Study Disputes Theories About Asthma in the Industrialized World

TIMES MEDICAL WRITER

The industrialized world has an inexplicably high and still-growing incidence of asthma and other autoimmune diseases. Most researchers attribute such increases to some facet of industrialized societies, such as increased sanitation, lesser exposure to common pathogens during childhood, vaccinations or pollution. A new study of asthma rates in indigenous communities in Australia appears to deliver a strong blow to such theories, however.

Dr. Patricia C. Valery of the Queensland Institute of Medical Research and her colleagues studied the incidence of asthma in 1,650 aboriginal children in five isolated communities. They interviewed every child and parent, determining the incidence of wheezing and other symptoms.

To their surprise, they reported in the June issue of European Respiratory Journal, they found that the incidence of asthma in the villages was about one in five, the same incidence observed in Australian cities. One possible explanation is that residents of the villages have a high level of smoking. The team is now organizing a second study to examine possible mechanisms for the high incidence among the villagers.

Artery-Bypass Surgery Bypasses Convention

A German-American team has performed the first coronary artery bypass conducted through a catheter inserted through the femoral vein in the leg. The unusual procedure, in effect, hijacked a nearby vein and used it to provide adequate blood flow to heart muscles that were starved for oxygen.

A team led by Dr. Stephen Osterle of Massachusetts General Hospital performed the 1999 surgery on a 53-year-old German man who had severe chest pain because his artery was almost totally blocked--too blocked for a conventional bypass or angioplasty. Using the catheter, the team inserted a thin collapsible wire through the artery wall into the nearby vein, then enlarged the wire to provide a channel for blood. A plug was inserted into the vein so that oxygenated blood had to flow into the heart.

The team reported in the June Circulation: Journal of the American Heart Assn. that, a year later, the man is well and suffers no chest pain.

Larynx Transplant Has Patient Singing

The first successful transplant of a larynx has now enabled a man whose own larynx was crushed in a motorcycle accident to sing and to work as a motivational speaker, according to Ohio researchers.

Timothy Heidler, 40, was a firefighter when he accidentally rode his motorcycle into a wire strung across the road. After the accident, he could speak only with an electronic voice box. But three days after the 12-hour procedure in 1999, he was able to say hello to his doctors at the Cleveland Clinic Foundation.

The procedure, reported in the May 31 New England Journal of Medicine, is somewhat controversial. Surgeons normally perform transplants only for life-threatening conditions because recipients must take immune-suppressing drugs for the rest of their lives. But as transplant drugs have become safer and more effective, physicians have been more willing to make exceptions such as this one.

Heart Study Dims Hopes for Beta Blocker Drug

An experimental beta blocker thought to be promising in the treatment of advanced heart disease actually provides little or no benefit, according to a major new study.

Like other beta blockers, the new drug, bucindolol, works by inhibiting receptors of the stress hormone norepinephrine, which is involved in the progression of heart failure.

A team headed by Dr. Eric Einhorn of the University of Texas Southwestern Medical Center in Dallas enrolled 2,708 advanced heart disease patients in the study. The patients received standard therapy for heart failure, plus either bucindolol or a placebo.

The team reported in the May 31 New England Journal of Medicine that the study was halted prematurely because no significant differences were observed between the two groups. There was a slight trend, however, toward longer survival in patients who received the drug and who were in the earliest stages of heart failure. The study was sponsored by the National Institutes of Health and the drug's manufacturer, Incara Pharmaceuticals.

Another Beta Blocker Shows Better Results

Another beta blocker has produced better results in a different trial. That drug is carvedilol, trade named Coreg, which has previously been shown to reduce mortality in patients with mild to moderate heart failure.

A team led by Dr. Milton Packer, of the Columbia University College of Physicians and Surgeons in New York City, studied 2,289 patients with severe heart failure. They were randomly assigned to receive either a placebo (1,133 patients) or carvedilol (1,156 patients) in addition to standard treatment.

The team reported in the May 31 New England Journal of Medicine that there were 190 deaths in the placebo group, but only 130 in the drug group over the average 10.4 months of the study. That translated to a 35% reduction in the risk of death. The study was sponsored by Roche Pharmaceuticals and GlaxoSmithKline, the drug's manufacturers.

Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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