MRIs Expected to Ease Reliance on Invasive Angiograms
Improvements in magnetic resonance imaging are making it possible to examine ever smaller blood vessels, leading to the day when an invasive angiogram will not be necessary to detect diseased coronary arteries, Boston researchers say. Instead, an angiogram would be used only if a blockage is actually found.
Dr. Warren J. Manning and his colleagues at Beth Israel Deaconess Medical Center have adapted MRIs to image the relatively small coronary arteries. They then studied 109 patients at Beth Israel and several other sites. Each patient was studied by MRI, then received a conventional angiogram. The team reported in the Dec. 27 issue of the New England Journal of Medicine that MRIs detected every diseased artery in 75% of patients and life-threatening problems in 89%.
Experts expect further improvements in the technology in the next five years that would allow use of the technique to become routine. About 40% of the patients who undergo a $5,000 angiography do not actually have a blockage. An MRI scan that obtained the same results would cost only about $1,000 and would not be accompanied by the typical six-hour recovery period.
In an angiogram, a thin catheter is threaded through a blood vessel in the groin until it reaches the coronary arteries, enabling doctors to view the interior of the vessels. Patients must remain motionless for about six hours after the procedure to allow the insertion site to heal, and about one in 100 patients suffers an adverse event, such as a severe blood clot.
Inhalant’s Benefits Studied
Patients with sinusitis recover faster and have fewer symptoms if an inhaled steroid is added to their conventional treatment of antibiotics and decongestants, according to a new study. U.S. patients make about 25 million visits to physicians each year with such sinus infections, which are marked by chronic inflammation and swelling of the sinuses and nasal passages.
Dr. Rowena Dolor of the Duke University Medical Center and her colleagues studied 95 adults with a history of recurrent and chronic sinus disease. In addition to their normal treatment, 47 were given two daily puffs of the inhaled steroid fluticasone, and 48 were given puffs of a placebo.
The team reported in the Dec. 26 Journal of the American Medical Society that 93% of the patients receiving fluticasone reported a cure or significant improvement of sinus problems, compared with 74% of those receiving the placebo. Patients receiving the fluticasone also had their symptoms improve three days earlier. The study was sponsored by GlaxoSmithKline, the manufacturer of fluticasone, which is trade named Flonase.
An Unhealthful Tradition?
The traditional “English breakfast” of fried foods and hot tea increases women’s risk of cancer of the esophagus, but not eating breakfast is even worse, according to Scottish researchers. Cereal and fruits proved to be the best morning fare.
Squamous cell carcinoma is the most common form of esophageal cancer in the United Kingdom, and rates are about three times higher in British women than in other European women. Dr. Linda Sharp of the University of Aberdeen and her colleagues studied the diets and other risk factors of 159 women with squamous cells carcinoma of the esophagus and compared them with a similar number of healthy women.
Those who ate the traditional breakfast were twice as likely to develop the disease, and those who ate no breakfast were even more likely, the team reported in the British Journal of Cancer.
Skipping breakfast is a problem, the team speculated, because food soaks up stomach acid in the morning and eases gastric reflux--acid in the throat, also known as heartburn--which increases the risk of cancer.
A Slippery Slope
Not surprisingly, people who have had a heart attack or who have high blood pressure are more likely to die from a heart attack on the ski slopes than people who have no such history, according to Swiss physicians.Those who don’t exercise regularly are also at increased risk.
Dr. Martin Burtscher of the University of Innsbruck and his colleagues reviewed the cases of 68 men who died from heart attacks while skiing in Austria.
The researchers reported in the November issue of Clinical Journal of Sports Medicine that 41% of the men who died had suffered a previous heart attack, compared with only 1.5% of the control group. Half the men who died had high blood pressure, compared with 17% of the control group. And only 4% of the men who died exercised vigorously at least once per week, compared with 15% of the control group.
Rigidity-Disorder Relief
People with a rare neurological disorder called stiff person syndrome benefit from a new immunological therapy, according to researchers from the National Institute of Neurological Diseases and Stroke.
Stiff person syndrome is characterized by muscle rigidity in the trunk and limbs and heightened sensitivity to stimuli such as noise, touch and emotional distress--all of which can touch off muscle spasms. The incidence is estimated to be about one case per 1 million people, but experts say the disorder is often misdiagnosed as Parkinson’s disease, multiple sclerosis or other conditions, and that the true incidence may be much higher.
Dr. Marinos C. Dalakas and his colleagues at NINDS studied 16 patients with the disease. Half were given intravenous immunoglobulins for three months and half a placebo. After a one-month interval, the medications were switched.
The team reported in the Dec. 27 New England Journal of Medicine that patients had significantly less stiffness and fewer spasms while they were receiving the immunoglobulins. At the end of the trial, 11 of the 14 patients who completed the study were able to either walk unassisted, resume work activities or remain upright without fear of falling.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
