BACKGROUND: The use of homeopathy is growing in the United States, but little is known about practice patterns of physicians using homeopathy and the patients who seek homeopathic care. MATERIALS AND METHODS: Data for consecutive patient visits to 27 doctors of medicine and doctors of osteopathy using homeopathy in 1992 were collected and compared with the National Ambulatory Medical Care Survey of 1990. RESULTS: Patients seen by the homeopathic physicians were younger, more affluent, and more likely to present with long-term complaints. Physicians using homeopathic medicine surveyed spent more time with their patients, ordered fewer tests, and prescribed fewer pharmaceutical medications than physicians practicing conventional medicine. CONCLUSIONS: While definite conclusions cannot be made based on this survey, we have documented that the use of diagnostic testing and conventional medications by physicians who use homeopathy to treat common chronic conditions is well below that of conventional primary care physicians. These findings, if associated with comparable clinical outcomes, suggest a potential for substantial cost savings. Further studies documenting outcomes, cost benefits, physician decision-making, and patient satisfaction will be required to further explore this subject.

Adolescent↗

PubMedDate not supplied

Intracranial inverting papilloma.

BACKGROUND: Inverting papillomas usually originate from the lateral wall of the nose and sporadically from the ethmoid, maxillary, sphenoid, or frontal sinuses. Intracranial extension and dural penetration is rare and often associated with recurrent disease that has degenerated into squamous cell carcinoma. A case of inverting papilloma with dural penetration in the absence of malignant degeneration has prompted an investigation into the incidence and treatment of dural invasion by benign inverting papilloma. METHODS: A literature search revealed 1468 cases of inverting papilloma. A detailed analysis was performed to obtain data on the incidence of intracranial invasion. RESULTS: Of the 1468 cases, 5 were noted to be associated with intracranial extension without histologic evidence of malignancy (0.34%). Treatment consisted of surgery alone in 3, radiotherapy in 1, and combined therapy in the last patient. Dural invasion was documented histopathologically in one case. CONCLUSION: Intracranial extension and dural penetration of benign inverting papilloma is extremely rare, and a uniform treatment plan has not been established. Further investigation is necessary in the pathophysiology and management of intracranial inverting papilloma.

Adult↗

PubMedDate not supplied

cis-platinum and 5-fluorouracil as initial therapy in advanced epidermoid cancers of the head and neck.

A total of 44 patients with previously untreated Stage IV squamous cell carcinomas of the head and neck were treated with a combination of cis-platinum (100 mg/sq m) and 96-hour infusion of 5-fluorouracil (5-FU) (1,000 mg/sq m/day) in two courses or with cis-platinum (100 mg/sq m) and 120-hour infusion of 5-FU (1,000 mg/sq m/day) in three courses. In the 26 patients receiving the two course regimen, the tumor response rate was 88.5%. In five of the 26 patients complete disappearance of the tumor was achieved; partial remission was obtained in 18 of 26 patients. The main side effects were nausea and vomiting (70%), leukopenia (27%), and mild-to-moderate renal toxicity (27%). In the 18 patients who received the three course regimen of 5-FU and cis-platinum, there were 11 (61%) complete responses, 6 (33%) partial responses, and 1 (6%) minimal response. The incidence of complete response was increased with each course given. No added toxicity was observed with surgery or radiotherapy.

Adult↗

PubMedDate not supplied

Smoking as a risk factor for injury death: a meta-analysis of cohort studies.

BACKGROUND: Injury and tobacco effects represent one-quarter of the global burden of disease. Understanding the causes of injury and the effects of smoking may help reduce those burdens. Some smokers have high risks of injury. We provide an initial meta-analysis of cohort associations between smoking and fatal injury. METHODS: Three authors independently searched MEDLINE, and bibliographies of the pertinent studies found, for cigarette smoker-specific injury death data which allowed estimation of an appropriate relative risk (RR) and 95% confidence interval (CI). Relative risks and dose response were summarized by fixed effects and Poisson modeling, respectively. RESULTS: Six studies covering 10 pertinent cohorts were located. Associations between smoking and injury death have been significant after adjustment or, in effect, stratification for age, race, sex, country, and, respectively, alcohol, marriage, education, and body mass; job and time period; job, alcohol, and exercise; etc. Summary dose-response trends were significantly positive (P < 0.00005). Cigarette smoking predicted summary injury death crude RRs of 1.61 (CI 1.44-1.81) vs never smokers and 1.39 (CI 1.25-1.55) vs ex-smokers. CONCLUSIONS: Smoking has significant, consistent, dose-response, often strong and independent, prospective associations with injury death, internationally.

Adult↗