John Elliott

Spinal prosthesis patient dies; new therapies spurred

The University of Maryland patient who received the first known spinal prosthesis from Maryland surgeon Charles C. Edwards, MD ( JAMA [MEDICAL NEWS] 242:1831-1837, 1979) is dead as a result of a severe kidney infection and subsequent meningitis and septic shock. The patient, a 33-year-old mother of two, had a history of kidney difficulties. She had been at home for more than a month when a Pseudomonas infection occurred, forcing rehospitalization. According to University of Maryland hospital officials, at the time of her death the patient remained free of any recurrence of the giant cell spinal tumor, the removal of which had necessitated Edwards pioneering procedure. By all accounts the custommade spinal prosthesis was a success, giving the patient steadily improving mobility. Her courage opened new avenues of surgical treatment to other patients, says Edwards. One avenue was immediately evident in the referral of a 30-year-old Illinois man to Edwards last

Better artificial arms under development.

An expression of intense concentration on his face, a scientist at the Illinois Institute of Technology (IIT), Chicago, sits before an artificial arm mounted on a table in his laboratory. Two electrodes attached to his own upper arm channel impulses into a microcomputer that in turn can activate tiny motors in the prosthesis. Without physically moving his limbs, the IIT engineer can flex the elbow of the experimental prosthesis, turn the wrist and, in an almost eerie manner, open and close the lifelike fist. The engineers own body is whole, but his work with artificial limbs controlled by electrical impulses from the brain promises much-improved function for amputees, persons with congenital malformations, and even stroke victims and paralyzed patients. The investigator is Daniel Graupe, PhD, professor of engineering at IIT. Though muscle-activated artificial limbs have been in use and even sold commercially for more than ten years, the work of

George Bray: the nutrition message must be spread.

The politics of nutrition and obesity, concerns that have grown to spectacular prominence in the last few years, are the new charges of George A. Bray, MD, obesity researcher and professor of medicine at the University of California, Los Angeles, School of Medicine. Recently appointed nutrition coordinator for the Department of Health, Education, and Welfare (DHEW), Bray has undertaken to teach the American public how to make prudent dietary choices—a task not only difficult but perhaps impossible in the face of an underfunded research effort in the area of nutrition as well as waning public concern for the serious health consequences of obesity. Although nutritional concern seems to have become more prominent in the last 15 years, Bray told JAMA MEDICAL NEWS, public interest has not truly grown. As a result the average American today is heavier than a person of the same height was ten years ago. Data from

Little consensus on prescribing of estrogens for postmenopausal women.

The latest consensus development conference at the National Institutes of Health tackled the thorny problem of estrogen replacement therapy for postmenopausal women. Those at the meeting, sponsored by the National Institute of Aging, concluded that exogenous estrogens clearly have been shown to increase the risk of endometrial cancer. The hormones are effective, however, in controlling the vasomotor symptoms, atrophy of vaginal epithelium, and osteoporosis that often accompany menopause. Still, aside from discouraging high-dose or longterm use of estrogen therapy, the consensus panel refrained from formulating specific guidelines for the prescribing of estrogens for postmenopausal women. They concluded, rather, that physicians should discuss the benefits and risks of the treatment with each patient and then leave the final decision up to her. Currently fewer than 7 million of the more than 30 million American women past menopause are using estrogens. In contrast, about 20 million prescriptions for the various estrogen compounds

Intraocular lenses survive sharp criticism.

Intraocular lens implantation in cases where a cataract has destroyed the natural lens yields significant visual advantages and is almost as safe as extraction of the cataract alone, says a panel of ophthalmologists convened by the National Eye Institute to reach a consensus on the procedure. The technique has been in use for more than 30 years, although it is still classified by the Food and Drug Administration as an experimental method using an investigational device. However, it has attracted considerable criticism in recent years. Critics charge, for example, that quality control of lens manufacture is erratic and that the unlimited availability of federal funds for it has turned the procedure into a virtual goldmine for ophthalmologists, eroding safety standards. Lens implantation is frequently carried out inasmuch as cataract surgery is now the most commonly performed procedure among Medicare beneficiaries and one of every four patients undergoing cataract extraction in

Lilly to provide consumer leaflet on Darvon.

In the continuing saga of the widely used pain-killing drug propoxyphene hydrochloride, Eli Lilly and Company, the principal manufacturer of the drug, has agreed to voluntarily distribute a warning on the hazards of using its product (Darvon) in excess or in combination with other drugs. The Food and Drug Administration has announced that the new consumer leaflet will be available from pharmacists when prescriptions for Darvon are filled. Darvon is a safe drug when used properly, said acting FDA Commissioner Sherwin Gardner. He added, however, that there is a potentially lethal risk involved when the drug is used with alcohol, tranquilizers, or sedatives. On his last day in office, however, former HEW Secretary Joseph Califano criticized the warnings as inadequate. He said that they fail to mention such things as the maximum recommended dose or the signs of drug dependency. Lilly manufactures at least 80% of the propoxyphene used in

Moves beginning to approve new indications for aspirin use.

Aspirin in daily doses of 1,300 mg is safe and effective for reducing the risk of recurrent transient ischemic attacks in men who have had transient ischemia of the brain due to fibrin platelet emboli. With that pronouncement, a special advisory committee to the Food and Drug Administration has recommended that the official indications for aspirin be expanded to include therapy for certain types of transient ischemic attacks (TIAs) in men only. The recommendation of the FDAs Peripheral and Central Nervous System Drugs Advisory Committee, if accepted by the agency, may substantially alter the way medicine is practiced, according to Ron Kartzinel, MD, director of the FDAs Division of Neuropharmacological Drugs. The action may also represent the first official step in what some believe may become a rush to confirm new uses for the 80-year-old drug, now known to inhibit synthesis of certain prostaglandins. The committee was very careful, says

Second beginning for in vitro fertilization research

The first tentative steps have been taken toward providing federal funding in the controversial research area of in vitro fertilization. The Ethics Advisory Board of the Department of Health, Education, and Welfare (HEW) recently conducted a hearing on the subject, described candidly by one of the participants as an effort to close the barn door after the horse is already out. In the wake of the birth in England of Louise Brown, the worlds first laboratory-conceived baby, the advisory group commissioned by HEW Secretary Joseph Califano heard testimony from US researchers anxious to match the success of their British counterparts. The testimony of Joseph D. Schulman, MD, head of the biochemical and developmental genetics section of the National Institute of Child Health and Human Development, perhaps best summed up the attitude of US researchers. If we dont go ahead with research in embryo transfer in humans, he said, then someone