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February 29, 1996


New pregnancy prevention drug being tested

Pitt researchers are studying levonorgestrel, a medication found in some types of birth control pills, against the traditional "morning-after pill" to prevent pregnancy. Pitt is the only U.S. site to participate in this World Health Organization (WHO)-sponsored trial, which is being conducted at 12 sites throughout the world.

The standard morning-after pill regimen includes a relatively high-dose combination of estrogen and levonorgestrel, each taken twice, 12-hours apart, within 48 hours of unprotected intercourse. The new regimen includes high doses of levonorgestrel alone.

"Although high doses of estrogen are not dangerous when given over a short period of time, they can cause a substantial amount of nausea and vomiting. We wanted to find an effective emergency contraception which also will reduce these symptoms," said Mitchell Creinin, assistant professor of obstetrics, gynecology and reproductive sciences at Pitt's School of Medicine, and primary investigator of the study.

A recent, small WHO trial found levonorgestrel and the standard morning-after pill regimen to be equally effective in preventing unwanted pregnancy, but levonorgestrel alone reduced nausea and vomiting.

"The purpose of this current trial is to confirm the efficacy and side effects of the new regimen in a larger study and to examine whether the effectiveness of levonorgestrel alone remains acceptable if the start of the treatment is extended from 48 to 72 hours after unprotected intercourse," Creinin said.


UPMC gets grant to study injuries

Injury is one of this country's most pressing health problems. During a nine-month period in 1993, hospital charges in Pennsylvania for treating injuries due to falls amounted to more than $381 million. During that same period, charges for treating motor vehicle crash injuries amounted to more than $141 million and for firearms injuries, almost $50 million.

Despite the dollar cost and the cost in terms of human suffering, efforts to study injury and improve systems of trauma care have only recently received national emphasis.

In an effort to further such research and propose innovative methods of prevention, the Center for Injury Research and Control (CIRCL) at the University of Pittsburgh Medical Center has been awarded a $1.2 million grant by the Centers for Disease Control.

The award makes CIRCL one of only 10 such centers in the United States.

"Emergency department physicians see the same injuries over and over. It is important that we begin to think of injuries as a disease process that can be studied and prevented," said Jeffrey Cohen, assistant professor of emergency medicine and CIRCL director.

"By identifying risk factors that contribute to injuries and designing interventional studies and programs, we can reduce the rate of intentional and unintentional injury in this country," Cohen said.

Under the three-year grant, CIRCL will conduct research in four areas: examining decisions by rural health care providers to either treat trauma victims or transport them to trauma centers; determining effective ways to prevent falls among the elderly; investigating long-term effects of mild traumatic brain injury, and improving methods of injury surveillance.


Community acquired pneumonia has high mortality rate

An analysis of many different research studies involving 33,148 patients with community-acquired pneumonia (CAP) showed that the death rate for patients hospitalized with the condition was high — 13.7 percent — according to a recent article in The Journal of the American Medical Association.

Michael J. Fine and colleagues from Pitt, as well as researchers from St. Louis's Washington University, reviewed 30 years of medical literature on the prognoses and outcomes of patients with CAP, the type of pneumonia that isn't acquired in a hospital.

Mortality rates varied depending on the type of patient. Among those who ended up being hospitalized, 13.6 percent died. The figure was 17.6 percent for elderly patients. Those with bacteremic pneumonia (bacteria in the bloodstream) had a 19.6 percent rate. The rate for those in nursing homes was 30.8 percent. For those in intensive care units, the rate was 36.5 percent.

Patients with certain types of bacterial infections were more likely to die than others, researchers found. Those included Pseudomonas aeruginosa (61.1 percent mortality rate), Klebsiella species (35.7 percent), Escherichia coli (35.3 percent) and Staphylococcus aureuas (31.8 percent).


Pitt to introduce "green" building material made from fly ash

Pitt's civil and environmental engineering department has signed a letter of cooperation with Kingsway Technology Ltd. to conduct research on using recycled electric utility fly ash in home building materials. Used in place of lumber, the new materials are expected to save money for builders and home buyers.

Ronald D. Neufeld, professor of civil and environmental engineering, said: "As the building industry in the United States faces dramatically increased costs of lumber, American builders are looking at alternative, environmentally benign materials such as autoclaved cellular concrete, or ACC. We will now have the ability to introduce the ACC technology to the North American market, to more closely evaluate its impact, as well as to provide critical training in production techniques." ACC is a lightweight, concrete-like construction material with a density of about one-fifth to one-third that of ordinary concrete block.

Seventy percent of the block is composed of fly ash that ordinarily would be industrial waste. ACC blocks and panels provide capital cost savings for the builder and energy cost savings for the end user.

The ACC market is well-established worldwide with the exceptions of the United States and Canada, Pitt researchers said.

Kingsway Technology Ltd. has been making and selling fly ash-based ACC materials for the past 40 years. The agreement between Kingsway and Pitt allows for the technology transfer.


Pitt taking part in heart laser study

Pitt heart surgeons are participating in a nationwide, FDA-approved clinical trial of an innovative laser treatment for heart disease in high-risk patients.

Called transmyocardial revascularization (TMR), the laser procedure makes a series of tiny channels into the heart. Preliminary studies indicate that the procedure has the potential to become a third alternative to bypass surgery and balloon angioplasty in improving blood flow to the heart.

