Patients With ESRD May Benefit More From CABG Than PCI.

MedPage Today  (12/1, Neale) reported on a study  published online in the Journal of the American Society of Nephrology finding that "for patients with end-stage renal disease who are on maintenance dialysis, CABG appears to boost outcomes in multivessel coronary artery disease compared with percutaneous coronary intervention (PCI)." The results "are consistent with the bulk of the evidence pointing toward a mortality benefit for CABG over PCI." The study was based on "data from the US Renal Data System" covering "21,981 patients with end-stage renal disease who were on maintenance dialysis, had multivessel coronary artery disease, had at least six months of Medicare coverage, and underwent either CABG or PCI between 1997 and 2009."

Weight Loss Surgery May Not Stave Off Type 2 Diabetes Long-Term

In its "Well" blog, the New York Times  (11/28, O'Connor) reports that "weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new" study  published in the journal Obesity Surgery. According to the article, "the study found that many obese type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation." The blog notes that "the findings contrast with the growing perception that surgery is essentially a cure for type 2 diabetes." The study monitored for a period lasting more than a decade thousands of diabetics who underwent gastric bypass surgery.

        MedPage Today  (11/29) reports that the study found that in "follow-up of 2,254 patients who showed complete remission of type 2 diabetes following bariatric surgery indicated that 35.1% (95% CI 32.0% to 38.4%) developed renewed symptoms within five years, according to David E. Arterburn, MD, MPH, of Group Health Research Institute in Seattle, and colleagues." The article adds that "moreover, the relapses did not appear to be closely related to subsequent regain of weight, the researchers reported." The researchers advised in their study, "Patients should be counseled that bariatric surgery alone does not reliably 'cure' diabetes."

FDA to commission outside review on energy drinks.

The New York Times (11/28, B7, Meier, Subscription Publication) reports that the Food and Drug Administration released a letter (pdf) Tuesday, saying it would likely "seek advice from outside experts to help determine whether energy drinks posed particular risks to teenagers or people with underlying health problems." Although the agency has previously said it was "investigating possible risks posed by popular products like 5-Hour Energy, Monster Energy and Red Bull," FDA spokesperson Shelly Burgess "said the new letter was the first time that the FDA had said it might turn to outside experts." The letter, which was sent to Democratic Sens. Richard J. Durbin (IL) and Richard Blumenthal (CT), "follows disclosures that the agency received reports of 18 deaths and over 150 injuries that mentioned the possible involvement of energy drinks."

        The AP (11/28) adds that the letter, which was sent on Nov. 21, "said that the FDA was studying energy drinks to see if they posed a risk when consumed by 'vulnerable groups' such as young people, or in excess - but it did not indicate that any immediate action would be taken against the drinks makers." In the letter, the FDA also "said there is no scientific literature that calls into question the safety of taurine and guarana, two ingredients often used in energy drinks." Sens. Durbin and Blumenthal had asked the agency to "look further into the health impact of energy drinks."

        According to CQ (11/28, Lorber, Lesniewski, Subscription Publication), the FDA's letter "took some pressure to elicit." Sens. Durbin and Blumenthal "sent four letters to the agency" regarding energy drinks. A "Durbin aide said the senators found the original response insufficient."

        Senators urge agency to act now. The Wall Street Journal (11/28, Esterl, Subscription Publication) reports Sens. Durbin and Blumenthal responded to the FDA letter in a joint statement released Tuesday. Quoting from the statement, the Journal noted that the senators lauded the FDA for undertaking a review on the potential impact of energy drinks on the health of children and adolescents, but emphasized that "more needs to be done and quickly."

        Bloomberg News (11/27, Edney) adds that in their statement, Durbin and Blumenthal said the FDA "can and should take action now to regulate energy drinks that are marketed as beverages."

        Separately, Bloomberg News (11/27, Stanford, Edney) notes that Goldman Sachs analyst Judy Hong issued a client note Tuesday, noting that the FDA's responses to the senators "questions over the safety" of energy drinks was "encouraging" and predicting that any "regulatory outcome" from the pending review is "likely to be 'benign.'"

Surgeon Implants Plastic Artery So Patient Can Continue Dialysis.

The Daily Telegraph (UK)  (11/28, Adams) reports on a new surgery that one surgeon "believes...has the potential to give" certain patients "years of extra life -- possibly buying time for a kidney transplant." The procedure has only been performed on one patient so far. In the procedure, a women who "had endured so much dialysis that she had run out of suitable blood vessels to 'tap' to clean her blood" was given "a foot-long plastic artery enabling dialysis once again."

Grapefruits May Trigger Overdoses Of Certain Medications.

