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This week in the medical journals

By Peggy Peck
MedPage Today Managing Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.



Centers for Disease Control & Prevention
Health Organizations
Health Treatment
Medical Research

Caution, caution

The major medical journals this week reported a pair of cautions about prescription drugs.

Rare infection

First, researchers at the Centers for Disease Control and Prevention described four deaths among previously healthy young women who took Mifeprex (mifepristone, RU-486), the so-called abortion pill.

All four women died from toxic shock caused by a rare infection from bacteria that occasionally attacks women who have just given birth. Early diagnosis of the infection is difficult because the first signs of infection -- vomiting, diarrhea, and cramps -- are similar to the expected side-effects of the drug.

The CDC urged doctors and patients to be aware of other warning signs of infection such as sudden drops in blood pressure, fluid retention, and rapid heart rate.

But even while they urged vigilance, the researchers and a Harvard editorial writer pointed out in the New England Journal of Medicine that these infections are extremely rare.

Rare fatal toxic shock reported following medical abortions

Old dementia drugs also risky

Earlier this year the FDA warned that newer atypical antipsychotics like Zyprexa (olanzapine) and Risperdal (resperidone), which are used to treat dementia, could increase mortality in elderly patients. Now, a team of Harvard researchers reported in the New England Journal of Medicine that substituting old standby drugs like Thorazine (chlorpromazine) and Haldol (haloperidol) may not be a good option.

When they analyzed medical records from almost 23,000 patients, the Harvard team found that patients taking the older drugs had an even higher risk of mortality than those who used the atypical antipsychotics.

However, the new report is based on a retrospective analysis, a study design that provides weaker evidence than randomized controlled trials.

Older antipsychotic drugs called risky compared with atypical agents

Diabetes-dementia link probed

Diabetes is already considered a major risk factor for heart attacks and stroke. Now researchers at Brown Medical School in Providence, Rhode Island, say that a diabetes-like low-insulin condition may also play a role in Alzheimer's disease.

Writing in the Journal of Alzhiemer's disease, the researchers reported that autopsy examinations of tissue from brains of Alzheimer's disease patients found insulin, insulin-like growth factor, and an insulin receptor were all at unexpectedly low levels -- 80 percent lower than the level found in normal brains.

The Brown team named the finding Type 3 diabetes to distinguish it from insulin-dependent or Type 1 diabetes and Type 2 diabetes, which is linked to obesity and drives up glucose levels in the blood.

Alzheimer's may be insulin-dependent disease

Too much of good thing

Tylenol (acetaminophen) is a good drug for treating the pains of everyday life, but too much Tylenol is lethal to the liver. It is so toxic that acetaminophen poisoning is now the leading cause of acute liver failure in the United States, according to a study by University of Washington researchers who reported this in the December issue of Hepatology.

And while the overdose is often intentional, the researchers pointed out that accidental overdoses can occur when people try to boost pain relief by combining Tylenol with one or more additional acetaminophen-containing pain killers.

Acetaminophen is leading cause of acute liver failure

Two effective treatments for leg pain

Peripheral arterial disease -- the "hardening" of leg arteries that causes pain when walking -- is a common problem among older Americans.

Bypass surgery to replace the narrowed leg vein is a common surgical treatment for the condition, but some doctors are treating the problem with angioplasty, the same minimally invasive techniques used to open narrowed blood vessels in the heart.

Now a study in The Lancet that compared the treatments in 452 patients concluded that both treatments work, but surgery requires longer hospitalization which means a higher price tag.

Surgery and angioplasty outcomes similar for leg ischemia

Teachable moment

There is never an ideal time to tell patients that they have cancer -- but the time that the diagnosis is delivered is the best time to persuade patients to stop smoking.

That was the conclusion of researchers from the M.D. Anderson Cancer Center in Houston who reported in Cancer that telling a patient it is time to quit, while also telling them of the cancer diagnosis, can help up to 70 percent of smokers quit.

By contrast only about 20 percent of smokers quit when doctors deliver the kick-the-habit message during a routine medical visit.

Cancer diagnosis is best moment for stop-smoking message

Into the swim

Finally, there was encouraging news about an unconventional treatment for mild-to-moderate depression: swimming. Not just swimming laps at the local Y, but swimming with bottlenose dolphins.

Researchers in Roatan, Bay Islands, Honduras, said that for nine of 10 patients swimming with dolphins was enough to lift their depression so that they no longer required treatment. This was a significantly better result than for patients who simply snorkeled or swam but didn't interact with Flipper and friends.

Endnote: A trip to the Caribbean has other benefits, too.

Swimming with dolphins relieves depression

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