Health Briefs
August
2 , 2002
by Robert A. Wascher, M.D., F.A.C.S.
Effectiveness of Restraining Orders
on Domestic Violence
Approximately 1.5 million American
women experience domestic violence every year, and about 20% of such women
will seek restraining orders. The effectiveness of such restraining orders
is unclear. In this week’s Journal of the American Medical Association,
a study of 2,691 women who had experienced domestic violence was undertaken.
The women evaluated in this study were divided into three groups: those
who had obtained a temporary restraining order against their abusive partner,
those who had obtained a permanent restraining order, and those who did
not seek any restraining order. During the 12 months following the initial
reported incident of domestic abuse, the women who had subsequently obtained
a temporary restraining order were almost 5 times as likely to be abused
again as the women who did not seek any type of restraining order. However,
the women who obtained permanent restraining orders were, in turn, 80%
less likely to be abused again as the women who did not seek any restraining
orders. The study’s authors concluded that permanent, but not temporary,
restraining orders are associated with a significant reduction in the
incidence of repeat domestic violence against women.
Bone Marrow Cells Improve Blood Flow in
Vascular Disease
In the current issue of the journal
Lancet is an intriguing study that looked at the ability of bone
marrow cells to restore blood flow to the legs of people with poor circulation.
The authors extracted a sample of bone marrow from each study patient, separated
out the different types of cells found in the marrow, and then injected
a specific type of bone marrow cell, called mononuclear cells, into the
calf muscles of the affected legs. Four weeks after the injections, the
researchers found evidence of improved blood flow and tissue oxygenation
in those patients who had their calf muscles injected with the bone marrow
cells. The ability to walk without experiencing leg pain (due to inadequate
blood flow) was also significantly improved following injection of the mononuclear
cells. All of these improvements were substantial, and were still present
6 months after the study began.
The authors believe that the bone marrow
mononuclear cells are able to act as stem cells for blood vessels in the
legs, and that such cells can also secrete proteins that stimulate additional
blood vessel growth in oxygen-starved tissues. This is a very exciting
study which needs to be replicated with larger numbers of patients. The
simplicity and minimal risk of injecting a person’s own bone marrow cells
into the muscles of the leg make this approach very compelling when compared
to the current surgical approaches to the difficult problem of peripheral
vascular disease.
Intestinal Hormone Kills Appetite
A recently discovered hormone
that is secreted in the intestines of mice (peptide YY3-36) has been found
to play a potentially important role in appetite control. The hormone appears
to be released after eating a meal, and is secreted in proportion to the
amount of calories contained in each meal. A new study in the journal Nature
suggests that this newly discovered hormone may play a key role in generating
the sensation of satiety (lack of hunger) that follows a meal in most people.
When injected into rats in this study, the hormone significantly reduced
food intake and weight gain. Moreover, the researchers found clear evidence
that this satiety hormone directly inhibited the brain centers in the hypothalamus
that control appetite and feeding behavior. When the hormone was injected
into human volunteers, caloric intake decreased by one-third over the following
24 hours.
After the disappointing outcomes in previous
studies that looked at the hormone leptin, this new study raises the hope
that an effective new treatment for overeating and obesity might be feasible
in the foreseeable future. Larger scale studies of the effects, both
good and bad, of this intestinal hormone on humans still need to be performed,
but this small and very preliminary study is very exciting nonetheless.
Botulinum Toxin & Post-Stroke Spasticity
The muscle paralyzing effect of
botulinum toxin has made this substance an unlikely therapeutic drug. Today,
it is most commonly used by cosmetic surgeons and dermatologists to temporarily
paralyze the facial muscles that accentuate the wrinkles around our eyes
and mouth. As reported in the current issue of the New England Journal
of Medicine, researchers have used injections of botulinum toxin into
the muscles of the wrists and fingers of patients who were left with spastic
limbs after suffering a stroke. Spastic tightening of the muscles in the
hands and fingers following a stroke often renders such limbs at least partially
useless. In this study, botulinum toxin injections significantly improved
the subjects’ ability to perform personal hygiene activities and dress themselves.
Botulinum injections also reduced the painful tightening of spastic limbs
and improved flexibility. This is an intriguing new application of botulinum
toxin, and may prove to be of very substantial importance to stroke victims
who have been left with painful and useless spastic limbs. While the improvement
in function was modest overall, and while stroke-induced paralysis is not
helped by botulinum injections, this study still represents a very important
and potentially useful advance in the care of patients who have experienced
stroke-related complications.
Dr.
Robert A. Wascher
Dr. Robert A. Wascher is
a senior research fellow in molecular & surgical oncology at the John Wayne
Cancer Institute in Santa Monica, CA
