Vikas Khurana

Statins reduce the risk of pancreatic cancer in humans: a case-control study of half a million veterans.

Objective: Statins are commonly used cholesterol-lowering agents that are noted to suppress tumor cell growth in several in vitro and animal models. Methods: We studied the association between pancreatic cancer and statins in veterans. A retrospective, nested case-control study was conducted using prospectively collected data from the Veterans Integrated Service Networks 16 Veteran Affairs database from 1998 to 2004. We analyzed data on 483,733 patients from 8 states located in south central United States. The primary variables of interest were pancreatic cancer and the use of statins before the diagnosis of pancreatic cancer. Multiple logistic regression analysis was done to adjust for covariates including age, sex, body mass index, smoking, diabetes, and race. The SAS software was used for statistical computing. Results: Of the 483,733 patients in the study, 163,467 (33.79%) were on statins, and 475 (0.098%) patients had a primary diagnosis of pancreatic cancer. Statin use of more than 6 months was associated with a risk reduction of pancreatic cancer of 67% (adjusted odds ratio, 0.33; 95% confidence interval, 0.26-0.41; P < 0.01).A dose-response relationship was noted between statin use and pancreatic cancer with an 80% risk reduction (adjusted odds ratio, 0.2; 95% confidence interval, 0.13-0.29; P < 0.01) with use of statin for more than 4 years. Furthermore, the protective effect of statin was seen across different age and racial groups, and was irrespective of the presence of diabetes, smoking, or alcohol use. Conclusions: Statins seem to be protective against the development of pancreatic cancer, and the magnitude of the effect correlates with the duration of statin use.

Urinary retention secondary to detrusor muscle hypofunction after botulinum toxin injection for achalasia.

have not responded to antiviral therapy can only be determined by prospective, dose-ranging studies with interval determination of liver enzymes, viral titers, and liver histology. Safety concerns with thalidomide, including the potential for teratogenicity and irreversible neurotoxicity, mandate that test subjects be considered at high risk for progression to cirrhosis and liver failure. Our observations in the present case indicate that such studies are warranted.

CANCER SCREENING IN THE ELDERLY POPULATION

This article reviews the current state of knowledge regarding cancer screening in the geriatric population. Care of the elderly requires knowledge of underlying physiologic changes, comorbidities, quality-of-life factors, and life expectancies. There is always the danger that ageism may prevent elderly cancer patients from receiving the proper treatment. On the other hand, overzealous treatment can lead to adverse results if elderly patients are not properly targeted based on current evidence of the benefits and risks of specific screening practices.

Potential Liver Damage Associated with Over-the-Counter Vitamin Supplements

The growing popularity and availability of over-the-counter (OTC) health products, including vitamins, raises serious concern about vitamin toxicity. We report a case of cirrhosis in a patient with habitual daily ingestion of an OTC dietary supplement that contained 13,000 microg vitamin A and was associated with marked clinical improvement after discontinuation. This case highlights the potential for liver damage that may be associated with long-term intake of OTC vitamin supplements, and indicates the need for medical supervision of such products.

CASE REPORT: Vascular Pancreatic Gastric Fistula: A Complication of Colloidal 32P Injection for Nonresectable Pancreatic Cancer

Major advances in cancer therapy have occurred during the last several years, with many new and efficacious medications against neoplastic diseases becoming available. Information of these therapies is available on the Internet, and patients with terminal disease seek these therapies as a last effort to preserve their life. Access to these modalities through the experimental protocols occurs prior to our understanding and knowledge of unusual and unpredictable adverse reactions. Recognition of these adverse reactions leads to modifications in the recommendations and precautions regarding the use of these therapeutic agents. A novel treatment option for nonmetastatic locally unresectable pancreatic cancer involving injection of the radioactive isotope of phosphorus has recently been under study (1–4). We report a hitherto underscribed effect of colloidal 32P injection with creation of a vascular pancreatic gastric fistula secondary to presumed tissue necrosis. This tissue effect may have wide implications for prescribers and the recipients of such therapy.

Ischemic colitis: a rare complication of hepatitis C therapy with peginterferon and ribavirin

Ischemic colitis: a rare complication of hepatitis C therapy with peginterferon and ribavirin

Review: smooth muscle relaxants treat abdominal pain and loperamide reduces diarrhoea in irritable bowel syndrome

(2000) Ann Intern Med 133, 136. Jailwala J, Imperiale TF, Kroenke K. . Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. . Jul 18; . : . –47. . [OpenUrl][1][PubMed][2][Web of Science][3] 
 QUESTION: What is the effectiveness of pharmacological agents for the treatment of irritable bowel syndrome (IBS)? Studies were identified by searching Medline (1966–99), EMBASE/Excerpta Medica (1980–99), PsycINFO (1967–99), and the Cochrane Controlled Trials Registry with terms that included colonic diseases, functional, irritable, spastic, bowel, and colon and by manually searching bibliographies of relevant studies. Published studies in the English language were selected if they examined use of a pharmacological treatment for IBS on >10 adult patients for ≥2 weeks; included a placebo group; reported an outcome measure of global status or individual symptoms, or both, of IBS; and used a randomised, double blind, parallel group or crossover design. Data were extracted on the diagnostic criteria for IBS, participant characteristics, interventions, study design, methodological quality (scored between 1 and 5 with a higher score representing higher quality; studies with a score ≥4 were classified as “high quality”), and outcomes. Pharmacological agents were classified as having “positive” effectiveness if the study reported significant improvement in global status or individual IBS symptoms; otherwise, they were classified as having “negative” effectiveness. 70 studies (4836 patients, median age … [1]: {openurl}?query=rft.jtitle%253DAnnals%2Bof%2BInternal%2BMedicine%26rft.stitle%253DANN%2BINTERN%2BMED%26rft.issn%253D0003-4819%26rft.aulast%253DJailwala%26rft.auinit1%253DJ.%26rft.volume%253D133%26rft.issue%253D2%26rft.spage%253D136%26rft.epage%253D147%26rft.atitle%253DPharmacologic%2BTreatment%2Bof%2Bthe%2BIrritable%2BBowel%2BSyndrome%253A%2BA%2BSystematic%2BReview%2Bof%2BRandomized%252C%2BControlled%2BTrials%26rft_id%253Dinfo%253Apmid%252F10896640%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10896640&link_type=MED&atom=%2Febmed%2F6%2F1%2F20.atom [3]: /lookup/external-ref?access_num=000088258500007&link_type=ISI

Urinary retention: a systemic complication of botulinum toxin injection therapy for achalasia

Urinary retention: a systemic complication of botulinum toxin injection therapy for achalasia

Reversible idiopathic pseudoobstruction (IPO): a heretofore undescribed association with metastatic ileal carcinoid tumor

Reversible idiopathic pseudoobstruction (IPO): a heretofore undescribed association with metastatic ileal carcinoid tumor