemical measurements (Gastroenterology 2005;129:807–18).

However, the results were somewhat compromised by high placebo response rates in a patient subgroup with low C-reactive protein (CRP) levels. In a related editorial, the role of CRP levels was emphasized as potentially helping physicians to improve treatment of patients in routine clinical care. “With increasing development of expensive, and potentially toxic, therapies, we need to optimize the benefit-to-risk profile of our therapies,” noted James D. Lewis of the University of Pennsylvania, Philadelphia (Gastroenterology 2005;129:1114–6).

Treating Bleeding Peptic Ulcer

According to a metaanalysis of randomized controlled trials comparing endoscopic and medical interventions for bleeding peptic ulcer with adherent clot, the two are comparable in terms of need for surgical intervention, length of hospital stay, transfusion requirement, and mortality, but endoscopic therapy is superior for preventing recurrent hemorrhage.

Charles J. Kahi of Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center, Indianapolis, and his colleagues identified six studies including 240 patients, of whom 61 underwent endoscopic clot removal and treatment with thermal energy, electrocoagulation, and/or injection of sclerosants. Another 85 patients received medical therapy including transfusions as needed, monitoring in the intensive care unit if indicated, and acid suppression with intravenous H₂ blockers and a proton pump inhibitor (Gastroenterology 2005;129:855–62).

The metaanalysis showed that rebleeding occurred in 5 of the 61 endoscopic therapy patients (8.2%) versus 21 of the 85 (24.7%) medical therapy patients.

Nontoxic Gluten for Celiac Patients

A Dutch study of different wheat varieties has shown that sufficient genetic variation exists to justify continuing the search for wheat with low amounts of the T-cell-stimulatory epitopes that trigger celiac disease, the most common food intolerance in the Western Hemisphere.

Liesbeth Spaenij-Dekking of Leiden (the Netherlands) University Medical Center and her colleagues prepared gluten samples from selected wheat varieties and then tested the gluten for the presence of T-cell-stimulatory epitopes. They used T-cell clones that were generated from small intestine biopsy specimens of celiac disease (CD) patients (Gastroenterology 2005;129:797–806).

The research team found “striking differences” in the clones' responses to individual wheat preparations, independent of the genome background of the accessions. They concluded that “this is promising for future breeding programs aimed at generating new varieties that will be acceptable for the manufacturing of food products for CD patients.”

In an accompanying editorial, Marco Londei of University College, London, and his associates point out that the current CD therapy of a gluten-free diet is neither easy to follow nor foolproof, as gluten can contaminate many foods during processing and preparation (Gastroenterology 2005;129:1111–3).

Reflux-Related Sleep Disorders

Acid suppression therapy significantly reduced the loss of workplace productivity in patients with gastroesophageal reflux disease-related sleep disorder, according to the first large, randomized controlled trial conducted on such therapy.

David A. Johnson, M.D., of Eastern Virginia School of Medicine, Norfolk, and his colleagues concluded that esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances, improving work productivity and sleep quality as measured by the Pittsburgh Sleep Quality Index questionnaire (Am. J. Gastroenterol. 2005;100:1914–22).

The 675 eligible patients were randomized to three treatment groups: esomeprazole 40 mg, esomeprazole 20 mg, and placebo; 650 of the patients were included in the efficacy analyses. Moderate to severe nighttime heartburn was relieved in 53.1% (111/209), 50.5% (111/220), and 12.7% (28/221) of patients receiving esomeprazole 40 mg, esomeprazole 20 mg, and placebo, respectively.

Certolizumab for Crohn's Disease

Certolizumab pegol (CDP870), a polyethylene glycolated Fab' fragment of a humanized anti-tumor necrosis factor-á monoclonal antibody, may be effective at a 400-mg subcutaneous dose and is well tolerated in patients with moderate to severe Crohn's disease, a placebo-controlled, phase II study showed.

Stefan Schreiber of the Hospital for General Internal Medicine and the Institute for Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany, and his colleagues conducted an international study of 292 patients at 58 centers in 10 countries. The researchers concluded that, while ongoing phase III studies are necessary to confirm their finding of clinical efficacy, the treatment had no untoward effects according to serial hematologic and biochemical measurements (Gastroenterology 2005;129:807–18).

However, the results were somewhat compromised by high placebo response rates in a patient subgroup with low C-reactive protein (CRP) levels. In a related editorial, the role of CRP levels was emphasized as potentially helping physicians to improve treatment of patients in routine clinical care. “With increasing development of expensive, and potentially toxic, therapies, we need to optimize the benefit-to-risk profile of our therapies,” noted James D. Lewis of the University of Pennsylvania, Philadelphia (Gastroenterology 2005;129:1114–6).

