Birth Methods Examined
In a study that challenges some popular assumptions about the relative safety of methods used for women in difficult births, researchers found that delivery by forceps or a vacuum tool can be just as safe as a caesarean section.
Delivery by caesarean, vacuum extraction and forceps are all equally safe once a woman has entered labor, according to researchers at UC Davis Medical Center and Harvard Medical School. However, the study found that all three methods present a slightly increased risk (less than 1%) of fetal brain hemorrhaging compared to normal vaginal delivery.
Vacuum extraction, developed during the 1950s, uses a vacuum to literally suck the fetus out of the uterus. Proponents argue that the soft cap placed over the vagina to provide suction is safer than hard metal forceps, but some critics have charged that its use produces more injuries than normal. The Food and Drug Administration released a cautionary advisory about the technique in May 1998, but the American College of Obstetricians and Gynecologists has argued that it is as safe as caesarean sections or forceps. The new findings support that position.
Dr. William M. Gilbert of UC Davis and his colleagues studied 583,340 California births between 1992 and 1994.
They reported in Thursday’s New England Journal of Medicine that brain hemorrhages occurred in one of 860 infants delivered by vacuum extraction, one of 664 delivered with forceps and one of 907 delivered by caesarean during labor. In contrast, if a caesarean was initiated before labor began, hemorrhaging occurred in only one of 2,750 infants. In a normal vaginal delivery, the rate was one per 1,900. The team concluded that it is not the method of delivery that causes hemorrhaging, but the fact that the infant was distressed and had to be delivered artificially.
Study Says Stroke Figures Are Low
The number of Americans who have strokes each year is higher than the currently accepted figure of 500,000, perhaps much higher, according to researchers from Knoll Pharmaceutical Co. The 500,000 figure is based on the Framingham Heart Study, and was superseded by numbers released earlier this year by the American Heart Assn. suggesting that there are 600,000 strokes per year. But the actual number is closer to 750,000, epidemiologist G. Rhys Williams and his colleagues report in the December Stroke: Journal of the American Heart Assn.
The researchers used a much larger database to develop their estimate, reviewing 6 million patient records from 938 hospitals in 19 states. The total represented 20% of all hospital discharges in 1995.
They found that the biggest increase was in the number of strokes among the elderly, with the risk increasing dramatically with age. As the population ages, they said, the rising number of strokes will produce a huge economic burden on society.
Childhood Hodgkin’s Drug May Be Inessential
Mechloroethamine is a drug routinely used in treating childhood Hodgkin’s disease, but it carries the risk of inducing secondary cancers later in life. A new study by German researchers, however, suggests that it can be safely eliminated from treatment regimens and that the amount of radiation used in therapy can be lowered, reducing the risk of later tumors without impairing the efficacy of treatment.
Dr. Gunther Schellong and his colleagues at the University Children’s Hospital in Muenster studied 578 patients newly diagnosed with Hodgkin’s. The children were given a lower dose of radiation and a shorter course of chemotherapy, with mechloroethamine not being used. They report in the December Journal of Clinical Oncology that overall survival in the group was 98%, similar to that observed with more aggressive therapy. Also, during five to eight years of follow-up, the researchers observed no secondary leukemias or other tumors that normally occur during the same period in children receiving conventional treatment.
Second Biopsies Could Reduce Cancer Deaths
Getting a second opinion on a biopsy sample for cancer saves time, money and lives, according to researchers from Johns Hopkins University. A study of more than 6,000 patients by Dr. Jonathan L. Epstein and his colleagues found that two out of every 100 people who come to a major medical center for cancer treatment following a biopsy arrive with a diagnosis that is “totally wrong.”
They report in the December issue of the journal Cancer that 1.4% of patients arrive with a wrong diagnosis. The actual error rate is closer to 2%, Epstein said, because of the people who are wrongly given a clean bill of health.
Winter Heart Attacks Deadlier, Study Says
People who have a heart attack in winter are about 19% less likely to survive than those who have one in the summer, according to Dr. Jill Pell and her colleagues at the Greater Glasgow Health Board in Scotland. The conclusion, reported in the December issue of Heart, is based on a study of almost 11,000 people who had aheart attack between 1988 and 1997.
The finding is probably not a concern for most Southern Californians, however, because the major risk factor is colder winter weather in other climates. Winter temperatures typical in most of the United States increase blood pressure by about 5 millimeters of mercury and make the blood stickier, increasing the risk of a clot.
Seat Adjustments Could Ease Cycling Back Pain
A slight adjustment in the angle of a bicycle seat can provide a significant reduction in back pain associated with cycling, according to Israeli researchers. It is generally thought that as many as 70% of people who cycle several times a week suffer from at least some back pain as a result of the activity.
Dr. Moshe Salai and his colleagues at Chaim Sheba Medical Center in Tel Hashomer studied the positions of the lumbar spine and pelvis in 30 cyclists seated on different types of bicycles and concluded that the angle between the pelvis and the lower end of the spinal column tended to be overextended, causing muscle pain.
They then contacted a cycling club and adjusted the seats of 40 riders downward by 10 to 15 degrees. After six months, the researchers reported in the December British Journal of Sports Medicine, three-quarters of the cyclists said they no longer had any back pain.
Lung Cancer Gene May Appear More in Women
Women are three times as likely as men to have a gene mutation associated with a particularly aggressive and deadly form of lung cancer among smokers, according to researchers at UC San Francisco and Harvard University. The mutated gene is called K-ras and it is associated with non-small cell adenocarcinoma, which accounts for about 40% of all lung cancer cases.
The researchers studied 365 patients newly diagnosed with the cancer, screening them for the K-ras defect and following their medical histories for four years. They report in the December Journal of the National Cancer Institute that patients with the K-ras mutation were twice as likely to die after surgery as those without it. Among those operated on when the cancer was still in a very early stage, those with the mutation were four times as likely to die.
The team also found that giving up smoking did not significantly reduce the risk of this form of lung cancer among women, although it has other significant health benefits.
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Medical writer Thomas H. Maugh II can be reached by e-mail at thomas.maugh@latimes.com.
