IMAGING FOR THE PREGNANT
Normally, radiation and pregnancy don't mix. But researchers have worked out a policy to safely use radiation to diagnose patients who may be pregnant. "Surprisingly, a search through the medical literature and an informal survey of some academic radiologists yielded a lack of clear policies or specific instructions on this issue," says Meghan Blake, a medical student at the University of Iowa Hospitals. "CT and other methods that use radiation are an integral part of how we diagnose acute care patients; it became apparent that a policy was needed." The fetus of pregnant women whose injuries are not in the pelvic or nearby area would not be in the direct X-ray beam and, therefore, not exposed to harm. In these cases, pelvic shielding is used, and the radiation doses are kept as low as possible. If the estimated dose to the fetus is less than 1 rem (from examinations such as a lumbar spine radiograph and an X-ray of the kidney and bladder), the radiologist should consider alternative imaging methods, such as ultrasound. If the estimated dose for the fetus is 1-5 rem (such as with fluoroscopy, abdominal CT, pelvic CT or angiography) an alternative imaging method should be considered. If the estimated dose is greater than 5 rem (such as with repeated CT, and longer fluoroscopy) the physicist should formally calculate the dose and the patient's chart should document the opinions of the radiologist, the physician who referred the patient for the test and the physicist.
PRESCRIBING FOR THE SMOKER
A study shows that quitting smoking is just as successful using over the counter nicotine replacement therapies, such as a skin patch or gum, as relying on prescription remedies. The study, reported in the journal Addiction, analyzed data collected from smokers before the U.S. Food and Drug Administration switched the status of the nicotine gum and patch from prescription to OTC. "The fact that smoking cessation rates with NRT compare favorably whether the products are self-administered in an OTC fashion or by physicians under a prescription-only regimen is significant, because OTC status dramatically increased the number of smokers who use the products to quit smoking," says study author Saul Shiffman of the University of Pittsburgh. "Moreover, we found that NRT can be used safely without physician intervention." The prescribed and non-prescribed ways were shown equally effective at six-week and six-month followups, and for both the gum, which requires the patient's active involvement and compliance, and the patch, which requires little of either.
COMBINATION FOR BREAST CANCER
Women with large, locally advanced breast tumors normally undergo surgery, then are prescribed chemotherapy. But a new study points to the benefits of having chemo before surgery as well. The results come from a survey started in 1992 at the Uiversity of North Carolina, Chapel Hill. Chemotherapy followed by surgery often allows the less drastic lumpectomy instead of total breast removal, the authors said. In the past, many of these patients were considered inoperable because of the volume of their tumors and the belief that the disease would soon spread and kill them. In the study, 76 percent of patients who received the pre-op chemo boost survived for at least five years. Post-treatment followup ranged from 35 to 117 months. "In addition, neoadjuvant therapy may make surgery a viable option for women whose tumors were considered inoperable due to their seriously advanced stage," said Dr. William Cance, professor of surgery, chief of surgical oncology and a member of the cancer center.
LESSON FOR THE HEART-IGNORANT
Most heart attack survivors have no idea what their No. 1 risk factor is for sudden cardiac death, a survey shows. They don't know if they are at risk for a dangerous heart rhythm disorder that kills some 400,000 Americans each year, the Centers for Disease Control and Prevention says. Studies show a person's ejection fraction -- the fraction of blood pumped from the heart with each beat -- is the No. 1 predictor of SCD risk. The study showed fewer than half of heart attack survivors knew their EF. In most cases, SCD is blamed on underlying causes such as the damage done by a prior heart attack. Unlike a heart attack, which is caused by clogged or blocked blood vessels, SCD stems from a glitch in the heart's electrical system called ventricular fibrillation. The result is sudden, rapid, out-of-rhythm beating of the lower chambers. Without instant help, death ensues in minutes. In recent years, doctors have realized that victims of cardiac arres have underlying disease or other risk factors, although they may not know it. Doctors now have tools to identify patients at risk for SCD and ways to prevent it, they said.
(EDITORS: For more information about PREGNANT, call 703-858-4306; about SMOKING, call 212-601-8201; about BREAST, call 919-966-5221; about HEART, call 312-558-1770.)
