April 11, 2002
Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer
It is uncertain whether male circumcision reduces the risk of penile human papillomavirus (HPV) infection and of cervical cancer in a man's female partner. The authors studied women and their male partners enrolled in seven case–control studies of cervical carcinoma in situ and cervical cancer in five countries in Europe, South America, and Asia. Circumcised men were significantly less likely than uncircumcised men to have penile HPV infection. Women whose partners had six or more lifetime sexual partners were less likely to have cervical cancer if their partners were circumcised than if they were uncircumcised. These data suggest that male circumcision may reduce the risk of penile HPV infection in men and the risk of cervical cancer in female partners of sexually promiscuous men.
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n–3 Fatty Acids and the Risk of Sudden Death
Fish contains long-chain n–3 polyunsaturated fatty acids, which are believed to have antiarrhythmic properties and may reduce the risk of sudden death after myocardial infarction. This study shows that men without cardiovascular disease who have higher blood levels of n–3 fatty acids have a reduced risk of sudden death. Fish consumption, or dietary supplementation with n–3 fatty acids, may be appropriate for the prevention of sudden death in persons at risk, whether or not they have evidence of cardiovascular disease.
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Valganciclovir for Treatment of Cytomegalovirus Retinitis
This randomized trial involved 160 patients with the acquired immunodeficiency syndrome (AIDS) and newly diagnosed cytomegalovirus retinitis. After four weeks, the response to induction therapy was satisfactory in 72 percent of patients who received oral valganciclovir, as compared with 77 percent of those who received intravenous ganciclovir. The median time to progression of retinitis was 160 days for the valganciclovir group and 125 days for the ganciclovir group. Valganciclovir is a prodrug that can be taken orally and is rapidly hydrolyzed to ganciclovir. This more convenient form of medication appears to be as effective as ganciclovir as induction therapy for cytomegalovirus retinitis, the leading cause of visual loss in patients with AIDS.
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Special Article: Hospital Volume and Surgical Mortality
For surgical procedures, operative mortality varies inversely with the number of procedures performed at a hospital. This study quantified the relation between volume and outcome among Medicare patients for 14 different surgical procedures. The relative effect of surgical volume on outcome varied markedly among types of procedures. For pancreatic resection, the absolute difference in mortality rates between the highest-volume and the lowest-volume hospitals was over 12 percent, whereas for carotid endarterectomy, the difference was only 0.2 percent. In selecting a hospital for a surgical procedure, Medicare patients should consider the number of procedures performed at that hospital, among other measures of surgical quality.
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Special Article: Variations in Outcome after Radical Prostatectomy
Radical prostatectomy is commonly performed in men with early-stage prostate cancer. This study assessed the outcome of surgery in relation to the number of prostatectomy procedures performed at individual hospitals (hospital volume) and by individual surgeons (surgeon volume). Neither hospital volume nor surgeon volume was related to operative mortality. However, postoperative complications and late urinary complications were more common in patients treated at low-volume hospitals or by low-volume surgeons than in those treated at high-volume hospitals or by high-volume surgeons. This study adds to a growing body of information that hospital volume and surgeon volume have significant effects on outcome — in this case, on important measures of postoperative complications that may affect patients' quality of life.
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Clinical Practice: Nephropathy in Patients with Type 2 Diabetes
A 60-year-old man with recently diagnosed type 2 diabetes mellitus has a serum creatinine level of 1.5 mg per deciliter (133 µmol per liter), and a dipstick test shows proteinuria (++). His blood pressure is 150/90 mm Hg. He smokes half a pack of cigarettes daily. What can be done to reduce the risk of progressive renal disease? This Clinical Practice article reviews strategies for preventing the development or progression of nephropathy in patients with type 2 diabetes.
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