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This week in the medical journals

Heart attack and stroke survival highlight reports

By Peggy Peck
Medpage Today Senior Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.



Medical Research

Critical time

After a heart attack and stroke, time is of the essence. This was reinforced in reports in the leading medical journals this week.

Time doesn't heal everything, which is especially so in the case of strokes, according to a report from Dutch researchers. They followed survivors of minor stroke and mini-strokes (more properly termed transient ischemic attacks, or TIAs). After 10 years, only 40 percent of the patients were still alive, and more than half of those still living had suffered at least one more stroke.

Almost 2,500 patients were included in the study that was reported in The Lancet. The researchers said that doctors must be dropping the ball on therapies aimed at preventing subsequent strokes or heart attacks.

They concluded that stroke survival should include a long-term treatment plan that includes aspirin, blood pressure drugs, and lifestyle changes to prevent future strokes and heart attacks.

Time, however, may be a great healer for heart attack patients, as long as they are lucky enough to survive the first 30 days. Heart attack survivors will always have a higher risk of sudden death -- when the heart suddenly stops beating -- but if they survive for two years the risk is only slightly higher than the risk for healthy people.

A study in The New England Journal of Medicine reported that about 1.4 percent of heart attack patients will suffer sudden death or cardiac arrest that requires resuscitation in the first month after a heart attack. When the researchers analyzed data from 14,703 patients, they found that the sudden death risk was greatest for those patients whose heart pumping capacity was most severely damaged by the original heart attack.

Less than half of minor stroke or TIA patients survive a decade

Chemotherapy, finally, for lung cancer

On the cancer front, chemotherapy research is finally paying off for some lung cancer patients. A study in The New England Journal of Medicine reported that patients with non-small-cell lung cancer, the most common kind, whose disease is not too advanced, may benefit from a new kind of chemotherapy after surgery to remove the cancer.

This new post-surgery chemotherapy decreased their risk of death by 31 percent and increased five-year survival by 15 percent, compared with patients treated with surgery alone. The five-year survival for the chemotherapy patients was 69 percent, versus 54 percent in the surgery group, a team of Canadian researchers reported. Moreover, the patients who underwent surgery plus chemotherapy were significantly less likely to have a recurrence of cancer during the five-year follow-up.

Adjuvant chemotherapy helps lung cancer patients

Hold the antibiotics, please

Ask your neighbor -- or your mother -- about the best treatment for bronchitis and chances are the answer will be antibiotics. Ask your child's daycare provider what to do about pink eye and chances are the answer will be antibiotics. Wrong on both counts, two journals reported this week, both trying to debunk the pervasive mantra of antibiotics, antibiotics, antibiotics.

Researchers in Southampton, England, said that giving antibiotics to patients with uncomplicated bronchitis doesn't shorten the duration of cough, congestion, or "sick feeling" caused by the disease, but antibiotics nonetheless make patients happy and more satisfied with their care. In their report in the Journal of the American Medical Association, the researchers said that with or without antibiotics the cough is likely to linger for as long as three weeks.

Down the road in Oxford, England, another team of researchers reported in The Lancet that antibiotics do nothing to improve recovery among children with conjunctivitis, the highly infective condition more commonly known as pink eye. But despite the evidence, the antibiotics-for-conjunctivitis debate is unlikely to be quickly resolved because many daycare centers and schools require 24 hours of antibiotic treatment before allowing children to return to school.

Antibiotic treatment unnecessary for acute infective conjunctivitis

Saving organ recipients

Human cytomegalovirus (CMV) infects 50 percent to 85 percent of adults worldwide and usually is a fairly harmless infection, but it can be a lethal infection in people who take drugs to suppress their immune systems after receiving organ transplants. Australian researchers, who reported their findings in The Lancet, said that routine treatment with antiviral drugs such as Valtrex and Zovirax can significantly reduce the risk posed by CMV or other viruses like herpes. The Australian team analyzed data from 19 studies that enrolled almost 2,000 transplant patients.

Antivirals reduce risk of CMV infection in transplants

No smoking gun

It is tempting to link all manner of illness with the nasty effects of secondhand smoke, but sometimes evidence gets in the way of a good theory. That's what happened to some Georgetown University researchers who reported that they were unable to link frequent ear infections to exposure to secondhand smoke.

But the researchers are not ready to write the final chapter on this secondhand-smoke tale. They noted that smokers have more infectious pathogens hanging around their nasal passages, which is also true of children who have frequent ear infections. Likewise, the smoking parents had fewer of the types of bugs that help fight infection; ditto the kids with multiple ear infections.

The problem, however, was that the smoking parents didn't match up with the ear-achy kids. The research was reported in Archives of Otolaryngology.

Parents' smoking status not factor in kids' otitis media

Thumbs-up for home births

Finally, for those who yearn for a return to the simpler days, there was word that the time-honored home birth is usually just as safe for mom and child as deliveries in high-tech birthing units. The study, which was reported in BMJ, tracked more than 5,400 midwife-assisted deliveries in the U.S. and Canada. The American College of Obstetricians and Gynecologists, whose members deliver babies in hospitals, was not persuaded. The organization opposes home births.

Endnote: If it was good enough for great grandma ...

Study: Low-risk home births found safe

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