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February 8, 2001
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Neurocognitive Function after Coronary-Artery Bypass Surgery
Decline in cognitive function is common after coronary-artery bypass grafting (CABG), especially in elderly patients. In this study of 261 patients who underwent CABG, the incidence of cognitive decline at the time of hospital discharge was 53 percent. The incidence decreased to about 25 percent at six months but returned to just above 40 percent by five years. Cognitive decline at the time of hospital discharge was a predictor of long-term cognitive decline.
Since older patients commonly undergo bypass surgery, the problem of postoperative cognitive decline is important. Patients whose cognitive functioning declines soon after surgery are at risk for long-term cognitive decline. Preventive interventions are needed.
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A Pneumococcal Conjugate Vaccine to Prevent Acute Otitis Media
In a randomized trial, 1662 children received a heptavalent pneumococcal polysaccharide conjugate vaccine or hepatitis B vaccine as a control. The frequency of acute otitis up to the age of two years was reduced by only 6 percent as compared with the rate in a control group. However, pneumococcal ear infections were reduced by 34 percent, and otitis caused by the serotypes in the vaccine was reduced by 57 percent.
This conjugate vaccine was effective and well tolerated. The diagnosis was confirmed by means of cultures of fluid from the middle ear. Given the frequency of otitis, the prevention of even a small fraction of episodes may be of substantial benefit.
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Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis
This study evaluated the efficacy of Doppler ultrasonographic measurements of the resistance to flow in the segmental renal arteries in predicting the outcome of revascularization in patients with hypertension and renal-artery stenosis. Among 131 patients, blood pressure improved in only 3 percent and renal function declined in 80 percent of the patients with resistance-index values of 80 or higher, whereas blood pressure improved in 94 percent and renal function declined in only 3 percent of the patients with resistance-index values below 80.
Among patients with hypertension and renal-artery stenosis, some have a response to revascularization, but some do not. The measurement of the renal resistance index may be a relatively simple and noninvasive way to identify patients who will benefit from revascularization and those who will not.
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Liver-Biopsy Specimen
Showing Fibrosis. |
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Regression of Fibrosis after Biliary Drainage in Patients with Stenosis of the Common Bile Duct Due to Chronic Pancreatitis
Hepatic fibrosis and secondary biliary cirrhosis may develop in patients with chronic obstruction of the common bile duct. This study of 11 patients with chronic bile-duct obstruction due to chronic pancreatitis examined the question of whether liver fibrosis can regress after biliary drainage. An analysis that excluded the two patients with restenosis of the biliary anastomosis showed a significant reduction in liver fibrosis after biliary decompression.
Liver fibrosis in patients with chronic pancreatitis and stenosis of the common bile duct may regress after biliary drainage. As the authors note, the patients they studied may not be representative of all patients with fibrosis. Nonetheless, the findings support the view that hepatic fibrosis may be reversible in some situations.
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Fomepizole for Methanol Poisoning
Poisoning with methanol may result in serious metabolic abnormalities, blindness, and death. Treatment of methanol poisoning entails the inhibition of the metabolism of methanol to its toxic metabolites. This study evaluated the efficacy of fomepizole, an inhibitor of methanol metabolism, in 11 patients with methanol poisoning. The drug effectively inhibited methanol metabolism and reversed the related metabolic acidosis. Nine patients survived; none had any detectable methanol-related visual deficit.
Fomepizole acts by inhibiting alcohol dehydrogenase, which catalyzes the conversion of methanol to formaldehyde, which is then converted to formic acid by the action of formaldehyde dehydrogenase. This drug should become the standard treatment for methanol poisoning.
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