Treating Bleeding Peptic Ulcer

According to a metaanalysis of randomized controlled trials comparing endoscopic and medical interventions for bleeding peptic ulcer with adherent clot, the two are comparable in terms of need for surgical intervention, length of hospital stay, transfusion requirement, and mortality, but endoscopic therapy is superior for preventing recurrent hemorrhage.

Charles J. Kahi of Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center, Indianapolis, and his colleagues identified six studies including 240 patients, of whom 61 underwent endoscopic clot removal and treatment with thermal energy, electrocoagulation, and/or injection of sclerosants. Another 85 patients received medical therapy including transfusions as needed, monitoring in the intensive care unit if indicated, and acid suppression with intravenous H₂ blockers and a proton pump inhibitor (Gastroenterology 2005;129:855–62).

The metaanalysis showed that rebleeding occurred in 5 of the 61 endoscopic therapy patients (8.2%) versus 21 of the 85 (24.7%) medical therapy patients.

Nontoxic Gluten for Celiac Patients

A Dutch study of different wheat varieties has shown that sufficient genetic variation exists to justify continuing the search for wheat with low amounts of the T-cell-stimulatory epitopes that trigger celiac disease, the most common food intolerance in the Western Hemisphere.

Liesbeth Spaenij-Dekking of Leiden (the Netherlands) University Medical Center and her colleagues prepared gluten samples from selected wheat varieties and then tested the gluten for the presence of T-cell-stimulatory epitopes. They used T-cell clones that were generated from small intestine biopsy specimens of celiac disease (CD) patients (Gastroenterology 2005;129:797–806).

The research team found “striking differences” in the clones' responses to individual wheat preparations, independent of the genome background of the accessions. They concluded that “this is promising for future breeding programs aimed at generating new varieties that will be acceptable for the manufacturing of food products for CD patients.”

In an accompanying editorial, Marco Londei of University College, London, and his associates point out that the current CD therapy of a gluten-free diet is neither easy to follow nor foolproof, as gluten can contaminate many foods during processing and preparation (Gastroenterology 2005;129:1111–3).

Reflux-Related Sleep Disorders

Acid suppression therapy significantly reduced the loss of workplace productivity in patients with gastroesophageal reflux disease-related sleep disorder, according to the first large, randomized controlled trial conducted on such therapy.

David A. Johnson, M.D., of Eastern Virginia School of Medicine, Norfolk, and his colleagues concluded that esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances, improving work productivity and sleep quality as measured by the Pittsburgh Sleep Quality Index questionnaire (Am. J. Gastroenterol. 2005;100:1914–22).

The 675 eligible patients were randomized to three treatment groups: esomeprazole 40 mg, esomeprazole 20 mg, and placebo; 650 of the patients were included in the efficacy analyses. Moderate to severe nighttime heartburn was relieved in 53.1% (111/209), 50.5% (111/220), and 12.7% (28/221) of patients receiving esomeprazole 40 mg, esomeprazole 20 mg, and placebo, respectively.

Certolizumab for Crohn's Disease

Certolizumab pegol (CDP870), a polyethylene glycolated Fab' fragment of a humanized anti-tumor necrosis factor-á monoclonal antibody, may be effective at a 400-mg subcutaneous dose and is well tolerated in patients with moderate to severe Crohn's disease, a placebo-controlled, phase II study showed.

Stefan Schreiber of the Hospital for General Internal Medicine and the Institute for Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany, and his colleagues conducted an international study of 292 patients at 58 centers in 10 countries. The researchers concluded that, while ongoing phase III studies are necessary to confirm their finding of clinical efficacy, the treatment had no untoward effects according to serial hematologic and biochemical measurements (Gastroenterology 2005;129:807–18).

However, the results were somewhat compromised by high placebo response rates in a patient subgroup with low C-reactive protein (CRP) levels. In a related editorial, the role of CRP levels was emphasized as potentially helping physicians to improve treatment of patients in routine clinical care. “With increasing development of expensive, and potentially toxic, therapies, we need to optimize the benefit-to-risk profile of our therapies,” noted James D. Lewis of the University of Pennsylvania, Philadelphia (Gastroenterology 2005;129:1114–6).

Treating Bleeding Peptic Ulcer

According to a metaanalysis of randomized controlled trials comparing endoscopic and medical interventions for bleeding peptic ulcer with adherent clot, the two are comparable in terms of need for surgical intervention, length of hospital stay, transfusion requirement, and mortality, but endoscopic therapy is superior for preventing recurrent hemorrhage.

Charles J. Kahi of Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center, Indianapolis, and his colleagues identified six studies including 240 patients, of whom 61 underwent endoscopic clot removal and treatment with thermal energy, electrocoagulation, and/or injection of sclerosants. Another 85 patients received medical therapy including transfusions as needed, monitoring in the intensive care unit if indicated, and acid suppression with intravenous H₂ blockers and a proton pump inhibitor (Gastroenterology 2005;129:855–62).

