Until now, there has been no truly effective treatment for hepatitis C, the blood-borne virus that is spread in the same ways as AIDS, and that is believed to infect about 4 million Americans.
A drug called interferon helps in 40 percent of cases, but the benefits are short-lived. Only 10 to 15 percent of patients remain in remission, six months after treatment is stopped.
But two studies published in today’s New England Journal of Medicine offer new hope. One, led by researchers at the Scripps Clinic and Research Foundation in La Jolla, Calif., found that six months after treatment, a combination of interferon and a drug called ribavirin was 31 to 38 percent effective among patients being treated for the first time. That’s 3 to 5 times the response rate for people getting interferon alone.
The other study, led by researchers at the University of Florida College of Medicine in Gainesville, found that six months after treatment, the same combination was 49 percent effective in patients who had relapsed after previous treatment. This is 10 times higher than treatment with interferon alone.
Together, the studies represent an “important advance,” says Dr. T. Jake Liang, chief of the liver diseases section at the National Institute of Diabetes, Digestive, and Kidney Diseases, part of the National Institutes of Health.
It is still not clear how long treatment should last. In the California study, there was little difference in outcome whether people were treated for six months or 12. But the studies are “a big step forward,” Liang said in a telephone interview.
The way not to panic: Another Prozac role
It’s official: Prozac, like the antidepressants Zoloft and Paxil, has now been shown to work against panic disorder, a debilitating illness that affects 3 million Americans.
In a study led by Dr. David Michelson of Eli Lilly, the maker of Prozac, the popular antidepressant proved safe and effective in reducing panic attacks and symptoms of phobia, anxiety, and depression in people with panic disorder, a syndrome in which a person suffers repeated attacks of panic. The study is in this month’s American Journal of Psychiatry.
In a separate study published in this week’s Journal of the American Medical Association, Brown University researchers showed that Zoloft, already used for acute depression, is also effective as an ongoing treatment for chronic depression.
Major lung surgery is small operation
Minimally invasive surgery, in which doctors operate through one or more small incisions, often aided by tiny TV cameras in fiber optic cables, is clearly an idea whose time has come.
But is it really possible to remove an entire, intact lung this way and send the patient home the same day?
Yes, says Dr. Eduardo R. Tovar, a thoracic surgeon at St. Jude Medical Center in Fullerton, Calif., who describes his technique in this month’s issue of Chest, a journal of the American College of Chest Physicians.
Traditionally, surgeons have used one long incision – from the shoulder blade, under the arm, around to the front – to remove a cancerous lung. In the last five years, they’ve also used minimally invasive surgery, which involves four or five small incisions between the ribs for viewing plus a 4-inch incision under the arm through which the lung is removed.
Now, Tovaro says he can remove a lung using only one small – 3-inch – incision on the patient’s side.
In the five patients reported on – he has also done four others – Tovar occasionally uses a miniature TV camera inserted through the same incision to see ligaments that he needs to cut. He anesthetizes nerves in the area by freezing.
One patient went home the same day. Four others went home the next morning. With standard minimally invasive surgery, patients stay in the hospital five to seven days.
“This is an eye-opening article,” said Dr. Joseph LoCicero, chief of general thoracic surgery at Beth Israel Deaconess Medical Center, although it is unclear how many patients can benefit.
It “boggled my mind,” added Dr. A. Jay Block, editor in chief of the journal. But, he said, “I doubt there are a whole lot of surgeons who could do this at the moment.”