eMJA: In Other Journals, 16 April 2007

A leading fertility expert in Israel, who removed hundreds of ova — without permission — from private patients undergoing fertility treatments in the late 1990s, will lose his medical licence for 2 and a half years as punishment, according to a news report in the BMJ. The expert had used the ova for the in-vitro fertilisation (IVF) of infertile women; in one woman, 232 ova were removed, with 155 used for IVF in 33 infertile women. Since the case came to light, the Israeli government has legislated to allow women who are not themselves undergoing fertility treatments to donate their ova altruistically.

To scan or not to scan?

At this time, screening for lung cancer by computed tomography (CT) should be considered an experimental rather than an evidence-based procedure, say US and Italian researchers. They conducted a small, preliminary study of the effect of such screening on lung cancer diagnosis and death from lung cancer in 3246 current or former smokers enrolled in one of three studies being conducted at the Mayo Clinic in Rochester, Minnesota, the Moffitt Cancer Center in Tampa, Florida, and at the Istituto Tumori in Milan, Italy. Compared with predictions of what would have occurred in the absence of screening, CT screening increased the rate of detection of small, resectable lung cancers but did not reduce the risk of either advanced lung cancer diagnosis or death from lung cancer. These findings mirror those of earlier studies of screening for lung cancer by chest x-ray. The researchers said that before CT screening is offered more widely, we should await the findings of the US National Lung Screening Trial and several other trials being conducted and planned in Europe.

JAMA 2007; 297: 953-961

Bad heart days

No day can be a good day for having your first heart attack; however, if you live in the United States, some days may be better than others. The Myocardial Infarction Data Acquisition System (MIDAS 10) Study Group reported that in New Jersey, from 1987 to 2002, patients with a first acute myocardial infarction (AMI) admitted on weekends had higher mortality than those admitted on weekdays. They pointed out that there was also a lower rate of invasive cardiac procedures on weekends and speculated that better access to care on weekends could improve outcomes for patients with AMI.

N Engl J Med 2007; 356: 1099-1109

Twin fates

Planned caesarean section may be beneficial for all twins, suggest UK researchers. They studied the records of 1377 UK twin pregnancies in 1994-2003, in which there was an intrapartum stillbirth or neonatal death but the other twin survived. They found an increased risk of death among the twins born second, rather than first, at term, which was related to delivery. Vaginally delivered second twins had a fourfold risk of death caused by intrapartum anoxia. However, an editorialist commented that it was important to obtain further evidence from randomised controlled trials before caesarean section for twin pregnancies at term becomes universal (and thus, a trial becomes impossible).

BMJ Online, 2 March 2007

Resuscitate me

In some witnessed out-of-hospital cardiac arrests, bystander cardiac-only resuscitation may be more effective than conventional cardiopulmonary resuscitation (CPR), according to a Japanese research group. The SOS-KANTO study group conducted an observational study of more than 4000 adult patients who had had an out-of-hospital cardiac arrest witnessed by bystanders. At 30 days after cardiac arrest, those who had received any bystander resuscitation (about 30%) had a more favourable neurological outcome than those who hadn’t (about 70%). However, in some types of patients — those with apnoea, those with a shockable rhythm, and when resuscitation began within 4 minutes of arrest — those who received cardiac compressions only from bystanders did better than those who received conventional CPR. The researchers suggested that interruption of chest compressions was the main reason why conventional CPR did not result in better neurological outcomes in these patients.

Lancet 2007; 369: 920-926

The A to Z of weight loss

US researchers say doctors whose patients want to try diets that are very low in carbohydrates, like the Atkins diet, can be reassured on two counts. Not only is any weight loss likely to be as large as for any other diet, but also any potential lipid effects are unlikely to be of immediate concern. Their A TO Z Weight Loss Study compared the effects of four diets representing a spectrum of carbohydrate intake — Atkins (very low), Traditional (high), Ornish (very high), and Zone (low) — in 311 premenopausal overweight and obese women. After 12 months of dieting, all four diets led to a modest weight loss of 2% to 5%, but the women assigned to the Atkins diet lost the most weight (an average of 4.7 kg) and there were no adverse effects on lipid variables.

JAMA 2007; 297: 969-977

Dr Ann Gregory, MJA

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