ABC World News (11/26, story 6, 1:35, Sawyer) reported that there is "new proof that a staple in American kitchens, grapefruit, can trigger" overdoses of certain medications.

        The Los Angeles Times  (11/26, Brown) "Booster Shots" blog reports, "It's been known for a long time that eating grapefruit and taking certain prescription oral medications - including the cholesterol drugs atorvastatin, lovastatin and simvastatin as well as some cancer and heart drugs - don't mix." However, in a new review published in CMAJ, "the team of researchers who discovered the dangerous interactions nearly 20 years ago reported that the number of drugs that can cause serious reactions when mixed with grapefruit increased dramatically between 2008 and 2012, from 17 to 43, as new drugs have been introduced." Altogether, "more than 85 drugs are thought to interact with grapefruit, the team wrote, 43 of them in dangerous ways."

        The Huffington Post  (11/26) reports that the researchers "also warn against a general 'lack of knowledge' about the dangers of mixing certain medications with grapefruit."

        The ABC News  (11/26) "Medical Unit" blog reports, "Grapefruits contain chemicals called furanocoumarins that interfere with how your body breaks down drugs before they enter the bloodstream. By preventing this normal breakdown of a drug, these chemicals in grapefruit can effectively cause a drug overdose and more severe side-effects." Some of "the side effects sometimes seen with grapefruit-induced overdoses" include "heart rhythm problems, kidney failure, muscle breakdown, difficulty with breathing and blood clots."

        BBC News  (11/27, Gallagher) reports on its website, "Dr David Bailey, one of the researchers, told the BBC: 'One tablet with a glass of grapefruit juice can be like taking five or 10 tablets with a glass of water and people say I don't believe it, but I can show you that scientifically it is sound.'"

        The Daily Telegraph (UK)  (11/27, Smith) reports, "Elderly patients were at particular risk because they are more likely to eat grapefruit and be on the medicines that interact with it, while their bodies are less able to cope with the effects of an overdose, the researchers said." Also covering the story are the Daily Mail (UK)  (11/27, Hope) and HealthDay  (11/27, Reinberg).

Temsirolimus May Help mRCC Patients On Hemodialysis.

Medwire  (11/23, Grasmo) reported that "research findings  published in the International Journal of Clinical Oncology suggest that temsirolimus effectively stabilizes disease progression in patients with metastatic renal cell carcinoma (mRCC) undergoing hemodialysis." According to the article, "temsirolimus, a novel specific inhibitor of mammalian target of rapamycin, has previously been shown to exhibit an inhibitory effect on tumor cell growth and demonstrated significant overall and progression-free survival benefits compared with interferon (IFN)-alpha in patients with untreated poor-prognosis mRCC." Medwire noted that "the findings from the current retrospective pilot study expand this research to include patients with renal impairment."

        Tumor Burden May Help Predict mRCC Prognosis. Medwire  (11/23, Noel) reported that "tumor burden plays an independent prognostic and predictive role in metastatic renal cell carcinoma (mRCC)," according to the results  of a clinical trial published Oct. 26 in the British Journal of Urology International. According to the article, "the trial comprised 124 patients, 66% of whom received either sorafenib or sunitinib, while 34% received placebo." The researchers found that found that "tumor burden (measured by RECIST 1.0) was directly and significantly related to progression-free survival (PFS) and overall survival (OS) even after adjusting for modified Memorial Sloan Kettering Cancer Centre (MSKCC) risk class and treatment." The noted that each "1-cm increase in tumor burden raised the risk for progression by 4.5% and the risk for death by 5.0%."

Diabetes Rates In Young People Projected To Soar.

HealthDay  (11/22, Gordon) reported, "If the current trends in diabetes for young people stay the same, rates of type 2 diabetes will rise by 49 percent by 2050, and rates of type 1 diabetes will increase by 23 percent," according to a study published in the December issue of the journal Diabetes Care. And, "if the incidence starts to increase, as it has in other parts of the world, the US Centers for Disease Control and Prevention estimates that rates of children with type 2 diabetes could quadruple, while the number of children with type 1 diabetes could triple." Study lead author Giuseppina Imperatore, MD, PhD, of the CDC's division of diabetes translation, said, "As a society, we will need to plan and prepare for the high-quality care of these children."

        WebMD  (11/22, Boyles) reported, "The spike in both type 1 and 2 will be particularly high among minorities." Robert E. Ratner, MD, chief scientific and medical officer of the American Diabetes Association, noted in an editorial accompanying the study that "just two decades ago, type 2 diabetes was almost never seen in children, but it has become more common with higher rates of childhood obesity." According to Ratner, "public health efforts that address the childhood obesity epidemic could have a profound impact on the future of type 2 diabetes."