Capsules : Male Fetuses Less Tolerant of Stress

Men have always thought of women as the weaker sex, but women know better. Any woman will tell you that men suffer from far more infirmities than the “fairer” sex. Now, new evidence suggests that the disparity extends back through childhood into the womb. A new Danish study finds that male fetuses are less likely than females to survive traumatic events around the time of conception.

Dr. Dorthe Hansen of the John F. Kennedy Institute in Glostrup, Denmark, and her colleagues identified 3,072 women who had given birth between January 1980 and December 1992 and who had suffered a traumatic event immediately before or after conception. Such events included a death, cancer or a heart attack in the immediate family.

They reported in Saturday’s British Medical Journal that boys represented only 49% of the 3,072 births, compared with 51.2% of births in the population at large. They speculate that the altered male / female ratio could have been caused by changes in hormone levels produced by stress associated with the traumatic events, decreased sperm quality in semen or an increased rate of spontaneous abortions of male fetuses.

Surgery Improved Heart Patients’ Chances

Two new studies provide further evidence that aggressive, invasive treatment for heart problems--bypass surgery and angioplasty, in particular--increase the long-term chances of survival. Although many cardiologists design their treatment programs based on that belief, the evidence that such aggressive treatment is worthwhile has been limited.

The first study considered heart attack victims who suffer from cardiogenic shock, a complication that is the leading cause of death among patients hospitalized after heart attacks. Such patients are extremely ill, and cardiologists have been reluctant to subject them to surgical procedures until they are stabilized by medical treatment.

The multi-center study enrolled 302 hospitalized patients suffering cardiogenic shock. About half (152) underwent either a bypass or angioplasty immediately, while the rest received only medical treatment initially. The team reported in Thursday’s New England Journal of Medicine that survival after 30 days was comparable in the two groups, but that those who underwent the surgical procedure were more likely to be alive after six months. After six months, 50.3% of those in the surgical group had died, compared with 63.1% in the medical care group. The findings were particularly dramatic in patients younger than 75, the team said, producing a savings of 20 lives for every 100 patients undergoing surgery.

The second study considered patients with unstable coronary-artery disease resulting from partial blockage of coronary arteries. It compared surgical treatment to therapy with a blood thinner called dalteparin, trade-named Fragmin. This multi-center study enrolled 2,457 patients from the Scandinavian countries. All received dalteparin for at least five days, then half continued on the drug and half underwent surgery.

The team reported in Saturday’s Lancet that after six months, 12.1% of those receiving only the blood thinner had suffered a heart attack or died, compared with 9.4% of those undergoing surgery. Symptoms of angina--crushing chest pains--and readmission to the hospital were cut in half by the surgical procedures.

The bottom line of both studies is that surgical intervention should be undertaken as soon as possible whenever coronary arteries are blocked.

Heart-Disease Study Questions Estrogen Use

A woman’s lack of estrogen production after menopause may not be the only reason she is more susceptible to the ravages of heart disease, according to a new study by researchers at Johns Hopkins University in Baltimore, Md. Her blood vessels may lose their ability to respond properly to estrogen, so that estrogen replacement therapy has only limited effectiveness.

During atherosclerosis, so-called smooth muscle cells in a blood vessel’s wall tend to grow out of control, stiffening the walls and impeding circulation. But women’s blood vessels are studded with estrogen receptors, and estrogen binding to these receptors tends to inhibit the growth of smooth muscle cells.

Dr. Wendy S. Post and her colleagues studied the genes for estrogen receptors in the blood vessels of healthy post-menopausal women and those with atherosclerosis. They report in the September issue of Cardiovascular Research that in the healthy women, about 4% to 5% of the genes were damaged by a process called methylatoin. But in the atherosclerotic vessels, three times that many genes were damaged, grossly inhibiting the ability of estrogen to stave off disease progress.

The findings could, Post said, explain the results of an earlier study, which found that estrogen replacement therapy provided little benefit for women who already had atherosclerosis.

Bone Marrow Donated Along With Kidney

A woman who got a transplanted kidney from her sister may not need to take strong drugs to tolerate the new organ because she also received transplanted bone marrow from the sibling. Surgeons said the woman, who has bone-marrow cancer, has not had to take the immune-suppressing drugs for a year and her cancer is strongly suppressed as well.

The bone marrow from the sister helped the patient’s immune system tolerate the transplanted organ, said Dr. Benedict Cosimi, who heads the transplantation unit at Massachusetts General Hospital in Boston.

Writing in the September Transplantation, the doctors said the patient developed kidney failure as a result of a cancer of the bone marrow called multiple myeloma.

Multiple myeloma causes abnormal plasma cells to proliferate, which can result in fewer red cells and platelets, tumors at multiple sites around the body, kidney or heart failure, or serious infections. Usually, a bone-marrow transplant requires doctors to kill off a patient’s bone marrow with strong radiation or drugs. But in this case, the team at Massachusetts General gave the woman mild drugs and antibodies against T-cells, one kind of immune-system cells produced by the bone marrow.

After the double transplant, the patient had normal kidney function with no sign of graft-versus-host disease, commonly known as rejection. She did get an immune-suppressing drug known as cyclosporine right after the transplant, but this was tapered off and stopped six weeks later.

Medical writer Thomas H. Maugh II can be reached at [email protected].