eMJA: In other journals - 2 September 2002

In Other Journals

2 September 2002

	Bound to bounce
	Getting out of hospital in time for the weekend might seem like a good idea, but Canadian researchers warn that a Friday discharge does not necessarily produce the best outcome. A search of Ontario’s hospital Discharge Abstract Database revealed 2 403 181 patients discharged after non-elective admissions between 1990 and 2000. In the 30 days after discharge 1.7% of all patients died and 5.4% were readmitted. Friday was the most popular day for discharge, but, even after controlling for multiple demographic and clinical factors, patients discharged on Fridays had a small but significantly increased risk of death or readmission (hazard ratio, 1.04, compared with those discharged on Wednesdays). CMAJ 2002; 166: 1672-1673

	Prospects for paternity
	The good news for male survivors of childhood cancers is that, although their sperm production may be markedly decreased, the sperm that are produced appear to carry a normal amount of healthy DNA. Researchers in Edinburgh recruited 33 men (median age, 21.9 years) who had been treated with chemotherapy and/or radiotherapy for a range of childhood cancers diagnosed at a mean age of 10 years, and two age-matched controls for each patient. As well as performing semen analysis, they measured the extent of DNA fragmentation in spermatozoa. About a third of the cancer survivors had normal semen quality, 10 were azoospermic, six had sperm concentrations of < 20 × 106/mL, and the median sperm concentration among those with any sperm was significantly lower than that of the control group. However, there was no significant difference between the groups in sperm DNA integrity. The findings suggest that cancer survivors who become fathers using assisted-reproduction techniques such as intracytoplasmic sperm injection do not have an increased risk of genetic damage in their offspring. Lancet 2002; 360: 361-367

	Negative growth
	A British study has raised concerns that patients who have been treated with human pituitary growth hormone (PGH) may be at increased risk of certain cancers, but the link is far from definite. Between 1959 and 1985, 1848 children and adolescents in the UK received human PGH. By 1995, 12 people had developed cancer (excluding non-melanoma skin cancers and neurological tumours) and by December 2000 there were 10 cancer deaths, giving a standardised mortality ratio of 2.8 compared with the matched general population. Two deaths each from colorectal cancer and Hodgkin’s disease were reported (compared with 0.18 and 0.85 deaths expected, respectively). Human PGH was replaced by a synthetic form of the hormone in 1985, after the risk of Creutzfeldt–Jakob disease was identified. Dosage regimens differ from those used previously and any carcinogenic potential of current therapy remains unexplored. Lancet 2002; 360: 273-277 Wanted — dead or alive Given the current worldwide shortage of organs for transplant, it is interesting to note the findings of a Swiss study, which shows that renal grafts from donors without heartbeats do as well as those from brain-dead donors with heartbeats. Between 1985 and 2000, 122 (10.8%) of the 1133 renal transplants at the University Hospital, Zurich, involved donors without heartbeats. When compared with 122 recipients of kidneys from donors with heartbeats (matched for sex, age and year of transplantation), patients in this group were more likely to require dialysis in the first week after transplantation (48.4% v 23.8%). However, the rates of long-term graft survival were similar (83.7% v 82.3% at five years, and 78.7% v 76.7% at 10 years). All of the donors without heartbeats were alive on arrival at hospital: most (80.3%) died as a result of trauma. N Engl J Med 2002; 347: 248-255

	Sweat it out
	Evidence is mounting for the therapeutic role of aerobic exercise in fibromyalgia. A randomised controlled trial in the United Kingdom compared two community-based programs for the condition. Researchers identified 136 patients from letters sent to GPs by rheumatology clinics over an 18-month period, and assigned the patients to participate in either aerobic exercise or relaxation and flexibility classes at a local “healthy living centre” twice weekly for 12 weeks. There was a high overall dropout rate (72 patients attended more than a third of the classes). However, patients assigned to the aerobic exercise group were significantly more likely than those in the relaxation group to report being much or very much better, both at three months (35% v 18%, respectively) and 12 months (38% v 22%). Examination at 12 months also revealed a decrease in the number of tender points (of the 18 sites specified in the fibromyalgia diagnostic criteria) in both groups. Only 31 of 69 patients in the exercise group and 44 of 67 patients in the relaxation group still met the diagnostic criteria for fibromyalgia. BMJ 2002; 325: 185-187

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