7 February 2005

Heavy metal — Indian style

US researchers have warned that users of some Ayurvedic (traditional Indian) herbal medicine products may be at risk for heavy metal toxicity. They found that 14 of 70 (ie, 1 in 5) of such products manufactured in South Asia intended for oral use and available for sale in the Boston area — including several recommended for paediatric use — contained potentially harmful levels of lead, mercury and/or arsenic.

The researchers said that, in the US, imported Ayurvedic herbal medicine products have not required proof of efficacy or safety, as they are marketed as dietary supplements. They called for mandatory testing of these products for toxic heavy metals, and also suggested that doctors consider intake of Ayurvedic herbal medicine products in the differential diagnosis of unexplained heavy metal toxicity.

JAMA 2004; 292: 2868-2873

Keyhole prostatectomy

Minimally invasive laparoscopic radical prostatectomy can be safe and effective for treating prostate cancer, according to a report from New Zealand. A single surgeon, experienced in laparoscopic surgery, has undertaken this procedure successfully in an initial series of 30 patients. With increasing experience, the operating time required fell from about 7 hours to about 4 hours. No conversions to open surgery or reoperations were required. Advantages over open surgery included less blood loss, less pain, a shorter hospital stay and an earlier return to normal activity.

At 6-month follow-up, continence rates were 83%. A laparoscopic nerve-sparing procedure was not offered, so all patients in this series were either impotent preoperatively or uninterested in maintaining potency.1 The Australian author of an accompanying commentary said that telerobotic prostatectomy could dramatically reduce the (much-vaunted) learning curve for this procedure.2

1. Aust N Z J Surg 2004; 74: 1065-1068
2. Aust N Z J Surg 2004; 74: 1038

Works like a charm

Wearing a magnetic wrist bracelet could help to reduce osteoarthritis-related pain in joints elsewhere in the body, say UK researchers. They conducted a randomised, placebo-controlled trial in five rural general practices, involving 194 men and women with osteoarthritis of the hip or knee. The researchers wanted to compare the effect of standard-strength magnetic bracelets (mean strength of 186 mTesla) with "weak" magnetic bracelets (which turned out to be of variable strengths due to a manufacturing error) and non-magnetic, dummy bracelets. Pain from osteoarthritis of the hip and knee decreased when wearing the magnetic bracelets, but it is uncertain whether this is a specific or non-specific, placebo effect.

BMJ 2004; 329: 1450-1454

Birth risk: what’s your view?

A large, multicentre US study of more than 33 000 women with singleton pregnancies and a prior caesarean delivery has found that, compared with an elective repeated caesarean delivery, a trial of labour carries a slightly higher perinatal risk.1 However, an estimated 588 caesarean deliveries would be needed to prevent a severe adverse perinatal outcome.2 Of note, women with clear indications for a caesarean delivery were excluded from the study.

1. N Engl J Med 2004; 351: 2581-2589
2. N Engl J Med 2004; 351: 2647-2649

Armed ovary

Autotransplantation of an ovary to a patient’s upper arm could help cervical cancer patients sidestep the premature ovarian failure and infertility that can follow postoperative radiotherapy. Dutch doctors have now successfully completed this procedure in a 29-year-old woman from Suriname, South America, after anastomosing the ovarian artery and vein to the brachial artery and basilic vein, respectively. Although the patient declined postoperative radiotherapy because of severe homesickness and subsequently experienced local recurrences of malignant disease, the transplanted ovary demonstrated adequate function over more than one year of follow-up. The patient experienced cyclic swellings of the upper arm without major discomfort, and ultrasound monitoring showed follicular activity at different stages.

Cancer 2004; Nov 8 (Epub)

Acu-moxi in Bell’s palsy

Acupuncture and moxibustion — acu-moxi — may be beneficial in treating facial palsy, according to Chinese researchers. They conducted a multicentre, randomised, single-blind trial in 480 patients with unilateral Bell’s palsy, comparing the effects of acu-moxi with a program of prednisone, vitamin B1 and B12, and oral dibazole, administered with or without acu-moxi. The researchers found that acu-moxi treatment alone led to the best improvement in scores of facial paralysis and disability. Further, treatment was more effective in cases of mild and acute (less than 8 days since onset) facial paralysis than in severe and non-acute (from 8 to 90 days) cases. Severe side effects, such as fainting during acupuncture and scalding during moxibustion, were not encountered in this trial. (Moxibustion involves the burning of a herb, in this case applied indirectly.)

Chin Med J (Engl) 2004; 117: 1502-1506

Dr Ann Gregory, MJA