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Am Fam Physician. 2000;61(2):478-480

Asymptomatic Prostatitis Screening Prevents Unnecessary Biopsies

(51st Annual Scientific Assembly of the American Academy of Family Physicians) Identifying and treating asymptomatic prostatitis in men with elevated prostate-specific antigen (PSA) levels reduced the number of biopsies by 18 percent, according to a study of 122 men in a urology practice at a tertiary care center. The study included men over age 50 with elevated PSA levels (mean: 11.5 ng per mL). Patients were excluded from the study if they had PSA levels greater than 50 ng per mL, acute urinary tract infection, or refused a biopsy. Interventions included digital rectal examinations, prostate massages, microscopic analysis of urine, expressed prostatitic secretions (EPS) and/or post prostatic massage urine (VB3), antibiotic therapy, and repeat PSA levels at six to eight weeks. Fifty of the 122 patients (41 percent) tested positive for EPS or VB3, indicating prostatitis. Following a four-week course of antibiotics (Bactrim DS, Ciprofloxacin if sulfa allergic), 10 of these 50 men had normal PSA levels (mean: 2.9 ng per mL), and 31 remained abnormal. Transrectal ultrasound guided biopsies (TRUS bx) were immediately performed, and cancer was found in nine of these 31 men. TRUS bx also revealed cancer in 36 of the 72 patients who had a negative EPS or VB3. Screening for prostatitis prevented 19 patients from receiving unnecessary biopsies.—jeannette m. potts, m.d., Cleveland Clinic Foundation, Cleveland, Ohio.

Candida Antigen Injection Proves Effective Treatment for Warts

(American Academy of Family Physicians) According to the results of a randomized, double-blind, placebo-controlled trial, Candida antigen is a safe and effective treatment option for common warts, achieving wart resolution in 81 percent of the patients with no recurrence of the wart at six months and no recognized side effects. Eighty-five patients in a primary care, sports medicine clinic were randomized to either a treatment group (41 patients) or a control group (44 patients) with follow-up for six months after treatment. Patients in the treatment group received an injection of 0.1 cc of 1:1,000 Candida antigen into the base of the wart, while patients in the control group received an injection of 0.1 cc of sterile saline. Each subject was given a follow-up injection after four weeks. Thirty-four of the 41 patients (83 percent) in the treatment group and 11 of the 44 patients (25 percent) in the control group had resolution of their wart. Some of the patients in the control group who did not achieve resolution of the wart following the placebo injection were unblinded and given Candida antigen injections. Of these 21 patients, 16 achieved resolution of their wart. Overall, 50 out of 62 patients (81 percent) who received a Candida antigen injection achieved resolution of their wart. Eight out of 41 patients (20 percent) reporting multiple warts had resolution of more than one wart, including warts that were not close to the injected wart. The investigator recommends further study to determine Candida antigen's mechanism of action, the optimal number of injections of Candida antigen and whether the treatment can be modified to achieve greater wart resolution.—kenneth h. haller, d.o., Ball Memorial Hospital, Muncie, Indiana.

Abuse During Pregnancy Linked to Smaller, Premature Newborns

(American Academy of Family Physicians) In a cross-sectional study of postpartum women and their newborn infants, the prevalence of physical and sexual abuse during pregnancy was 19.4 percent and 9.4 percent respectively, and the newborns of these abused women had higher incidences of stillbirths, being born preterm, lower birth weight and birth length as well as smaller chest circumference measurements. The investigators randomly selected 372 postpartum patients and their newborn infants in a governmental maternity hospital in the Philippines for the study. These women were interviewed using an abuse assessment screen questionnaire to determine if there was any abuse during the pregnancy. The maternal and neonatal charts, the medical history and the neonatal outcomes were reviewed. Patients with maternal complications were excluded from the analysis. Husbands, live-in partners and parents were the primary perpetrators of physical abuse during pregnancy (33 percent, 30.5 percent and 29 percent, respectively). Physical abuse most often included threats of abuse, slapping, bruises and cuts, usually to the head. Sexual abuse during pregnancy was most often inflicted by the sexual partner and usually occurred during the first trimester. Abused women were more likely than nonabused women to be unemployed (95.8 percent), to be younger (66.6 percent were 20 to 25 years of age), to be less educated (41.7 percent) and to have unemployed spouses (31.9 percent). Abused women were also less likely to have prenatal care check-ups during pregnancy. The investigator recommends further studies with larger, more diverse populations.—carolina s. valencia, m.d., Santo Thomas University Hospital, Manila, Philippines.

Ambulance Response Time Is Crucial to Patient Survival in Rural Areas

(American Academy of Family Physicians) According to an analysis of emergency medical transportation services in a rural Nebraska town, the average trauma run duration of about an hour signals the need for steps to be taken to reduce this time and increase patients' chances of survival. This analysis also discovered the need for education and preventive health measures for those specific subgroups in a given population that have a disproportionate use of ambulance services. The analysis looked at all 242 people requiring emergency medical transportation services during 1997 in a rural community in Nebraska which has miles of unmarked dirt roads. Official documents from each trauma run were collected and analyzed for total time of run (the time ambulance in route minus time return to hospital), distance traveled in miles, type of situation encountered, and the patients' sex, race and age. There were 68 total trauma runs (1.1 per 100 population). Rural runs outside of the town averaged 61 minutes and 35.3 miles. The investigator recommends several steps to reduce the duration of rural ambulance runs. The first step is to map and identify all unmarked roads in the area. The second step is to alert the closest available personnel (such as emergency medical technicians) so they can assess the situation and intervene before the ambulance arrives. The analysis also showed a marked difference between the number of emergency ambulance runs which involved a Native American (32 percent) and the percentage of the county population that was Native American (2.9 percent). The investigator calls for additional research of emergency services in rural areas to determine if their results are similar.—jonben d. svoboda, University of Nebraska Medical Center, Omaha, Nebraska.

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