CT Scans: They are responsible for 2 per cent of all cancers

CT (computed tomography) scans are the cause of up to 2 per cent of all cancers.  The effect could be far worse among children, who are more sensitive to irradiation.

The scans, which seem to especially cause cancers of the lungs and colon, produce a radiation dose similar to that of the atom bombs that were dropped over Hiroshima and Nagasaki in 1945.

Each scan produces a radiation dose of around 15 mSv in an adult, and 30 mSv in a newborn child, and as standard treatment is for two to three scans, the overall dose reaches 45 mSv.  Survivors of Nagasaki and Hiroshima were exposed to doses slightly below 50 mSv.

Around 11 per cent of all CT scans are carried out on children to determine if they have appendicitis, and researchers fear that, even if they do not develop cancer immediately, they are still at greater risk as adults as their radiation load continues to increase.

In the US alone, 62 million scans are performed every year, mainly to check on seizures, chronic headaches and trauma, an extraordinary increase since 1980 when just 3 million scans were performed.

Researchers from Columbia University Medical Center in New York base their cancer estimates on radiation exposure from survivors of the atomic bomb blasts, and from a major study into the health of 400,000 workers in the nuclear industry.
They also reckon that up to a third of all CT scans are unnecessary or could be replaced by safer technology such as ultrasound.

If that’s so, it means that 20 million adults and 1 million children are unnecessarily irradiated every year in the US – and also being exposed to the risk of cancer.

(Source: New England Journal of Medicine, 2007; 357: 2277-84).

La mortalidad por el uso de fármacos en los pacientes con enfermedad inflamatoria intestinal, 1996-2003

La mortalidad por el uso de fármacos en los pacientes con enfermedad inflamatoria intestinal, 1996-2003 Susan M. Hutfless Susan M. Hutfless ^{, ‡} , Xiaoping Weng ^‡ , Liyan Liu ^‡ , James Allison ^{‡ , §} and Lisa J. Herrinton ^{‡ , , ‡,} Weng ^‡ Xiaoping, Liyan Liu ^‡, James Allison ^{‡, §} y Lisa J. Herrinton ^{‡, , ,
‡} Division of Research, Kaiser Permanente Northern California, Oakland, California ^‡ División de Investigación, Kaiser Permanente del Norte de California, Oakland, California
Epidemiology Department, Harvard School of Public Health, Boston, Massachusetts Departamento de Epidemiología, Harvard School of Public Health de Boston, Massachusetts
^§ Gastroenterology Division, University of California at San Francisco, San Francisco, California ^§ División de Gastroenterología, Universidad de California en San Francisco, San Francisco, California
Received 27 October 2006;  accepted 6 September 2007.  Available online 26 September 2007. Recibió el 27 de octubre de 2006; aceptado 6 de septiembre de 2007. Disponible en línea 26 de septiembre de 2007.

Referred to by: Mencionado por:

This Month in Gastroenterology Este mes en Gastroenterology Gastroenterology ,  Volume 133, Issue 6 ,  December 2007 , Pages 1749-1752 Gastroenterology, Volumen 133, Número 6, de diciembre de 2007, Pages 1749-1752 Jan Tack and John M. Carethers Enero Tack y John M. Carethers Abstract | Full Text + Links | PDF (877 K) Abstract | Full Text + Links | PDF (877 K)

