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December 21, 1998

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Medical News Tips

Listed below are story ideas from Johns Hopkins Medical Institutions.

LOW-DOSE RADIATION MAY KEEP ARTERIES CLEAR AFTER ANGIOPLASTY

Johns Hopkins heart specialists are testing a device that delivers low doses of radiation to coronary arteries as part of a national clinical trial to see if radiation prevents the vessels from closing up after they're opened by balloon angioplasty or a stent.

The device, which hooks to a catheter containing tiny radioactive "seeds," is used in conjunction with angioplasty, in which a balloon is inflated inside an artery to flatten clumps of plaque. The hope is that the seeds will slow cell growth at the angioplasty site, reducing the chance of restenosis, a re-narrowing of the artery. Up to one half of angioplasty patients have restenosis within six months of the procedure, requiring many to have a second angioplasty or heart bypass surgery.

In the study, physicians use the device immediately following a balloon angioplasty, inserting it into the treated artery for less than five minutes, then removing it.

"The radiation exposure from the catheter is less than 1 percent of that of a regular chest X-ray," says Jeffrey A. Brinker, M.D., director of interventional cardiology and one of the principal investigators of the trial. "The seeds never come in contact with the patient's tissue or blood, so they are very safe."

For the study, the Hopkins interventional cardiology group is seeking 20 patients who have coronary artery disease and have been told they might need angioplasty. Patients who have had an emergency cardiac condition within the last 72 hours, or who have undergone angioplasty within the past month are ineligible.

To volunteer for the study, call Teri Murtha, R.N., at (410)955-6839.

IF YOUR SIBLING HAS HEART DISEASE, YOU MIGHT BE AT RISK

Apparently healthy brothers or sisters of people with premature heart disease may be up to 12 times more likely to develop coronary heart disease than the general population, according to a study by Johns Hopkins researchers.

Results of the study were published in the Nov. 1 issue of the American Journal of Cardiology.

The Hopkins team studied 846 siblings, ages 30 to 59, of people with premature heart disease. While the study group showed no apparent signs of heart disease, they had a high prevalence of coronary risk factors. Overall, they had higher levels of cholesterol and fats in their bloodstream, and higher blood pressure than the general population. They also were more likely to smoke cigarettes.

"Although all siblings had a source of medical care and most saw their physicians at least once a year, most were unaware of their elevated lipid levels and blood pressure," says Diane M. Becker, Sc.D., lead author of the study and director of The Johns Hopkins Center for Health Promotion. "This calls for more aggressive national guidelines for heart disease and better screening for the apparently healthy siblings of people with heart disease."

MORTALITY RATES FROM ABDOMINAL ANEURYSMS DECLINING

Although operations to repair ruptured abdominal aortic aneurysms continue to be risky -- especially among the elderly -- death rates linked with the surgery have declined in recent years, according to a Johns Hopkins study.

"We also found that surgeons who perform the most operations to repair these aneurysms have the best rates of patient survival, suggesting that patients suspected of having a rupture who are medically stable should be transported to high-volume hospitals where surgeons perform more of the operations," says Bruce A. Perler, M.D., senior author of the study and a professor of surgery.

Called silent killers because they often cause no symptoms, aneurysms, or swellings of the abdominal aorta -- the main artery supplying blood to the lower body -- occur in more than 5 percent of people age 60 and older. They can be fatal if they leak or rupture. About 75 percent of these abnormalities go undiagnosed. Some are found unexpectedly during physical exams or picked up on X-rays taken for unrelated reasons.

Using the Maryland Health Services Cost Review Commission database, the researchers tracked 527 patients who underwent emergency surgery to repair ruptured abdominal aortic aneurysms at Maryland hospitals between 1990 and 1995. The mortality rate from the procedure decreased from 59.3 percent to 43.2 percent during that time period, most likely from a combination of factors such as improvements in anesthesia and better postoperative intensive care, Perler says.

The study was published in a September issue of the Journal of Vascular Surgery.

HEART TRANSPLANT RECIPIENTS NEED TO WATCH THEIR DIETS

The biggest challenge for heart transplant recipients is not staying alive but staying with a healthy lifestyle, a Johns Hopkins study shows.

A review of 42 patients who underwent heart transplant at Hopkins between 1983 and 1995 showed that obesity and high cholesterol were significant problems within three months of transplantation. Four of the patients gained more than 50 pounds, caused in part by the anti-inflammatory medication prednisone.

Results were published in a September issue of the Journal of Transplant Coordination.

"Although prednisone dosage should be adjusted to the lowest possible dose, dietary and lifestyle changes remain the foundation of effective management of these posttransplant complications," says Sharon M. Augustine, R.N., M.S., lead author of the study and nurse coordinator for heart transplant.


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