THIS WEEK
January 11, 2001
in the New England Journal of Medicine
 
 
"These data do not
support the hypothesis that
. . . use of hand-held
cellular telephones
causes brain tumors."

    
Cellular-Telephone Use and Brain Tumors
Worldwide, there are more than 500 million subscribers to cellular-telephone services. There is some concern that the microwave signals emitted by these telephones may cause brain tumors. In this case­control study, no statistically significant differences between the patients with tumors and the controls were found regarding the use of cellular telephones.

The results of this investigation cannot exclude the possibility that prolonged and frequent use of a cellular telephone increases risk of intracranial tumors. Nevertheless, within its limitations, it is an important study with reassuring results.

Related Editorial

graph   Adverse Events, Including Death, Associated with the Use of 1,4-Butanediol
1,4-Butanediol is an industrial solvent that has been incorporated into dietary supplements because it is claimed to have bodybuilding, anti-aging, aphrodisiac, sedative, and antidepressant actions. This report describes nine episodes of acute illness characterized by vomiting, fecal and urinary incontinence, agitation, and obtundation associated with the ingestion of dietary supplements containing 1,4-butanediol by eight patients, two of whom died.

1,4-Butanediol and (gamma)-butyrolactone became popular as dietary supplements after (gamma)-hydroxybutyrate, a naturally occurring metabolite of (gamma)-aminobutyric acid, was proscribed by the Food and Drug Administration, because they were thought to have actions similar to those of (gamma)-aminobutyric acid. This study focused on 1,4-butanediol, which is found in at least 20 dietary supplements and, as described in this article, can be highly toxic.

 
 
"Early treatment with
dexamethasone to
prevent chronic lung
disease in extremely-low-
birth-weight infants
is not indicated."
  Adverse Effects of Early Dexamethasone Treatment in Extremely-Low-Birth-Weight Infants
Many low-birth-weight infants are treated with high doses of a glucocorticoid in an attempt to prevent lung disease. This study evaluated the effects of moderate doses of dexamethasone in infants with a birth weight of 501 to 1000 g. The mortality rate and the rate of chronic lung disease at 36 weeks' postmenstrual age were 21 percent and 63 percent, respectively, in the dexamethasone group, as compared with 24 percent and 69 percent, respectively, in the placebo group, whereas the rates of spontaneous gastrointestinal perforation, hypertension, and poor growth were higher in the dexamethasone group.

The lack of a benefit of dexamethasone, together with the higher rates of complications, adds to the evidence from earlier studies that dexamethasone is not indicated for low-birth-weight infants. The complication rates were high despite treatment with lower doses of dexamethasone than those given in earlier studies.

graph
  Improvement in Sleep Apnea in Chronic Renal Failure Treated by Nocturnal Hemodialysis
Sleep disorders are common in patients with end-stage renal disease and do not improve during treatment with conventional hemodialysis in a health care facility. These investigators examined the effects on sleep disorders of nocturnal hemodialysis, performed every night at home during sleep. In 14 patients studied by polysomnography during treatment with conventional and then nocturnal hemodialysis, the mean number of episodes of apnea and hypopnea decreased from 25 to 8 per hour of sleep. Among the seven patients who had sleep apnea, the mean number of such episodes fell from 46 to 9 per hour of sleep, and the decrease was accompanied by an increase in oxygen saturation.

The improvement in sleep in these patients was substantial and occurred both in patients with central apnea and in those with obstructive apnea. Better sleep is just one of the many clinical and biochemical benefits of the more intensive therapy that can be achieved by nocturnal hemodialysis at home.

Related Editorial

This article, which is part of the Journal's Immunology series, is the second of a two-part comprehensive review of the pathogenesis and treatment of allergic diseases.

graph The American Cancer Society has estimated that nearly 17,000 intracranial tumors were diagnosed in the United States in 1999. This article provides a state-of-the-art review of the epidemiology and biology of intracranial tumors, categories of tumors, clinical presentation and diagnosis, and therapy.

 

Abortion is the most politicized medical procedure in the United States. The most recent controversy surrounds so-called "partial-birth abortion." In this article, Annas analyzes the June 2000 Supreme Court decision that held that a Nebraska law (as well as all other laws banning these abortions) is unconstitutional.