CHICAGO—Patients with acute myocardial infarction (MI - heart attack) who are referred for percutaneous coronary intervention (such as angioplasty and stent placement in the coronary artery) do not have a reduction in the amount of damaged heart tissue when administered two drugs compared with a single drug to restore blood flow, according to a study in the February 25 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, "In hospitals with catheterization facilities, primary percutaneous coronary interventions (PCIs) are better then thrombolysis (drug therapy used to dissolve blood clots) in patients with ST-segment elevation acute MI. Specifically designed randomized trials have also shown that patients with acute MI presenting at hospitals without catheterization facilities benefit more from PCI performed after transfer to centers with catheterization laboratories than from on-site thombolysis."

Adnan Kastrati, M.D., from Deutsches Hezzentrum, Technische Universitat, Munich, Germany, and colleagues from the Bavarian Reperfusion Alternatives Evaluation (BRAVE) Study Investigators, assessed whether early administration of the combination of the drugs reteplase plus abciximab produces better reduction of infarct size compared with abciximab alone in patients with acute MI referred for PCI. The study, conducted from May 3, 2001 through June 2, 2003, included 253 patients who were admitted to 13 community hospitals without catheterization facilities (n=186) and to 5 hospitals with catheterization facilities (n=67), within 12 hours of symptoms of an acute MI. Patients randomly received either the combination of reteplase and abciximab (n=125) or abciximab (n=128) alone. All patients were then transferred for PCI. Infarct size was later determined by imaging from a single-photon emission computed tomography (SPECT).

"The final infarct size of the left ventricle, the primary end point of the trial, was 13 percent in the reteplase plus abciximab group and 11.5 percent in the abciximab group," the researchers report. "The mean (average) difference in final infarct size of the left ventricle between the reteplase plus abciximab group and the abciximab group was 1.3 percent." The researchers noted that several hours after the drug administration, patients receiving the combination therapy had superior blood flow through the blocked artery. The researchers also found, "the cumulative 6-month incidence of the composite end point (death, recurrent MI, or stroke) was also comparable between the two treatment groups, whereas there was a trend toward more major bleeding events with reteplase plus abciximab."

CHICAGO—Patients who monitored their blood pressure at home were able to decrease blood pressure medication and slightly lower their costs, according to a study in the February 25 issue of the Journal of the American Medical Association (JAMA).

Jan A. Staessen, M.D., Ph.D., from University of Leuven, Leuven, Belgium, and colleagues from the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) Trial Investigators, compared self-measurement and conventional office measurement of blood pressure in the treatment of patients with hypertension (high blood pressure). The study included 400 patients with a diastolic blood pressure (the lower number in the blood pressure measurement, such as for a blood pressure of 140/80, the diastolic pressure is 80) reading of 95 mm Hg (millimeters of mercury) or more as measured at physicians' offices and then randomized them to receive antihypertensive drug treatment based on office blood pressure readings (n=197) or home blood pressure readings (n=203). The study took place between March 1997 to April 2002 in Belgium and Dublin, Ireland. The participants recorded several (usually 6) home measurements a day and averaged the daily BP over one week. The other group's measurements were averaged from three readings at the physicians' office. The patients were followed up for one year.

"At the end of the study, more home BP (blood pressure) than office BP patients had stopped antihypertensive drug treatment (25.6 percent vs. 11.3 percent) with no significant difference in the proportions of patients progressing to multiple-drug treatment (38.7 percent vs. 45.1 percent)," the researchers found. "The final office, home, and 24-hour ambulatory BP measurements were higher in the home BP group than in the office BP group."

CHICAGO—Among patients with migraine headache, the antiepileptic drug topiramate appears effective in preventing migraine attacks and for reducing the use of rescue medication for headaches, according to a study in the February 25 issue of the Journal of the American Medical Association (JAMA).

"Migraine headache is a neurologic disorder associated with significant disability and impaired quality of life, adversely affecting daily activity and work-related productivity for many persons" according to background information in the article. The authors state that approximately 11 percent of the U.S. population experiences migraines and the prevalence is thought to be about the same in other industrialized countries.

Jan Lewis Brandes, M.D., from the Nashville Neuroscience Group, Nashville, Tenn., and colleagues, evaluated the efficacy and safety of topiramate for migraine prevention during a 26-week study conducted at 52 North American outpatient clinical centers. Four hundred eight-three patients were randomized to four treatment groups: placebo or topiramate at 50 milligrams/day (mg/d), 100 mg/d, or 200 mg/d. From that group, 468 (87-percent women) were included in the analysis after some participants dropped out of the study, most often because of adverse side-effects from the medication, including paresthesia (tingling sensations), fatigue, and nausea.

"Mean (average) monthly migraine frequency decreased significantly for patients receiving topiramate at 100 mg/d [milligrams per day] (-2.1) and topiramate at 200 mg/d (-2.4) vs. placebo (-1.1)," the authors report. "Statistically significant reductions occurred within the first month with topiramate at 100 and 200 mg/d." The researchers found that the participants in the 100 mg/d and 200 mg/d had reductions in the number of days with migraines per month, and were also able to reduce their rescue medication use for headaches, such as aspirin, acetaminophen, triptans, and opioids.

CHICAGO—Ear cartilage piercing is inherently more risky than lobe piercing, according to a report in the February 25 issue of the Journal of the American Medical Association (JAMA) that looks at an outbreak of infection with the bacteria Pseudomonas aeruginosa, among customers of a commercial piercing business in Oregon..

William E. Keene, Ph.D., M.P.H., from the Oregon Department of Human Services, Portland, Ore., and colleagues conducted an investigation of persons who had piercings at a jewelry kiosk from August to September 2000. The health officials sent questionnaires to the customers and collected environmental samples in the kiosk, including countertops, plumbing fixtures, and ear-piercing guns. The kiosk workers were screened for pseudomonas organisms by stool and hand cultures.

"From 186 piercings in 118 individuals, we identified 7 confirmed P aeruginosa infections and 18 suspected infections," the authors write. "Confirmed cases were 10 to 19 years old. Most were initially treated with antibiotics ineffective against Pseudomonas. Four were hospitalized, four underwent incision and drainage surgeries (1 as an outpatient), and several were cosmetically deformed. Upper ear cartilage piercing was more likely to result in either confirmed or suspected infection than was lobe piercing."

The health officials did not find Pseudomonas aeruginosa from any of the solid surfaces at the kiosk. But, it was cultured from 2 of the 4 workers, from an atomizer solution containing a disinfectant, and from waste water in traps beneath the sinks. The authors write that a number of events aligned to cause this outbreak: "First, open piercing guns were used to drive relatively blunt studs through cartilage, rather than recommended (and, in Oregon, legal) alternatives such as needle piercing. Second, a 'single-use' disinfectant bottle was refilled repeatedly, becoming contaminated with P aeruginosa, presumably at the sink where organisms were recovered. Finally, at least 1 worker sometimes sprayed the sterile studs and piercing gun with disinfectant, not appreciating that sterile implements would not benefit from a spray with any disinfectant, much less a contaminated one."

INFECTIONS MORE COMMON IN UPPER EAR PIERCING