Weak data mire colon screening debate

Article Abstract:

Colon cancer is the second leading cause of death from cancer, but screening is controversial. The Congressional Office of Technology Assessment has concluded that screening does not detect enough colon cancer, or reduce mortality enough, to justify payment by Medicare. The Office of Technology Assessment took the most pessimistic view of the data, and the American Cancer Society, as well as a number of physicians, have debated this recommendation. The American Cancer Society still recommends testing for hidden (occult) blood in the stool after age 40, and flexible sigmoidoscopy (in which a two-foot tube is inserted into the colon) after age 50. Twenty years ago most colon cancers were detectable by digital rectal exams, but today many tumors occur beyond the point where they can be detected even with the sigmoidoscope. Therefore, some doctors suggest that colonoscopy is more cost-effective because it finds more tumors. However, this does not take into account potentially serious or even fatal complications, such as perforation of the bowel. One physician suggests that if colonoscopy finds nothing, an upper gastrointestinal tract endoscopy (insertion of a tube into the esophagus) should be performed, because ulcers were found in up to one fourth of these patients. However, none of these patients had life-threatening diseases, and it could equally well be concluded that endoscopy could have been avoided. Without a control group for either the colonoscopy or endoscopy research, conclusions are controversial. Delayed follow-up of a positive stool test can lead to a delayed diagnosis of cancer, lower quality of life and higher mortality. Ideally, a better screening technique employing DNA analysis will soon provide better identification of individuals at risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Colorectal cancer, Colonoscopy, Social policy, American Cancer Society, editorial, Sigmoidoscopy, United States. Office of Technology Assessment

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Orthopedic surgery turns attention to relatively few fractures that fail to heal over time

Article Abstract:

The diagnosis of ununited fractures, broken bones that do not heal, has not been comprehensively described. Ununited fractures represent less than 5 percent of all broken bones, but the cost of treating these cases is estimated to be two billion dollars annually. At a recent symposium, guidelines for diagnosis were presented. A broken bone should be considered an ununited fracture only if the bone has failed to heal after six months, and no improvement has been detected clinically or by X-rays in the past three months. If these conditions are not met, the diagnosis of delayed union or slow progress should be made, even if only a small amount of healing is evident. Sometimes intervention treatments are called for; the most frequently used is the autograft bone transplant, in which bone tissue is taken from the same individual and transplanted to the fracture site. Important considerations in the use of this technique are reconstructing the structural integrity of the bone and facilitating the healing process. Careful cleaning of open fractures helps prevent ununited fractures and infections. Studies have found that injection of autologous bone marrow cells stimulates healing in as many as 80 percent of ununited fractures and in close to 100 percent of slow healing bones; it also reduces the risk of complications. It is believed that other stimulatory factors may be derived from the skeletal system, from sources such as platelets and fibroblast growth factors (blood components involving in clotting). One possible complication of stimulation techniques to enhance healing is inflammation. Further research in this area is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Physiological aspects, Healing, Orthopedic surgery, Platelet-derived growth factor, Fractures, Ununited, Ununited fractures, Bone-grafting, Bone transplantation

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Knee implant problem has orthopedic surgeons begging for independent data

Article Abstract:

Physicians' satisfaction with the array of knee implants that have been offered by corporate salesmen has been less than the salesmen's promises: effectiveness needs to be verified by independent investigation. Orthopedic surgeons, not the manufacturing companies, should decide which designs work best, said members of the American Academy of Orthopaedic Surgeons at the group's 1990 annual meeting. Advertisements are now the primary source of information for physicians, with supervision by the Food and Drug Administration often bogged down in bureaucratic delays. Studies should indicate whether the device must be implanted by a specially skilled physician, and should provide long-term follow-up, at least six years, according to some doctors. Examples of disastrous knee prostheses are presented. Proposals for remedying the situation include evaluation by the Academy or by regional medical societies, or the establishment of an independent research institute. Surgical solutions, tailored as they are to individual patient needs, are not suited to standard experimental study designs. No systematic approach for solving the orthopedists' problem has yet been provided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Orthopedic equipment and supplies, Orthopedic appliances, Orthopedic implants, Artificial knee, Knee prostheses

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