This week in the medical journals
Not all baby news is happy
By Peggy Peck
Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.
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In the medical journals this week there was news of a spectacular birth of a child for a cancer survivor who had been rendered infertile by the chemotherapy that saved her life.
In an amazing tour de force, her fertility was restored by a transplant of her own frozen ovarian tissue. Israeli researchers reported the successful birth in the New England Journal of Medicine, which went public immediately with the good news in an early online release.
Before the 28-year-old woman underwent chemotherapy for treatment of non-Hodgkin's lymphoma, a portion of her ovarian tissue was removed by surgeons and frozen. Although the toxic chemotherapy destroyed her ability to produce eggs, function was restored when the frozen tissue was transplanted into her ovaries. The Israeli team was able to perform in-vitro fertilization with one of her eggs and her husband's sperm.
On Monday the woman delivered a healthy baby girl by Cesarean section. It is the third live birth after ovarian transplant.
Not all baby news is happy.
For example, researchers who followed more than 750,000 babies and their parents for an average of 20 years reported in Epidemiology that parents, especially mothers, of babies born too soon and too small have an increased risk for early death.
The risk was greater for mothers than for fathers, with mothers of preemies having a 66 percent increase in risk of coronary heart disease and a 32 percent increase in risk of early death from all heart disease. Fathers of tiny, premature babies had a 6 percent increase in risk of early fatal stroke and were 3 percent more likely to die early from heart disease, reported the researchers from the Karolinska Institute in Stockholm.
Postpartum depression, meanwhile, most often affects moms but a new study says that pops, too, can suffer the baby-blues. Moreover, when fathers have postpartum depression it can trigger behavioral problems in their sons, according to a report in The Lancet.
Researchers from Oxford who studied data from 9,500 children and parents say that children whose fathers reported symptoms of depression eight weeks after the child was born were twice as likely to be hyperactive and significantly more likely to have behavior problems before age 4. But a separate analysis of boys and girls revealed that only boys were significantly affected by a father's mood, while both boys and girls were significantly affected by maternal depression.
Treatment news for hepatitis
Also big news this week was hepatitis B, which infects an estimated 400 million people worldwide and is a leading cause of liver transplants.
A pair of studies in the New England Journal of Medicine provided evidence for two new, and effective, approaches to treatment of chronic hepatitis B, which is spread through unprotected sex, needle-sharing by IV drug users, accidental needle sticks, or from mother-to-child in the womb.
In one study researchers reported that a long-acting interferon compound called Pegasys, which is used to treat hepatitis C, is highly effective for most cases of hepatitis B as well.
But in some people, the viral infection changes over the course of time and becomes hepatitis B "e antigen-negative" and this variant of hepatitis B requires 144 weeks of treatment, with a drug called Hepsera. When treatment is stopped after less than year, the virus "rebounds," the researchers said.
Autoimmune hepatitis, on the other hand, often requires no treatment if the patients have no symptoms, according to Canadian researchers who report their findings in Hepatology. Unlike viral hepatitis in which the liver becomes inflamed by a viral infection, autoimmune hepatitis occurs when the patient's immune system attacks the liver and causes inflammation.
The condition occurs most often in women ages 15 to 40 and it can cause jaundice, fever, and liver dysfunction, symptoms that mimic an attack of viral hepatitis. Patients with symptoms require treatment to suppress their immune system, but the researchers found no evidence that treatment "does anything for people without symptoms."
Less toxic cancer treatment
In cancer news, researchers said a gentler approach to chemotherapy works as well for patients with advanced colon cancer as more toxic treatments. An international team said the cancer pill Xeloda taken twice a day for two weeks, followed by a week off, for 24 weeks worked as well as an intravenous chemotherapy regimen, but patients were much less likely to have side effects like dangerously low levels of white blood cells, mouth sores, diarrhea and hair loss, according to the report in the New England Journal of Medicine.
Doctor, please follow the instructions
The folks who pay so many of the bills in American medicine, like Medicare and private insurers, have been pushing so-called evidence-based medicine as a way to improve health care and cut the bottom line.
This trend has kept hundreds of guideline writers employed, but a new study suggests that physicians are not willing guideline followers. The study, in Archives of Internal Medicine, found that most primary care physicians are still ordering up annual physicals even though the guidelines say those check-ups are not needed.
Sixty-five percent of doctors surveyed said annual physicals are needed and almost half said those physicians should include a boatload of diagnostic tests, also, according to the evidence, not needed.
A second study in Archives of Internal Medicine found that when women are referred for their first mammogram, they want some advance counseling, including information from their primary care doctors about how abnormal results will be handled and the true risk of false-positive findings.
Patients, meanwhile, continue to hang on to myths about cancer and its treatment, according to a report in Cancer. For example, about 40 percent of healthy Americans think that surgery, which is one of the pillars of cancer treatment, can actually spread the disease. Likewise, more than 27 percent think that the "cure" for cancer is known but is being withheld by a profit-hungry conspiracy of drug companies, doctors and hospitals.
Marcus Welby, M.D., where are you when we need you?
The cloudy side of vitamin C
Finally, Linus Pauling, the Nobel Prize-winning guru of vitamin C, was wrong. Mega doses of vitamin C will not ward off the common cold. Nor is a vitamin C a good treatment for colds. Those are the cold, hard facts delivered this week in the June issue of the free online journal, Public Library of Science. The researchers wrote that they conducted an exhaustive review of all vitamin C studies and could only come up with a hint that vitamin C might shorten the duration of colds, but even that hint lacked "significance," the term researchers use when a finding could be due to chance.
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