Other Clinical Risks

CT is fast, reliable, and convenient, but its comparatively high x-ray dose has only just begun to attract attention. In the United States, it has been estimated that CT could be responsible for about 6,000 additional cancers a year, roughly half of them fatal (ECRI Institute, 2008). 

To ensure patients are not unnecessarily exposed to high dose levels, consider the following  

The expected benefits of a CT need to outweigh the radiation risks and CT referral guidelines should be regularly reviewed, particularly where children are concerned. 

Scanning protocols should be optimized to minimize doses. 

Those performing CT exams should be specihcally trained for CT and maintain their training. 

---

The early clinical experience with COC in Europe was associated with high catastrophic fracture rates. The historical fracture rates ranged between 0% and 13% in some studies (Willmann 2003). However, the in vivo fracture rates within the overall patient population for contemporary alumina hip components have been reported by CeramTec to range between 1 and 3% in 10,000 (Willmann 2003). The risk of cement fracture is thus anticipated to be much lower relative to other clinical risks, which have been associated with all joint replacements, including loosening and infection. Other clinical complications of THA typically occur at a rate of 1% or higher. 

Individuals with established CHD, other clinical atherosclerotic disease (CAD), or diabetes have a greater than 20% risk over a 10-year period of developing CHD.3 The ATP III guidelines set the target LDL cholesterol level at less than 100 mg/dL (2.59 mmol/L) for high-risk patients who have a history of one or more of the following ... 

Pancreatitis Pancreatitis has been observed in antiretroviral nucleoside-experienced pediatric patients receiving lamivudine. Use lamivudine with caution in pediatric patients with a history of prior antiretroviral nucleoside exposure, a history of pancreatitis, or other significant risk factors for the development of pancreatitis. Stop lamivudine treatment immediately if clinical signs, symptoms, or lab abnormalities suggestive of pancreatitis occur (see Adverse Reactions). 

In the early 1990s, a series of well-designed clinical studies convincingly demonstrated that TFAs increased plasma total and LDL-cholesterol to levels similar to those produced by saturated fatty acids. More than this, TFAs reduced plasma HDL-cholesterol level. The overall effect was that the ratio of LDL-cholesterol to HDL-cholesterol was approximately double that for an equivalent intake of saturated fatty acids (Ascherio et al., 1999). In addition, TFAs adversely affect other CHD risk factors. Plasma triglycerides and Lp[a] levels are increased (Ascherio et al., 1999) and it was shown recently that consumption of TFAs was associated with a deleterious increase in small, dense LDL particles (Mauger et al., 2003). 

Other clinical trials where MHRA may wish to seek advice or where there is a difficult risk/benefit balance. 

Nevertheless, at least six randomized, double-blind, placebo-controlled, intervention trials have assessed the effect of vitamin or micronutrient supplements on AMD risk. The consensus from these and other trials seems to suggest a positive response of the retina as well as improved visual performance from vitamin and mineral supplementation such as the AREDS formulation (see above). Specifically, the AREDS results should be interpreted as understanding that the formulation was effective in slowing the risk of progression of AMD in persons 55 years of age and older who had some macular changes consistent with early age-related maculopathy. More recently, substantiation of these results was reported on a primarily white population as part of the Rotterdam Study. An above-median intake of beta-carotene, vitamin C, vitamin E, and zinc was associated with a 35% reduced risk of AMD. Still other clinical research has demonstrated shortterm beneficial effects in small populations for lutein and a combination of lutein and antioxidants in AMD. 

---