Background & Aims: Most previous population-based studies of mortality in inflammatory bowel disease (IBD) did not account for medication use. Antecedentes y objetivos: La mayoría de anteriores estudios basados en la población de la mortalidad en la enfermedad inflamatoria intestinal (EII) no cuenta para el uso de fármacos. We evaluated mortality by IBD medication use among members of the Kaiser Permanente Northern California IBD Registry. Methods: The retrospective, population-based cohort study included 9032 persons who received at least one inpatient or 2 outpatient diagnoses of IBD during 1996–2002. Se evaluó la mortalidad por el uso de fármacos de EII entre los miembros de la Kaiser Permanente del Norte de California IBD Secretaría. Métodos: La retrospectiva, population-based cohort study incluyeron 9032 personas que recibieron por lo menos una o 2 ambulatoria hospitalaria diagnóstico de la EII durante 1996-2002. Age and sex standardized mortality ratios measured the associations between IBD and all-cause and cause-specific mortality. Edad y sexo normalización de las razones de mortalidad mide las asociaciones entre IBD y por todas las causas y la mortalidad por causas específicas. Age, sex, and smoking adjusted odds ratios measured the association of mortality by IBD medication use. Results: Compared with health plan members without IBD, mortality was increased in patients with Crohn’s disease (CD) (1.4; 95% confidence interval, 1.2–1.6) but not ulcerative colitis (UC) (1.0; 95% CI, 0.9–1.2). La edad, el sexo, el tabaquismo y odds ratios ajustados que mide la asociación de la mortalidad por el uso de fármacos de IBD. Resultados: En comparación con el plan de salud de los miembros sin IBD, fue el aumento de la mortalidad en pacientes con la enfermedad de Crohn (CD) (1,4, 95% intervalo de confianza, 1.2-1.6), pero no la colitis ulcerosa (CU) (1,0, IC 95%, 0,9-1,2). CD was associated with increased mortality from infectious and parasitic diseases (4.1; 95% CI, 1.7–8.5), septicemia (6.8; 95% CI, 2.2–15.8), small intestinal cancer (48.1; 95% CI, 5.8–17.4), respiratory diseases (1.9; 95% CI, 1.3–2.7), digestive diseases other than IBD (2.4; 95% CI, 1.0–4.8), and liver diseases (2.6; 95% CI, 1.0–5.3). CD se asoció con aumento de la mortalidad por enfermedades infecciosas y parasitarias (4,1, IC 95%, 1,7-8,5), la septicemia (6,8, IC 95%, 2,2-15,8), los pequeños cáncer intestinal (48,1, IC 95%, 5,8-17,4) , Las enfermedades respiratorias (1,9, IC 95%, 1,3-2,7), enfermedades digestivas distintos de EII (2,4, IC 95%, 1,0-4,8), y enfermedades hepáticas (2,6, IC 95%, 1,0-5,3). UC was associated with increased mortality from digestive diseases other than IBD (3.9; 95% CI, 2.4–6.0). UC se asoció con un aumento de la mortalidad por enfermedades digestivas distintos de EII (3,9, IC 95%, 2,4-6,0). The relationship with CD mortality was 0.7 for aminosalicylates (95% CI, 0.5–1.1), 1.3 (95% CI, 0.9–1.9) for immunomodulators, and 1.0 (95% CI, 0.7–1.4) for corticosteroids. La relación con el CD de mortalidad fue 0,7 por aminosalicylates (95% CI, 0.5-1.1), 1,3 (95% CI, 0.9-1.9) para inmunomoduladores, y 1,0 (95% CI, 0.7-1.4) de los corticosteroides. Among patients with UC, these odds ratios were 0.8 (95% CI, 0.5–1.1) for aminosalicylates, 0.5 (95% CI, 0.3–0.9) for immunomodulators, and 0.8 (95% CI, 0.6–1.1) for corticosteroids. Conclusions: Mortality is increased in CD. Entre los pacientes con UC, estos odds-ratios fueron 0,8 (95% CI, 0.5-1.1) para aminosalicylates, 0,5 (95% CI, 0.3-0.9) para inmunomoduladores, y 0,8 (95% CI, 0.6-1.1) de los corticosteroides. Conclusiones : La mortalidad aumenta en CD. Infections, respiratory diseases, and digestive diseases are important specific causes of death. Número de infecciones, enfermedades respiratorias, enfermedades digestivas y son importantes causas de muerte. IBD medication use has varying associations with mortality. IBD uso de fármacos tiene varias asociaciones con la mortalidad.

Abbreviations: CI, confidence interval; ICD, International Classification of Diseases; SMR, standardized mortality ratio Abreviaturas: IC, intervalo de confianza; CIE, Clasificación Internacional de Enfermedades; SMR, la tasa de mortalidad normalizada

S.M.H. SMH owns stock in Pfizer and GlaxoSmithKline. Es titular de acciones de Pfizer y GlaxoSmithKline. L.J.H. LJH receives grant support from Procter and Gamble and Protein Design Laboratories. Recibe el apoyo de la concesión de Procter & Gamble y Laboratorios Protein Design. X.W., L.L., and J.A. XW, LL, y JA have no conflicts of interest to report. No tienen conflictos de intereses al informe.