The clinical study will compare TMR with second, or "re-do," bypass surgery. Patients undergoing the laser procedure have had previous bypass surgery and may have other complications such as diabetes and hypertension, ruling out conventional open heart surgery.

TMR "drills" 15 to 30 channels, each about one millimeter in diameter, through the heart muscle into the left ventricular chamber of a beating heart. The laser is computer-synchronized with the patient's heartbeat and triggered to fire, in less than one-twentieth of a second, at the interval between heartbeats when the left ventricle is filled with blood. The blood acts as a backstop for the laser's energy, preventing it from damaging other heart tissue.

The holes on the exterior of the heart close by natural clotting while the interiors of the holes remain open. The beating of the heart forces the oxygen-enriched blood into the interior channels and thus provides blood directly to the deprived area of the heart muscle.


New drug shows promise for treating fatal lung disease

A new drug shows promise in treating people with primary pulmonary hypertension (PPH), a rare and usually fatal disease of lung blood vessels. People with PPH are chronically short of breath. For many, the only alternative is a lung or heart-lung transplant.

According to cardiologists at the University of Pittsburgh Medical Center who took part in a multi-center nationwide study, the drug, called prostacyclin, improved symptoms, exercise capacity and quality of life of PPH patients.

The study is detailed in the Feb. 1 issue of the New England Journal of Medicine.

"Before prostacyclin, no medication had ever shown a long-term benefit for these patients. In this study, intravenous use of prostacyclin had dramatic effects," said Srinivas Murali, associate professor of medicine and director of transplantation cardiology in UPMC's cardiology division.

"This drug may delay and in some instances eliminate the need for transplants." Waiting times for transplants range from 12 to 14 months for a single lung to more than two years for a heart-lung transplant.

PPH usually affects women in their 20s and 30s. Its cause is unknown. Lung arteries become thickened, increasing pressure and causing the right side of the heart to work harder. This can lead to heart failure and death. People with PPH are chronically short of breath and may need continuous or intermittent oxygen treatment.


HIV plasma viral load is most accurate predictor of survival, study shows

Viral load, the amount of human immunodeficiency virus (HIV) RNA in the bloodstreams of infected people, is a better predictor than CD4+ T-cell counts of how quickly HIV-infected individuals will develop AIDS and, ultimately, of their survival, according to a study presented at the Third Conference on Retroviruses and Opportunistic Infections in Washington, D.C., Jan. 28-Feb. 1.

The study, the largest AIDS outcome analysis of viral load measurements to date, demonstrates that direct quantification of HIV RNA by branched DNA predicts HIV disease progression earlier and more accurately than CD4+ T-cell counts, the most commonly used marker, regardless of how far the disease has progressed at the time of measurement.

"Our findings demonstrate that HIV RNA levels measured by branched DNA can predict disease progression as far as 10 years into the future," said John W. Mellors, the study's lead investigator, Pitt associate professor of medicine and director of the Pitt Treatment Evaluation Unit. "Comparatively, you can actually see a doubling of HIV RNA levels at least two years before you see a 100 cell decline in CD4 levels." Triple-drug combination dramatically reduces HIV in bloodstream, study indicates A study shows that a new triple-drug combination dramatically reduces the amount of HIV in the bloodstream (viral load) and increases the number of CD4 cells in HIV-infected patients after 24 weeks of therapy. An increase in CD4 cells indicates a healthier immune system.

"Our findings indicate that the combination of [the drugs] IDV, ZDV and 3TC has potent anti-retroviral activity. This regimen could be the latest, most promising therapy to treat AIDS," said John W. Mellors, Pitt associate professor of medicine and a study co-investigator.

Besides Pitt, schools participating in the study included New York University, the University of California at San Diego, and the University of North Carolina at Chapel Hill.

Study results were announced at the Third Conference on Retroviruses and Opportunistic Infections, held in Washington, D.C., Jan. 28-Feb. 1.


UPMC to study artificial liver assist device

The University of Pittsburgh Medical Center (UPMC) has signed a sponsored research agreement with a Minneapolis-based biotechnology firm to evaluate a novel design for a bio-artificial liver assist device. Excorp Medical, Inc., will give UPMC researchers more than $1 million over three years to conduct studies, including tests of the device in humans.

The device is intended to temporarily support patients with acute liver failure. Unlike patients with end-stage kidney disease, who can be supported with dialysis, patients with liver failure have no clinically approved, artificial means of stabilizing their afflicted organs.

The proposed system passes a patient's blood through a device outside the body, where pig liver cells separated from the blood by polymer membranes help remove toxins from the patient's liver cells.

Jack Patzer, assistant professor of surgery and chemical engineering, is principal investigator of the UPMC studies.


Sports medicine physician gets $1.5 million endowment in honor of Arthur J. Rooney Sr.

A $1.5 million endowment honoring the late Arthur J. Rooney Sr., founder of the Pittsburgh Steelers, has been awarded to Douglas B. McKeag, professor and vice chairperson of the University's departments of family practice and orthopaedic surgery.

The endowment of the Arthur J. Rooney Sr. Chair in Family Practice and Orthopaedic Surgery will help to fund research and advanced training in sports medicine in the two specialties.

McKeag is director of primary care sports medicine at the University of Pittsburgh Medical Center and a team physician for Pitt's athletics department.

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