THIS WEEK
December 21 , 2000
in the New England Journal of Medicine

 
Phenylpropanolamine and the Risk of Hemorrhagic Stroke
Phenylpropanolamine is a sympathomimetic amine present in many appetite suppressants and cold remedies. Reports have suggested that it may increase the risk of hemorrhagic stroke. In this large case­control study, an increased risk of hemorrhagic stroke was found in women who used appetite suppressants containing phenylpropanolamine, as well as in women who took cold remedies containing phenylpropanolamine for the first time.

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Adverse Health Effects Associated with Dietary Supplements Containing Ephedra
Alkaloids Dietary supplements that contain ephedra alkaloids (also known as ma huang) are commonly used to enhance energy levels and to lose weight. This study critically examined 140 reports of adverse events (including hypertension, tachycardia, strokes, and seizures) submitted to the Food and Drug Administration over a period of nearly two years. Thirty-one percent were considered to be definitely or probably related to the use of the supplements. There were 10 deaths and 13 instances of permanent disability.

Related Editorial

Caffeine Intake and the Risk of First-Trimester Spontaneous Abortion
The ingestion of caffeine has been associated with spontaneous abortion. In this study, caffeine intake during pregnancy was assessed in 562 women who had spontaneous abortions during the first trimester and 953 matched control women. Among the women who were nonsmokers, the risk of spontaneous abortion doubled in women who ingested at least 500 mg of caffeine (approximately five cups of coffee) per day.



Cancer and Venous Thromboembolism
The association between venous thromboembolism and cancer is well known, but little is known about the prognosis of patients with cancer who have an episode of venous thromboembolism. In this study, the incidence of distant metastasis was higher and the survival shorter in a group of such patients than in a control group.

Patient-to-Provider-to-Patient Transmission of HCV

In developed countries, the main source of hepatitis C virus (HCV) infection is injection-drug use. The transmission of HCV from infected personnel to susceptible patients during medical care is rare, but it does happen. This study reports on an unusual outbreak of HCV involving patients in a hospital. The findings suggest that an anesthesiology assistant contracted HCV from a chronically infected patient and subsequently transmitted the virus to five other patients.

Inadvertent transmission of infectious diseases during medical care is a substantial public health problem. This study provides epidemiologic and molecular evidence that five patients with no known risk factors for HCV infection contracted the infection from an anesthesiology assistant who had been infected by another patient. Breaches of infection-control procedures are associated with a high risk of the transmission of blood-borne pathogens; even very small amounts of blood are adequate to cause clinically important infection.