Support provided by the Crohn’s and Colitis Foundation of America, the Kaiser Foundation Community Benefit Program, and the Valley and Ellis Foundation. Apoyo prestado por la Crohn y Colitis Foundation de América, la Fundación Kaiser Comunidad Benefit Program, y la Fundación Valle y Ellis.

La mortalidad por el uso de fármacos en los pacientes con enfermedad inflamatoria intestinal, 1996-2003

La mortalidad por el uso de fármacos en los pacientes con enfermedad inflamatoria intestinal, 1996-2003 Susan M. Hutfless Susan M. Hutfless ^{, ‡} , Xiaoping Weng ^‡ , Liyan Liu ^‡ , James Allison ^{‡ , §} and Lisa J. Herrinton ^{‡ , , ‡,} Weng ^‡ Xiaoping, Liyan Liu ^‡, James Allison ^{‡, §} y Lisa J. Herrinton ^{‡, , ,
‡} Division of Research, Kaiser Permanente Northern California, Oakland, California ^‡ División de Investigación, Kaiser Permanente del Norte de California, Oakland, California
Epidemiology Department, Harvard School of Public Health, Boston, Massachusetts Departamento de Epidemiología, Harvard School of Public Health de Boston, Massachusetts
^§ Gastroenterology Division, University of California at San Francisco, San Francisco, California ^§ División de Gastroenterología, Universidad de California en San Francisco, San Francisco, California
Received 27 October 2006;  accepted 6 September 2007.  Available online 26 September 2007. Recibió el 27 de octubre de 2006; aceptado 6 de septiembre de 2007. Disponible en línea 26 de septiembre de 2007.

Referred to by: Mencionado por:

This Month in Gastroenterology Este mes en Gastroenterology Gastroenterology ,  Volume 133, Issue 6 ,  December 2007 , Pages 1749-1752 Gastroenterology, Volumen 133, Número 6, de diciembre de 2007, Pages 1749-1752 Jan Tack and John M. Carethers Enero Tack y John M. Carethers Abstract | Full Text + Links | PDF (877 K) Abstract | Full Text + Links | PDF (877 K)

