Obsessive-Compulsives May Find Relief From Unlikely Source

For those who have obsessive-compulsive disorder--a disabling mental disorder characterized by repeated, patterned behavior, such as washing one’s hands, checking that doors are locked and so forth--surgical destruction of a small part of the brain can provide immense relief.

As many as 2% of Americans may suffer from the disorder sometime during their lives. Some cases resolve spontaneously, while others are helped by therapy or drugs.

But about 10% continue deteriorating despite such efforts. These patients, numbering more than 200,000, are potential candidates for psychosurgery.

Psychosurgery--the destruction of parts of the brain--has a long and sometimes inglorious history. Frontal lobotomies and orbital undercutting, the so-called ice pick procedure in which surgeons inserted a thin probe behind the eye to slice off part of the brain, have become associated with patient abuse, and are rarely performed now.

But the development of sophisticated imaging and surgical techniques that allow extremely precise interventions are beginning to change neurologists’ perception of psychosurgery. Surgery for Parkinson’s disease and epilepsy is now becoming common.

New results in the March issue of the journal Neurosurgery suggest that psychosurgery may also be useful in obsessive-compulsive disorder. Dr. Bodo Lippitz and his colleagues at the Karolinska Institutet in Stockholm analyzed the results of psychosurgery in 35 such patients. They found that the surgery was successful, providing 50% to 100% improvement on psychiatric tests in 55% of the patients.

Examining the results more closely, they found that the surgery was nearly 100% effective when the surgery destroyed a small area of the brain called the orbitofrontal cortex, which has previously been linked to obsessive behavior. The surgery was successful whether the area was destroyed by heating with a special probe or by tightly focused beams of radiation.

Study Casts Doubt on Kids’ Growth Hormone

Human growth hormone produced by genetic engineering techniques is not approved by the Food and Drug Administration for stimulating growth in healthy children, but physicians are free to prescribe it for that use. (Once a drug is approved for any use, physicians can legally prescribe it for other uses.)

Many do because some parents are willing to spend as much as $25,000 a year and subject their children to daily injections in hopes of a few extra inches of growth. An estimated 20% of the 30,000 U.S. children receiving the hormone do so for such cosmetic height enhancement, but it has never been clear whether such efforts are beneficial.

A new study by researchers at Stanford University shows that such treatment increases height by only 2 inches on average, leading some experts to question whether the results are worth the trouble.

Dr. Raymond L. Hintz and his colleagues studied 80 children who received the drug for as long as 10 years. They reported in Thursday’s New England Journal of Medicine that individual results varied, that 20% of the children received no benefit at all, and that the average increase over predicted adult heights was only 2 inches. Hintz and colleagues observed no side effects from the drugs, however.

Transplants Successful in ‘Bubble Boy’ Patients

Severe combined immunodeficiency disease--the so-called “bubble boy disease,” named after a Texas youth who lived in a germ-free environment for 12 years before succumbing to the rare genetic disorder--can be successfully treated with bone marrow transplants, according to Duke University physicians.

The patients lack an enzyme that is required for their immune system to function, and are thus highly susceptible to infectious diseases. Many die within the first year of life. The defect has been treated, with limited success, by gene therapy and by expensive treatment with a synthetic form of the enzyme.

Dr. Rebecca Buckley and her colleagues at the North Carolina university reported in Wednesday’s Journal of the American Medical Assn. that 21 of 22 babies with the disorder who received a bone marrow transplant from a family member by 3 1/2 months of age have survived and are partially or completely cured.

The treatment is less effective if given later, but still beneficial. Of 89 patients her team has treated, Buckley said, 72 are alive and faring well.

Low-Protein Diet Looks to Delay Kidney Dialysis

Kidney failure patients who adhere to a strict low-protein diet can delay the need for dialysis by as much as a year, according to a Johns Hopkins University study in the January Journal of the American Society of Nephrology. The study is in sharp contrast to current practice, which is to start dialysis earlier and earlier in patients with terminal kidney failure (meaning death will occur without dialysis or a transplant).

The diet consists mostly of fruits and vegetables, and excludes such high-protein foods as meat, fish, poultry, cheese and milk. Patients are given supplements containing essential amino acids that the human body cannot produce.

Dr. Mackenzie Walser and colleagues reported that the death rate among patients on the diet was 2.5%, compared with the 25% rate among patients on dialysis.

Anti-Ulcer Prilosec Is Top Worldwide Seller

The most popular medication in the world is the anti-ulcer, anti-acid drug called Prilosec, which had sales of $5.14 billion in 1998, making it the first drug to surpass the $5-billion mark. Prilosec was well ahead of the second-place contender, the anti-cholesterol drug Zocor, which had sales of $3.95 billion.

The antidepressant Prozac was third at $2.81 billion.

Altogether, about 25 drugs each surpassed $1 billion in sales. The greatly hyped drug Viagra, however, was well back in the pack, with sales of $788 million.

But Prilosec’s days in the lead are probably numbered, analysts say. Astra AB’s patent on the drug expires in 2001, paving the way for other companies to produce less-expensive generic versions. Other companies are also introducing new competitors that are likely to steal sales from Prilosec.