2 August 2004

Diet variety

A US expert includes a low-carbohydrate diet (with “healthy” fats and proteins as well as regular exercise) among the methods that doctors can encourage their overweight patients to experiment with for weight control.1 Dr Walter Willett was commenting on recent randomised controlled trials that have studied such diets. One study, by Yancy and colleagues, had found that, compared with a low-fat diet, a six-month low-carbohydrate ketogenic diet program led to greater weight loss (9.4 kg v 4.8 kg) and had better participant retention (76% v 57%).2 In the low-carbohydrate diet group, fat made up an average of two-thirds of the daily energy intake. Interestingly, the low-carbohydrate dieters seemed to voluntarily reduce their energy intake. Further, on average, their blood lipid levels were not “harmed”, as has been feared with such diets; however, the researchers advised that it would be prudent to monitor the serum lipid profiles of followers of low-carbohydrate diets. Willett pointed out that individual responses to a low-carbohydrate diet may vary widely — in this study, weight loss ranged from 0 to more than 20 kg.

1. Ann Intern Med 2004; 140: 836-837
2. Ann Intern Med 2004; 140: 769-777

Who’s the boss?

Cognitive therapy may help high-risk patients deal with distressing auditory hallucinations that command them to, among other things, harm themselves (eg, “set yourself alight”) or others (eg, “kill the therapist”). A UK pilot study randomised 38 such patients to receive either treatment as usual or usual treatment plus cognitive therapy for command hallucinations. Although the frequency, loudness and content of the voices heard remained the same in both study groups, the 18 patients who received cognitive therapy (a median of 16 sessions) were less likely than those who received usual care to comply with or otherwise act to appease the commanding voice or voices.

Br J Psychiatry 2004; 184: 312-320

Smoking doctors 50 years on

About a half to two-thirds of all persistent cigarette smokers will eventually be killed by their habit, according to an editorialist in the BMJ.1 Epidemiologist Meir Stampfer was commenting on a report of 50 years of data (1951 - 2001) from a total of nearly 35 000 male doctors who participated in the British Doctors Study.2 The study also found that stopping smoking at any age confers a survival benefit: cessation at age 60, 50, 40 or 30 years gained about 3, 6, 9 and 10 years of life expectancy, respectively.

1. BMJ 2004; 328: 1507
2. BMJ 2004; 328: 1519-1528

Supersperm

In 1979, a 17-year-old patient, who needed further cancer treatment after an orchidectomy for a malignant testicular teratoma, had five ampoules of sperm from four ejaculates cryopreserved. Thirteen years later, in 1992, after radiotherapy (including to the contralateral testicle), four courses of chemotherapy and a laparotomy with resection of a retroperitoneal mass, he was discharged from follow-up and he and his partner started planning a family. A decade later, in 2002, after 3 years of trying to conceive naturally, followed by a diagnosis of persistent azoospermia, and then four IVF/intracytoplasmic sperm injection cycles using up all five ampoules of cryopreserved sperm, a son was born (3.7 kg, and healthy).

The UK authors of this case report say it provides evidence that long-term cryopreservation can successfully preserve sperm quality and fertility. In this case, post-thaw sperm quality was good in all but one of the banked ejaculates, and fertilisation and fresh embryo transfer were achieved in three of the four cycles, with a take-home baby resulting from the last one.

Hum Reprod 2004; 19: 1448-1449

Relieving renal colic

NSAIDs are better than opioids for relieving acute renal colic, according to a systematic review conducted by Australian authors. Holdgate and Pollock reviewed 20 trials involving a total of 1613 patients that compared any NSAID with any opioid in managing acute renal colic. Although results varied widely between the individual studies, possibly reflecting the wide range of agents, doses and routes of administration described, the review found that, overall, patients taking NSAIDs had slightly better pain relief and were less likely to need rescue analgesia. Further, patients receiving opioids, especially pethidine, were more likely than those receiving NSAIDs to experience vomiting.

BMJ 2004; 328: 1401-1404

Kids who need kidneys

Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data collected over four decades (from April 1963 to March 2002) have shown that, despite a trend over time towards improved survival, mortality rates for children with end-stage renal disease are 30 times higher than for other children. The long-term survival rate for 1634 children and teenagers needing renal replacement therapy was 79% at 10 years and 66% at 20 years. Authors for the Australian and New Zealand Paediatric Nephrology Association say that treatment with transplantation, rather than dialysis, may improve overall survival further, and that the challenge ahead is to reduce the incidence of cardiovascular and malignant diseases that account for the bulk of long-term mortality in children with end-stage renal disease.

N Engl J Med 2004; 350: 2654-2662

Dr Ann Gregory, MJA