Background & Aims: Most previous population-based studies of mortality in inflammatory bowel disease (IBD) did not account for medication use. Antecedentes y objetivos: La mayoría de anteriores estudios basados en la población de la mortalidad en la enfermedad inflamatoria intestinal (EII) no cuenta para el uso de fármacos. We evaluated mortality by IBD medication use among members of the Kaiser Permanente Northern California IBD Registry. Methods: The retrospective, population-based cohort study included 9032 persons who received at least one inpatient or 2 outpatient diagnoses of IBD during 1996–2002. Se evaluó la mortalidad por el uso de fármacos de EII entre los miembros de la Kaiser Permanente del Norte de California IBD Secretaría. Métodos: La retrospectiva, population-based cohort study incluyeron 9032 personas que recibieron por lo menos una o 2 ambulatoria hospitalaria diagnóstico de la EII durante 1996-2002. Age and sex standardized mortality ratios measured the associations between IBD and all-cause and cause-specific mortality. Edad y sexo normalización de las razones de mortalidad mide las asociaciones entre IBD y por todas las causas y la mortalidad por causas específicas. Age, sex, and smoking adjusted odds ratios measured the association of mortality by IBD medication use. Results: Compared with health plan members without IBD, mortality was increased in patients with Crohn’s disease (CD) (1.4; 95% confidence interval, 1.2–1.6) but not ulcerative colitis (UC) (1.0; 95% CI, 0.9–1.2). La edad, el sexo, el tabaquismo y odds ratios ajustados que mide la asociación de la mortalidad por el uso de fármacos de IBD. Resultados: En comparación con el plan de salud de los miembros sin IBD, fue el aumento de la mortalidad en pacientes con la enfermedad de Crohn (CD) (1,4, 95% intervalo de confianza, 1.2-1.6), pero no la colitis ulcerosa (CU) (1,0, IC 95%, 0,9-1,2). CD was associated with increased mortality from infectious and parasitic diseases (4.1; 95% CI, 1.7–8.5), septicemia (6.8; 95% CI, 2.2–15.8), small intestinal cancer (48.1; 95% CI, 5.8–17.4), respiratory diseases (1.9; 95% CI, 1.3–2.7), digestive diseases other than IBD (2.4; 95% CI, 1.0–4.8), and liver diseases (2.6; 95% CI, 1.0–5.3). CD se asoció con aumento de la mortalidad por enfermedades infecciosas y parasitarias (4,1, IC 95%, 1,7-8,5), la septicemia (6,8, IC 95%, 2,2-15,8), los pequeños cáncer intestinal (48,1, IC 95%, 5,8-17,4) , Las enfermedades respiratorias (1,9, IC 95%, 1,3-2,7), enfermedades digestivas distintos de EII (2,4, IC 95%, 1,0-4,8), y enfermedades hepáticas (2,6, IC 95%, 1,0-5,3). UC was associated with increased mortality from digestive diseases other than IBD (3.9; 95% CI, 2.4–6.0). UC se asoció con un aumento de la mortalidad por enfermedades digestivas distintos de EII (3,9, IC 95%, 2,4-6,0). The relationship with CD mortality was 0.7 for aminosalicylates (95% CI, 0.5–1.1), 1.3 (95% CI, 0.9–1.9) for immunomodulators, and 1.0 (95% CI, 0.7–1.4) for corticosteroids. La relación con el CD de mortalidad fue 0,7 por aminosalicylates (95% CI, 0.5-1.1), 1,3 (95% CI, 0.9-1.9) para inmunomoduladores, y 1,0 (95% CI, 0.7-1.4) de los corticosteroides. Among patients with UC, these odds ratios were 0.8 (95% CI, 0.5–1.1) for aminosalicylates, 0.5 (95% CI, 0.3–0.9) for immunomodulators, and 0.8 (95% CI, 0.6–1.1) for corticosteroids. Conclusions: Mortality is increased in CD. Entre los pacientes con UC, estos odds-ratios fueron 0,8 (95% CI, 0.5-1.1) para aminosalicylates, 0,5 (95% CI, 0.3-0.9) para inmunomoduladores, y 0,8 (95% CI, 0.6-1.1) de los corticosteroides. Conclusiones : La mortalidad aumenta en CD. Infections, respiratory diseases, and digestive diseases are important specific causes of death. Número de infecciones, enfermedades respiratorias, enfermedades digestivas y son importantes causas de muerte. IBD medication use has varying associations with mortality. IBD uso de fármacos tiene varias asociaciones con la mortalidad.

Abbreviations: CI, confidence interval; ICD, International Classification of Diseases; SMR, standardized mortality ratio Abreviaturas: IC, intervalo de confianza; CIE, Clasificación Internacional de Enfermedades; SMR, la tasa de mortalidad normalizada

S.M.H. SMH owns stock in Pfizer and GlaxoSmithKline. Es titular de acciones de Pfizer y GlaxoSmithKline. L.J.H. LJH receives grant support from Procter and Gamble and Protein Design Laboratories. Recibe el apoyo de la concesión de Procter & Gamble y Laboratorios Protein Design. X.W., L.L., and J.A. XW, LL, y JA have no conflicts of interest to report. No tienen conflictos de intereses al informe.

Support provided by the Crohn’s and Colitis Foundation of America, the Kaiser Foundation Community Benefit Program, and the Valley and Ellis Foundation. Apoyo prestado por la Crohn y Colitis Foundation de América, la Fundación Kaiser Comunidad Benefit Program, y la Fundación Valle y Ellis.

Australian Prescriber, Volume 30 Number 6 – December 2007

Drug price reforms: the new F1-F2 bifurcation(Editorial) T Faunce & H
Lofgren

Drugs for the doctor’s bag A Baird

Dental notes
Drugs for the doctor’s bag

Abnormal laboratory results
Evaluation of adrenocortical function in adults. J Ho & DJ Torpy

Relationships between health professionals and industry: maintaining a
delicate balance PA Komesaroff

Dental notes
Relationships between health professionals and industry

Medicines Australia Code of Conduct: breaches

The story of one complaint

Treatment of myasthenia gravis
SW Reddel

Dental notes
Treatment of myasthenia gravis

Patient support organisation

Myasthenia gravis: a patient’s perspective

Antipsychotic drugs in pregnancy and breastfeeding
D Kennedy

New drugs
abatacept, exenatide, telbivudine

Numero completo disponible en
http://www.australianprescriber.com/upload/pdf/issues/130.pdf

