Number reacting to smallpox vaccination is higher than expected
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《英国医生杂志》
Although few US military personnel have myopericarditis reactions to smallpox vaccinations, the number is high enough to be of concern if a larger population needs vaccination, the American Medical Association told a media briefing in New York last week.
Smallpox vaccination caused myopericarditis in 1.6 people per 10 000 who had never been vaccinated before, said Dr Dimitri Cassimatis, a cardiology fellow at Walter Reed Army Medical Center in Washington, DC. He reported results for more than 450 000 US military personnel. The rates of myopericarditis were higher than expected from reports from the 1950s to 1970s (Journal of the American College of Cardiology 2004;43:1503-10).
Symptoms included burning sensations or pressure in the chest, fatigue, and shortness of breath. He suggested that the immune system was switched on by immunisation and was sometimes directed against heart tissue. Treatment with non-steroidal anti-inflammatory drugs and avoidance of strenuous exercise for a month or six weeks were usually effective, but steroids might be needed in a few patients.
However, Dr Cassimatis cautioned that, in a terrorist attack, "if these results are generalisable to the public, we could see thousands of cases—1600 cases per 10 million exposed ."
Another topic covered by the briefing was the increasing popularity of stenting for carotid artery blockage and for repairing aortic aneurysms, now called "the silent killer."
Dr David Holmes Junior, professor of medicine at the Mayo Clinic College of Medicine, Minnesota, said that new stents greatly improved outcomes in coronary angioplasty. "With regular stents only 60% of patients are free of events at one year. With drug eluting stents, 90% or more are free of events at one year, and the gap continues to widen," he said. Even so, it was important to continue efforts to lower cholesterol concentrations and blood pressure and to persuade patients to quit smoking, increase exercise, control weight, and control blood glucose if diabetic. "Willpower lasts 30 days and is soluble in alcohol," he commented.
Stenting for aortic aneurysms through a minimally invasive approach has a lower mortality than conventional surgery and results in shorter stays in hospital, said Dr Craig Kent, chief of the vascular surgery division at New York Presbyterian Hospital.
Stenting through a minimally invasive approach is also an option for blockages of the carotid artery instead of endarterectomy, said Dr Kenneth Ouriel, head of surgery at the Cleveland Clinic, Ohio, who said that 30% of strokes are caused by carotid artery disease. He reported a study of 310 patients in which those who had stents did as well as patients having conventional surgery. A carotid stent still needs approval from the Food and Drug Administration but would be particularly useful in the sickest patients, he said.
The briefing also covered radiofrequency ablation and new drugs showing promise for treating atrial fibrillation. In atrial fibrillation, radiofrequency ablation—an experimental technique—produces cure rates at one year of 60% to 80% in patients with no other heart disease and cure rates of 20% to 40% in patients with other heart disease, said Dr Kevin Donahue, assistant professor of medicine at the Johns Hopkins University School of Medicine, Baltimore. In the United States 2.5 million people have atrial fibrillation, he said. Under investigation are drugs that block an ultra-rapid potassium channel unique to atrial cells.(New York Janice Hopkins T)
Smallpox vaccination caused myopericarditis in 1.6 people per 10 000 who had never been vaccinated before, said Dr Dimitri Cassimatis, a cardiology fellow at Walter Reed Army Medical Center in Washington, DC. He reported results for more than 450 000 US military personnel. The rates of myopericarditis were higher than expected from reports from the 1950s to 1970s (Journal of the American College of Cardiology 2004;43:1503-10).
Symptoms included burning sensations or pressure in the chest, fatigue, and shortness of breath. He suggested that the immune system was switched on by immunisation and was sometimes directed against heart tissue. Treatment with non-steroidal anti-inflammatory drugs and avoidance of strenuous exercise for a month or six weeks were usually effective, but steroids might be needed in a few patients.
However, Dr Cassimatis cautioned that, in a terrorist attack, "if these results are generalisable to the public, we could see thousands of cases—1600 cases per 10 million exposed ."
Another topic covered by the briefing was the increasing popularity of stenting for carotid artery blockage and for repairing aortic aneurysms, now called "the silent killer."
Dr David Holmes Junior, professor of medicine at the Mayo Clinic College of Medicine, Minnesota, said that new stents greatly improved outcomes in coronary angioplasty. "With regular stents only 60% of patients are free of events at one year. With drug eluting stents, 90% or more are free of events at one year, and the gap continues to widen," he said. Even so, it was important to continue efforts to lower cholesterol concentrations and blood pressure and to persuade patients to quit smoking, increase exercise, control weight, and control blood glucose if diabetic. "Willpower lasts 30 days and is soluble in alcohol," he commented.
Stenting for aortic aneurysms through a minimally invasive approach has a lower mortality than conventional surgery and results in shorter stays in hospital, said Dr Craig Kent, chief of the vascular surgery division at New York Presbyterian Hospital.
Stenting through a minimally invasive approach is also an option for blockages of the carotid artery instead of endarterectomy, said Dr Kenneth Ouriel, head of surgery at the Cleveland Clinic, Ohio, who said that 30% of strokes are caused by carotid artery disease. He reported a study of 310 patients in which those who had stents did as well as patients having conventional surgery. A carotid stent still needs approval from the Food and Drug Administration but would be particularly useful in the sickest patients, he said.
The briefing also covered radiofrequency ablation and new drugs showing promise for treating atrial fibrillation. In atrial fibrillation, radiofrequency ablation—an experimental technique—produces cure rates at one year of 60% to 80% in patients with no other heart disease and cure rates of 20% to 40% in patients with other heart disease, said Dr Kevin Donahue, assistant professor of medicine at the Johns Hopkins University School of Medicine, Baltimore. In the United States 2.5 million people have atrial fibrillation, he said. Under investigation are drugs that block an ultra-rapid potassium channel unique to atrial cells.(New York Janice Hopkins T)