Highlights of this issue
CMAJ 1999;160:1277
Severe post-phlebitic syndrome
Improvement with use of intermittent compression units
See also:
Post-phlebitic syndrome — pain, swelling and, less commonly, ulceration of the leg — occurs in about 60% of patients who suffer an episode of proximal deep vein thrombosis. Physicians usually recommend elastic compression stockings. However, some patients do not benefit from these or find them unacceptable because they find them unsightly or uncomfortable. In a small randomized crossover trial conducted by Jeffrey Ginsberg and associates, 15 patients were randomly assigned to use an extremity pump to apply either therapeutic pressure (50 mm Hg) or placebo pressure (15 mm Hg) for 1 month and the other pressure for the second month. The symptom scores were significantly better with the therapeutic pressure than with placebo pressure. The treatment was deemed successful in 12 (80%) of the patients; 9 continued to use the pump after the end of the study.
Venous thrombosis
How long should anticoagulation last?
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Susan Solymoss provides a crisp and up-to-date review of the evidence on this common but often perplexing clinical question. Solymoss is coauthor of an article recently published in the New England Journal of Medicine that reports on a prospective trial comparing short-term (3 months) anticoagulation therapy and extended therapy in patients with idiopathic deep vein thrombosis. The study was terminated early because of the significant difference in rates of recurrent thromboembolism in the 2 treatment arms: 27.4% per patient-year after 3 months of anticoagulation therapy, versus only 1.3% per patient-year after extended treatment. Major bleeding episodes were more common in the group receiving extended anticoagulation.
Radiofrequency radiation from cell phone base stations
Is there a health hazard?
See also:
- Research letter: Radiofrequency radiation in five Vancouver schools: exposure standards not exceeded
- Research letter: Alleviating nausea and emesis by Pavlovian conditioning
Artnarong Thansandote and associates at Health Canada investigated 3 schools in Vancouver that were in close proximity to a cellular telephone transmitter station and 2 control schools. They found that levels of radiofrequency radiation were far below allowable environmental limits and thus posed no risk to students or staff. In an accompanying editorial, Ron House of the University of Toronto reviews potential health concerns related to electromagnetic radiation, ranging from high-frequency gamma rays to the extremely-low-frequency radiation associated with power lines.
Gestational diabetes
High rates among Cree women
See also:
- Evidence: Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec
- Evidence: Prevalence of gestational diabetes mellitus among Swampy Cree women in Moose Factory, James Bay
- Editorial: Ironies most bittersweet
Two studies in this issue document the high prevalence of gestational diabetes mellitus in aboriginal populations in Canada. In the first, Shaila Rodrigues and colleagues studied the data for all births to Cree women in the eastern James Bay region of northern Quebec during a 2-year period. Almost all of the women had undergone screening for gestational diabetes after 22 weeks' gestation. The prevalence of gestational diabetes was found to be 12.8% (95% confidence interval 10.1%15.5%). It was significantly higher among women in the inland communities than among those in the more remote, coastal communities (18.0% v. 9.3%, p = 0.002).
In a similar study, Marshall Godwin and associates reviewed the medical charts of almost all Swampy Cree women who gave birth at the Weeneebayko Hospital in Moose Factory, James Bay, Ont., between 1987 and 1995. They noted a prevalence of gestational diabetes of 8.5% (95% confidence interval 6.9%9.9%). As expected, women with gestational diabetes had heavier babies and an increased likelihood of assisted delivery. Interestingly, cesarean section rates were not significantly higher among these women. Expected adverse infant outcomes associated with gestational diabetes — hypoglycemia, hypocalcemia and jaundice —were noted, but neonatal mortality was almost identical in both groups.
In an accompanying editorial, Philip Hall explores some of the historical and, in fact, evolutionary reasons for the excessive prevalence of gestational diabetes in Canada's aboriginal population.
