Monitoring Blood Sugar After Surgery Is Beneficial
Actively treating patients who develop high levels of blood sugar during recuperation from surgery can ease complications and improve survival, according to a new study.
Non-diabetic patients who undergo surgery often develop diabetes symptoms during their immediate recovery, but physicians have never been quite sure how aggressively to treat them. A new Belgian study suggests that prompt treatment of the symptoms can cause dramatic improvements in the patients’ health and recovery.
Dr. Greet Van den Berghe of the Catholic University of Leuven, Belgium, studied patients in the intensive care unit after surgery. About 765 patients received aggressive treatment with insulin as soon as their blood sugar levels exceeded 110 milligrams per deciliter. The normal range is 80 to 110 mg/dl. A similar number did not receive insulin until their sugar levels reached 215 mg/dl, and even then their blood sugar readings were kept between 180 and 200 mg/dl.
The researchers reported in the Nov. 8 New England Journal of Medicine that the patients treated aggressively had a 32% lower death rate, 46% fewer bloodstream infections, 41% fewer kidney infections and only half as many blood transfusions. The findings were so dramatic that the study was ended prematurely, and all subjects began receiving intensive treatment. But experts cautioned that nearly all the patients were heart surgery patients and that hospital staff knew which ones were receiving aggressive therapy, which might have influenced the outcome. Most suggested further trials before the practice is widely implemented.
Treating Infections Early Is Crucial to Saving Lives
Lives can be saved if intensive treatment of severe infections begins as soon as patients enter the emergency room rather than waiting until they are transferred to the intensive care unit, another study in the New England Journal of Medicine has found. Severe infections, also known as severe sepsis and septic shock, kill an estimated 215,000 Americans each year and result in $16 billion in hospital costs.
Dr. Manuel P. Rivers and his colleagues at Henry Ford Hospital in Detroit studied 263 patients who arrived at the emergency room with severe infections. Half received normal treatment and half received a regimen called Early Goal Directed Therapy, which is similar to how patients would be treated in the ICU. Among other features of the therapy, patients had a fiber-optic sensor inserted into their hearts to measure oxygen levels so that physicians could respond to oxygen deficiencies more rapidly.
The researchers found that patients receiving the therapy had a lower mortality rate, 30.5%, compared with a 46.5% among those who treated were by standard methods. They also had a substantially lower incidence of organ failure and spent about four fewer days in the hospital.
Hormone Therapy Raises Risk of Dry Eye Syndrome
Hormone replacement therapy increases the risk of dry eye syndrome, a lack of eye moisture that can impair the ability to read, drive and work. Researchers are not sure how estrogen produces the effect, but they suspect that it may inhibit oil-producing glands or affect a gland in the eyelid that produces an oily substance in tears.
Dr. Debra Schaumberg of Brigham and Women’s Hospital in Boston studied the records of 25,389 women older than 48. She and her colleagues reported in the Nov. 7 Journal of the American Medical Assn. that women taking estrogen alone were about 70% more likely to have dry eye syndrome than those not on hormone replacement therapy. Women taking a combination of estrogen and progesterone were 30% more likely to have the syndrome.
More Radiation Therapy May Aid Younger Women
Young women being treated for breast cancer do not receive enough radiation, according to a new study that found that a “booster dose” dramatically lowered the risk of recurrence. Normally, after a breast tumor is removed, oncologists give a woman about 50 units of radiation during a five-week period to reduce recurrence. But that approach has not been very successful.
Dr. Harry Bartelink and his colleagues at the Netherlands Cancer Institute in Amsterdam studied 5,318 breast cancer patients, giving 2,661 of them an extra 16 units of radiation.
After five years, the booster dose had little effect on the survival rate for women ages 41 to 50, the team reported in the Nov. 8 New England Journal of Medicine. For younger women, however, the chance of tumor recurrence was 10.2% in those receiving the booster dose, compared with 19.5% in women who did not receive the extra radiation.
Drug Eases Symptoms of Sickle Cell Disease
A new drug that appears to make red blood cells more slippery, enabling them to pass more readily through constricted capillaries, eases the symptoms of sickle cell disease, according to a new study. The drug, called Purified Poloxamer 188, also helps oxygenate tissues, which further reduces pain.
A team headed by Dr. Eugene P. Orringer of the University of North Carolina’s School of Medicine in Chapel Hill studied 255 adults and children undergoing sickle cell crises that required hospitalization. Most were already taking hydroxyurea, the only drug previously shown to reduce pain and sickling. Half received a placebo, and half received PP 188.
The team reported in the Nov. 7 Journal of the American Medical Assn. that patients receiving the drug were about 50% more likely to have their pain subside within a week than those receiving a placebo, or dummy pill. The greatest benefits were seen in children and in those already taking hydroxyurea.
Fifth Artificial Heart Recipient Is Doing Well
A Philadelphia patient has become the fifth to receive the artificial heart produced by Abiomed Inc. of Danvers, Mass. Dr. Louis E. Samuels of MCP Hahnemann University performed the procedure last Monday. The patient’s identity has not been revealed. All five patients are doing well.
Measuring Amino Acid Forecasts Pregnancy Risks
Measuring the amount of homocysteine in the blood during early pregnancy can help predict who is at risk for pre-eclampsia, an increase in blood pressure that is associated with complications for the mother and infant. Homocysteine is an amino acid formed naturally when the body breaks down proteins.
Dr. Amanda M. Cotter and her colleagues at Trinity College in Dublin, Ireland, measured homocysteine levels in 56 women with severe pre-eclampsia and 112 women without it.
They reported in the American Journal of Obstetrics and Gynecology that women with elevated levels of the amino acid were three times as likely to develop the disorder.
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The writer can be reached at thomas.maugh@latimes.com.
