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A study was conducted to evaluate and compare the prevalence rates of polyps in asymptomatic black and white patients. Results indicated that as compared with white patients, blacks had a higher risk of polyps sized more than 9mm and it was found more in older blacks above 60 years of age.

A study aims to determine whether omega-3 polyunsaturated fats (PUFAs) have beneficial antiarrhythmic effects in patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). It concluded that among patients with recent episode of sustained ventricular arrhythmia and an implantable cardioverter defibrillator (ICD), fish oil supplementation does not reduce the risk of VT/VF and might be proarrhythmic in some patients.

Patients who have surgery to correct congenital heart disease have an increased risk of developing endocarditis. Endocarditis is a bacterial infection of the heart valves. Researchers analyzed the medical and autopsy records of 3,860 people who had had surgery for congenital heart disease since 1958. Surgery for aortic valve stenosis appeared to be the greatest risk factor for endocarditis, which developed in 13% of the patients with this disease. For most other conditions, the incidence of endocarditis sometime within 25 years after surgery was less than 10%., Context. -- The incidence of infective endocarditis after surgical repair of congenital heart defects is unknown. Objective. -- To determine the long-term incidence of endocarditis after repair of any of 12 congenital heart defects in childhood. Design. -- Population-based registry started in 1982. Setting. -- State of Oregon. Participants. -- All Oregon residents who underwent surgical repair for 1 of 12 major congenital defects at the age of 18 years or younger from 1958 to the present. Main Outcome Measure. -- Diagnosis of infective endocarditis confirmed by hospital or autopsy records. Results. -- Follow-up data were obtained from 88% of this cohort of 3860 individuals through 1993. At 25 years after surgery, the cumulative incidence of infective endocarditis was 1.3% for tetralogy of Fallot, 2.7% for isolated ventricular septal defect, 3.5% for coarctation of the aorta, 13.3% for valvular aortic stenosis, and 2.8% for primum atrial septal defect. In the cohorts with shorter follow-up, at 20 years after surgery the cumulative incidence was 4.0% for dextrotransposition of the great arteries; at 10 years, the cumulative incidence was 1.1% for complete atrioventricular septal defect, 5.3% for pulmonary atresia with an intact ventricular septum, and 6.4% for pulmonary atresia with ventricular septal defect. No children with secundum atrial septal defect, patent ductus arteriosus, or pulmonic stenosis have had infective endocarditis after surgery. Conclusion. -- The continuing incidence of endocarditis after surgery for congenital heart defect, particularly valvular aortic stenosis, merits education about endocarditis prophylaxis for children and adults with repaired congenital heart defects. JAMA. 1998;279:599-603

