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Am Fam Physician. 1998;58(8):1831-1832

Persons Who Smoke Cigars Have an Increased Risk of Cancer

(31st Annual Meeting of the Society for Epidemiologic Research) Results of a study of 24,470 men who answered questions about smoking habits at multiphasic checkups from 1964 to 1973 indicate that men who smoke cigars have a twofold increase in cancers of the lung and of the mouth and pharynx, compared with nonsmokers. The subjects in the study were 20 years of age or older (mean age: 40.6 years) at the time of examination. The study, which followed the subjects through 1996, included 1,815 men who smoked cigars. None of the cigar smokers had smoked cigarettes or pipes. The age-adjusted risk ratio for all cancers was 1.15. Site-specific cancers included the lung (risk ratio: 2.08), the mouth and the pharynx (risk ratio: 2.08), all upper aerodigestive cancers (1.77), and all cigarette-related cancers (risk ratio: 1.47). Higher increases of cancer were associated with higher quantities of cigar smoking.—irene s. tekawa, m.d., et al., Kaiser Permanente Division of Research, Oakland, Calif.

Sarcopenia Is Associated with Injurious Falls in the Elderly

(Society for Epidemiologic Research) Sarcopenia, the loss of muscle mass due to aging, is a risk factor for injurious falls in the elderly. This is the conclusion of a study that investigated the association of the amount of skeletal muscle mass in a person's legs with the relative risk of falling in 121 elderly men (average age: 76.4 years) and women (average age: 75.7 years). Variables included body fat, balance and gait, physical activity and medication use. Age was significantly associated with falls in men but not in women. The risk of falling had a “u-shaped” association with muscle mass in each sex; the risk of falling was increased significantly in the lowest and highest tertiles of muscle mass, compared with the middle tertile. The relative risk of falls in women was significantly increased in those whose leg muscle mass fell in the first (relative risk: 1.629) and third (relative risk: 1.546) tertiles, in those with gait abnormalities (relative risk: 1.880) and in those who used medication (1.643). Increased body fat was protective against injuries due to falls in men but not in women. The investigators believe that the risk of falls in those with high muscle mass may be a result of increased activity and exposure to falls. Men who had low leg muscle mass, gait abnormalities, were taking more than three medications or were more physically active had more falls with injuries. Women who had low leg mass, balance abnormalities or were taking more than three medications had an increased risk of falls with injuries.—debra l. waters, m.d., et al., University of New Mexico School of Medicine, Albuquerque, N.M.

Test Predicts if Aggressive Therapy Will Help Patients with Advanced HIV

(12th World AIDS Conference) Results of a study of patients with moderately advanced human immunodeficiency virus (HIV) infection show that an antiviral resistance test (genotyping test) can predict which patients with HIV infection may benefit from aggressive follow-up treatment after combination drug therapy has failed. The genotyping test identifies mutations that enable the virus to resist drug treatment. The study included 51 men and three women for whom combination therapy had not been effective. All of the patients had been receiving antiviral drugs for an average of four years, and each had taken four out of the five available nucleoside analogs. In addition, the patients had spent at least one year on a drug regimen that included a protease inhibitor. Each patient's viral load had increased at least fivefold or had gone from undetectable to detectable levels despite treatment. About one-third of the patients had progressed to a diagnosis of acquired immunodeficiency syndrome. As part of the study, the 54 patients began an aggressive drug regimen that included two protease inhibitors with two nucleoside analogs as backup drugs. Forty-one percent of the patients had a full response to treatment, and 26 percent had a partial response. About 33 percent did not do well. The study results were compared with results of the genotyping tests performed on viral samples that were taken before the new drug regimen was begun and had been stored since the start of the study. A direct correlation was found between responses to the new drug regimen and the results of the genotyping tests. Of patients whose viral samples showed no mutations, 70 percent had a decrease in viral load to undetectable levels. Of patients with two mutations, 11 percent had a decrease in viral load to the undetectable range. None of the patients with three or more mutations had a decline in viral load to undetectable levels. The investigators believe that physicians should routinely perform the genotyping test in HIV patients with a long history of antiviral treatment to help determine subsequent therapies.—andrew zolopa, m.d., et al., Stanford University School of Medicine, Stanford, Calif.

Modafinil Improves Quality of Life in Patients with Narcolepsy

(12th Annual Meeting of the Associated Professional Sleep Societies) Modafinil, an investigational wake-promoting drug, helps control daytime sleepiness and improves energy levels in persons with narcolepsy, according to a placebo-controlled study that included 481 persons with narcolepsy. The patients were randomized to receive placebo once daily (163 patients), 200 mg of modafinil once daily (161 patients) or 400 mg of modafinil once daily (157 patients). During the nine-week trial, the patients receiving 200 mg of modafinil reported more than a 50 percent improvement in performance of daily activities and social functioning, compared with the patients who received placebo. Those who received 400 mg of modafinil reported even more improvements in their energy levels and were more productive. When the patients were taken off modafinil for two weeks, their symptoms of narcolepsy reappeared. According to investigators, modafinil has fewer side effects than methylphenidate or amphetamines. More information on this research can be found online at—ann e. rogers, ph.d., r.n., et al., University of Michigan School of Nursing, Ann Arbor, Mich.

A New Treatment for Abdominal Aneurysm Is Safe and Effective

(26th Annual Symposium on Vascular Surgery of the Society for Clinical Vascular Surgery) Patients with abdominal aortic aneurysm may benefit from a new treatment for abdominal aortic aneurysm called endovascular surgery, according to a study of 50 patients with abdominal aortic aneurysm who underwent the endovascular procedure. In the endovascular procedure, the aneurysm is repaired from inside the aorta using a catheter instead of through a large incision extending over the abdomen. In the study, three patients had to be converted to open surgery during the procedure. One high-risk patient had a fatal myocardial infarction three days after the surgery. However, almost 90 percent of the patients in the study were discharged within two or three days of the surgery, compared with 5.8 days in patients undergoing the open procedure. At a mean follow-up period of eight months, all of these patients were doing well. During the surgery, a catheter containing a collapsed polyester tube is inserted into the patient's femoral artery and moved to the site of the aneurysm. Then, a spring-type attachment system hooks the tube to the inside walls of the artery on either end of the aneurysm and is anchored into place. Blood is able to flow through the implant, cutting off the supply of blood to the aneurysm.—michel makaroun, m.d., et al., University of Pittsburgh Medical Center, Pittsburgh, Pa.

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Copyright © 1998 by the American Academy of Family Physicians.

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