Martin Canas
GAPURMED
La Plata (Argentina)
macanas@netverk.com.ar

Cribado de cancer cervical en adolescentes: a veces menos es mas

Clinical Practice Guideline Watch Cervical Cancer Screening in Adolescents: Sometimes Less Is More Updated guidelines state that HPV DNA testing has no role in the management of adolescents with abnormal Pap smears. Elucidation of the link between cervical cancer and infection with high-risk types of human papillomavirus (HPV) has led to increased use of HPV DNA testing in the management of women with abnormal Pap smears. However, 80% of female adolescents become HPV DNA positive soon after their first sexual encounters, with the vast majority of these infections clearing spontaneously within 2 years. Hence, HPV DNA testing in adolescents with abnormal cervical cytology would lead to the referral of many adolescents for colposcopy even though they are at low risk for cervical cancer. In 2006, the American Society for Colposcopy and Cervical Pathology (ASCCP) convened a consensus conference to update its evidence-based guidelines for managing women with abnormal cervical cancer screening tests. Based on current data on the ubiquity and natural history of HPV infection in teenagers and results from the National Cancer Institute–sponsored Atypical Squamous Cells of Undetermined Significance (ASC-US) Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study (ALTS), the consensus conference recommended that HPV DNA testing should not be used to manage adolescents with abnormal Pap smears. New recommendations for adolescents (age, 20) are as follows: Adolescents with ASC-US should undergo repeat Pap smears every 12 months. At 12 months, only adolescents with high-grade squamous intraepithelial lesion (HSIL) or greater should be referred for colposcopy. At 24 months, only those with ASC-US or greater should be referred for colposcopy. Adolescents with LSIL should undergo repeat Pap smears every 12 months. At 12 months, only those with HSIL need to be referred for colposcopy. At 24 months, only those with ASC-US or greater should be referred. In adolescents with either ASC-US or LSIL, “HPV DNA testing is unacceptable . . . and if inadvertently performed, should not influence management.” Comment: Implementation of these recommendations will save money (the cost of an HPV DNA test can exceed US$100). In addition, teenagers will no longer need to worry about carrying a “high-risk” (cancer-causing) strain of HPV. Copies of the guidelines complete with algorithms can be downloaded from the American Society for Colposcopy and Cervical Pathology website. When it comes to managing adolescents with abnormal Pap smears, doing less is better than doing more. — Alain Joffe, MD, MPH, FAAP Published in Journal Watch Pediatrics and Adolescent Medicine December 12, 2007 Citation(s): Wright TC Jr et al. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007 Oct; 197:346. Medline abstract (Free)

2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests.

Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D; 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference.

Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. tcw1@columbia.edu

A group of 146 experts representing 29 organizations and professional societies met September 18-19, 2006, in Bethesda, MD, to develop revised evidence-based, consensus guidelines for managing women with abnormal cervical cancer screening tests. Recommendations for managing atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion (LSIL) are essentially unchanged. Changes were made for managing these conditions in adolescents for whom cytological follow-up for 2 years was approved. Recommendations for managing high-grade squamous intraepithelial lesion (HSIL) and atypical glandular cells (AGC) also underwent only minor modifications. More emphasis is placed on immediate screen-and-treat approaches for HSIL. Human papillomavirus (HPV) testing is incorporated into the management of AGC after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for HPV testing as an adjunct to cervical cytology for screening in women 30 years of age and older was formally adopted with only very minor modifications.

PMID: 17904957 [PubMed - indexed for MEDLINE]

New England Journal of Medicine

Perspective

Going Dutch — Managed-Competition Health Insurance in the Netherlands
A.C. Enthoven and W.P.M.M. van de Ven

Dutch Doctors and Their Patients — Effects of Health Care Reform in the Netherlands
J.A. Knottnerus and G.H.M. ten Velden
Knock Out, Knock In, Knock Down — Genetically Manipulated Mice and the Nobel Prize
J.P. Manis

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N.T.H. Mai and Others

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Outcomes 18 Months after the First Human Partial Face Transplantation
J.-M. Dubernard and Others

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Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes
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Mechanisms of Disease: Platelet Activation and Atherothrombosis
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Central Venous Catheterization — Subclavian Vein D.A.V. Braner and Others

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