The metaanalysis showed that rebleeding occurred in 5 of the 61 endoscopic therapy patients (8.2%) versus 21 of the 85 (24.7%) medical therapy patients.

Pediatric vs. Standard Colonoscopes

Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.

Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).

After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.

Fordyce Granules in Colorectal Cancer

The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.

C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).

FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.

Pancreatic Cancer-Induced Diabetes

Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.

Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.

However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.

Aspirin Lowers Colorectal Cancer Risk

Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.

Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).

The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.

As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”

Pediatric vs. Standard Colonoscopes

Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.

Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).

After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.

Fordyce Granules in Colorectal Cancer

The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.

C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).

FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.

Pancreatic Cancer-Induced Diabetes

Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.

Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.

However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.

Aspirin Lowers Colorectal Cancer Risk

Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.

Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).

The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.

As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”

Pediatric vs. Standard Colonoscopes

Pediatric colonoscopes are no more effective than the standard equipment for outpatient adult colonoscopy, although having the option of an alternative scope after an unsuccessful examination may help achieve passage to the caecum, reported S.H. Al-Shurieki and J.B. Marshall of the division of gastroenterology, University of Missouri School of Medicine, Columbia.

Their randomized controlled trial of 240 consecutive adult outpatients found that initial frequency of total colonoscopy was similar with pediatric and adult colonoscopes (95.8% vs. 96.6%). Patients were randomized to either scope, but if the endoscopists encountered difficulty performing the procedure with the assigned scope, they had the option of switching to the alternative instrument. Also, if a severely fixed, angulated sigmoid colon was encountered, a final backup option was available—that of switching to a thinner-diameter pediatric colonoscope than the original (Dig. Liver Dis. 2005;37:698–704).

After colonoscope changes, the final frequency of total colonoscopy improved, compared with rates for initial assignments, to 98.3% for pediatric and 99.2% for standard instruments.

Fordyce Granules in Colorectal Cancer

The presence of recognizable Fordyce granules (intraoral ectopic sebaceous glands) may be associated with systemic diseases, and a previously unrecognized activation of the sebaceous gland system may occur in individuals carrying hereditary nonpolyposis colorectal cancer syndrome, or Lynch syndrome, according to a controlled study of genetically unrelated patients.

C. De Felice of Azienda Ospedaliera Universtaria Senese, Siena, Italy, and associates reported on 15 members of five different genetically unrelated hereditary nonpolyposis colorectal cancer syndrome (HNPCC) kindreds and 630 unrelated, age- and sex-matched healthy controls. Following examination of the subjects' oral mucosa surfaces, they were categorized as either Fordyce granule (FG) positive or FG negative. The most common site for the FGs in HNPCC patients was the lower gingival and vestibular oral mucosa (Gut 2005;54:1279–82).

FGs were evident in 13 of the 15 affected patients (86.7%) versus 6 of the 630 controls (0.95%). The difference in FG proportions remained significant only when carriers of germline mutations in mismatch repair genes were accounted for; mismatch repair genes were detectable in 8 of the 15 cases (three of the five families) and identified as MLH1 mutations.

Pancreatic Cancer-Induced Diabetes

Approximately 1% of subjects aged 50 or older will develop pancreatic cancer within 3 years of first meeting criteria for diabetes—a rate nearly eight times higher than that for persons of similar age and sex in the general population, according to a population-based study in Rochester, Minn.

Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn., studied 2,122 Rochester residents who first met criteria for diabetes at or above age 50 and identified 18 (0.85%) who were diagnosed with pancreatic cancer within 3 years (Gastroenterology 2005;129:504–11). This result, along with earlier epidemiologic studies, suggests that subjects with new-onset diabetes are a high-risk group for pancreatic cancer, the researchers said.

However, they note, “The success of the strategy to use hyperglycemia as a screening tool … will depend largely on our ability to differentiate pancreatic cancer-induced diabetes from type 2 diabetes using a serologic marker.” Thus, hyperglycemia and diabetes may be useful as clinically relevant markers of undiagnosed pancreatic cancer, although further study will be required to test that strategy.

Aspirin Lowers Colorectal Cancer Risk

Regular, long-term use of aspirin reduces the risk of colorectal cancer, but significant reduction is not achieved until more than 10 years of use have elapsed, according to a prospective cohort study.

Maximum benefits were gained at doses exceeding 14 standard (325 mg) tablets per week. Andrew T. Chan, M.D., of Massachusetts General Hospital and Harvard Medical School, and his colleagues therefore noted that “optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease” (JAMA 2005;294:914–23).

The researchers, who used medication intake data from 82,911 of the 121,701 women enrolled in the Nurses' Health Study, also found that nonaspirin NSAIDs appeared to have a similar protective effect, again in a dose-dependent manner.

As in many other studies, they noted, “we did observe an increase in the incidence of reported major gastrointestinal bleeding with increasing aspirin dose.”