Advances in surgical techniques have greatly altered the prognosis for children who have heart defects. Thirty or forty years ago, many children with such defects did not live to adulthood. Now, most undergo surgical repair during childhood and do reach adulthood. This study examined the 25-year mortality for persons who had surgical repair of a heart defect in childhood. Data were obtained for individuals who underwent reparative surgery for one of eight congenital heart defects before the age of 18 years between 1958 and 1989 in Oregon. A total of 2,701 subjects underwent such surgery during this time period; the results reported in this study are based on the follow-up of 94 percent of this group. Operative mortality occurred in 22 percent of patients who had simple transposition of the great arteries, in 11 percent who had tetralogy of Fallot, and in less than 7 percent who had other abnormalities. These rates were significantly lower for those operated on in the last five years, with an operative mortality of 7 percent for transposition of the great arteries and 3 percent or less for the other abnormalities. Late cardiac mortality (at 25 years after surgery) was 5 percent for those who were operated on for tetralogy of Fallot, isolated ventricular septal defect (VSD), or pulmonic stenosis. It was 17 percent for aortic stenosis and 10 percent for coarctation of the aorta. For transposition of the great arteries, two rates were calculated because of the different surgical procedures used to treat it. Late cardiac mortality at 15 years was 15 percent for those who underwent the Mustard operation; the rate was 2 percent at 10 years for those who underwent the Senning procedure. These results indicate significant improvement in mortality of children with certain congenital heart defects. However, predictions of future mortality can not be based on these data. Cardiac surgery is now performed in younger children who have suffered less cardiac disease, and surgical techniques continue to improve. Long-term studies, such as the current report, help to identify specific patient groups who need intense follow-up care and determine how to further decrease mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Importance: Maternal smoking during pregnancy adversely affects offspring lung development, with lifelong decreases in pulmonary function and increased asthma risk. In a primate model, vitamin C blocked some of the in-utero effects of nicotine on lung development and offspring pulmonary function.Objective: To determine if newborns of pregnant smokers randomized to receive daily vitamin C would have improved results of pulmonary function tests (PFTs) and decreased wheezing compared with those randomized to placebo.Design, Setting, and Participants: Randomized, double-blind trial conducted in 3 sites in the Pacific Northwest between March 2007 and January 2011. One hundred fifty-nine newborns of randomized pregnant smokers (76 vitamin C treated and 83 placebo treated) and 76 newborns of pregnant nonsmokers were studied with newborn PFTs. Follow-up assessment including wheezing was assessed through age 1 year, and PFTs were performed at age 1 year.Interventions: Pregnant women were randomized to receive vitamin C (500 mg/d) (n = 89) or placebo (n = 90).Main Outcomes and Measures: The primary outcome was measurement of newborn pulmonary function (ratio of the time to peak tidal expiratory flow to expiratory time [TPTEF:TE] and passive respiratory compliance per kilogram [Crs/kg]) within 72 hours of age. Secondary outcomes included incidence of wheezing through age 1 year and PFT results at age 1 year. A subgroup of pregnant smokers and nonsmokers had genotyping performed.Results: Newborns of women randomized to vitamin C (n = 76), compared with those randomized to placebo (n = 83), had improved pulmonary function as measured by TPTEF:TE (0.383 vs 0.345 [adjusted 95% CI for difference, 0.011-0.062]; P = .006) and Crs/kg (1.32 vs 1.20 mL/cm H2O/kg [95% CI, 0.02-0.20]; P = .01). Offspring of women randomized to vitamin C had significantly decreased wheezing through age 1 year (15/70 [21%] vs 31/77 [40%]; relative risk, 0.56 [95% CI, 0.33-0.95]; P = .03). There were no significant differences in the 1-year PFT results between the vitamin C and placebo groups. The effect of maternal smoking on newborn lung function was associated with maternal genotype for the α5 nicotinic receptor (rs16969968) (P < .001 for interaction).Conclusions and Relevance: Supplemental vitamin C taken by pregnant smokers improved newborn PFT results and decreased wheezing through 1 year in the offspring. Vitamin C in pregnant smokers may be an inexpensive and simple approach to decrease the effects of smoking in pregnancy on newborn pulmonary function and respiratory morbidities.Trial Registration: clinicaltrials.gov Identifier: NCT00632476. [ABSTRACT FROM AUTHOR]

Hypothesis: Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patientswithsevere, long-standing symptoms of gastroesophageal reflux disease(GERD). Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which meansthey neverhadbeen selected for screening.Onepossible explanation is that no correlation exists between the severity ofGERDsymptoms and cancer risk. Wehypothesize that severe GERD symptoms are not associated with an increase in the prevalence of BE, dysplasia, or cancer in patients undergoing primary endoscopic screening. Design: Cross-sectional study. Setting: University hospital. Patients: A total of 769 patients with GERD. Interventions: Primary screening endoscopy performed from November 1, 2004, through June 7, 2007. Main Outcomes Measures: Symptom severity, proton pump inhibitor therapy, and esophageal adenocarcinogenesis (ie, BE, dysplasia, or cancer). Results: Endoscopy revealed adenocarcinogenesis in 122 patients. An increasing number of severe GERD symptoms correlated positively with endoscopic findings of esophagitis (odds ratio, 1.05; 95% confidence interval, 1.01-1.09). Conversely, an increasing number of severe GERD symptoms were associated with decreased odds of adenocarcinogenesis (odds ratio, 0.94; 95% confidence interval, 0.89-0.98). Patients taking proton pump inhibitors were 61.3% and 81.5% more likely to have adenocarcinogenesis if they reported no severe typical or atypical GERD symptoms, respectively, compared with patients taking proton pump inhibitors, who reported that all symptoms were severe. Conclusions: Medically treated patients with mild or absent GERD symptoms have significantly higher odds of adenocarcinogenesis compared with medically treated patients with severe GERD symptoms. This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity. [ABSTRACT FROM AUTHOR]

The author replies to letters written in response to the article "Prevalence of Colon Polyps Detected by Colonscopy Screening in Asymptomatic Black and White Patients."

This letter to the editor replies to Drs. Strauss, Dorian, and Verma who commented on fish oil supplementation and the risk of ventricular arrhythmias in patients with implantable cardioverter-defibrillators.