Less-Invasive Bypass Surgery Shows Low Risk, Fast Recovery

More than 400,000 Americans have bypass surgery every year to unclog blocked arteries leading to their hearts. Typical patients spend six to 10 days in the hospital and an additional 60 to 90 days recuperating at home before they can resume their normal activities.

Some surgeons have begun using minimally invasive techniques to perform such bypasses, as well as heart valve surgery, because patients recover more quickly. But the potential risks have not been completely clear.

Now, two new studies presented last week at the American College of Cardiology meeting in New Orleans show that the risks are no greater than those associated with conventional surgery. And there are some important benefits: faster recoveries and lower costs.

The findings open the way to widespread use of the surgery. Proponents estimate that at least 70% of bypass patients are candidates for the new techniques.

Surgeons at the New York University Medical Center compared results from 109 bypass patients given minimally invasive bypass surgery with those from 88 patients undergoing conventional surgery. They found that the patients who received minimally invasive surgery needed 12% fewer blood transfusions, had 83% fewer infections and left the hospital four days earlier. The cost of their treatment was also $2,000 less than the conventional surgery.

Separately, surgeons at the Boston University School of Medicine compiled data on 1,410 minimally invasive bypass surgeries conducted at 92 institutions and obtained similar results. They also found that the rate of post-surgical atrial fibrillation--an irregular heartbeat that prevents blood from being pumped effectively--was significantly lower than in conventional surgery.

Anti-Clot Drugs Measure Up Well

Two other studies presented at the cardiology meeting showed that new genetically engineered drugs designed to break up clots that cause heart attacks are just as good as tPA, the drug now widely employed for that purpose, but are easier to use.

Although tPA is effective at breaking up clots, it is rapidly destroyed in the bloodstream and must be administered in a continuous infusion lasting 90 minutes or longer. For that reason, physicians prefer to administer it only in hospitals. The two new drugs, called lanoteplase and tenecteplase, are modified so that they are not destroyed so quickly and can be given in a single injection. They thus could be used in an ambulance on the way to the hospital.

Tenecteplase was compared with tPA in 16,950 patients in 29 countries. Deaths after one month were 6.2% in patients receiving either drug.

Lanoteplase was compared with tPA in 15,078 patients in 35 countries. After 30 days, 6.8% of those getting lanoteplase had died, compared with 6.6% of those receiving tPA.

The manufacturers are applying to the Food and Drug Administration for approval of the new drugs.

Can a Tomato a Day Keep Cancer Away?

Researchers in Boston have found more evidence that eating tomatoes can help prevent certain types of cancer.

Men who had low levels in their blood of a natural ingredient that gives tomatoes their red color are 44% more likely to develop aggressive prostate cancer than men with higher levels, researchers from Brigham and Women’s Hospital in Boston report today in the journal Cancer Research.

Increased consumption of tomatoes has previously been associated with reduced cancer rates for several types of tumors, including prostate and breast cancers. Tomatoes contain lycopene, an ingredient that, like vitamin E, acts as an antioxidant that prevents fats and other substances from being converted into more harmful chemicals.

Clozapine Helps Parkinson’s Patients

Low doses of the anti-schizophrenia drug clozapine can prevent the psychosis often brought on when Parkinson’s disease patients are treated with drugs to control their symptoms. An estimated 1 million Americans suffer from Parkinson’s disease, which is characterized by tremors, rigidity and difficulties in moving.

These symptoms can be controlled, at least in the early stages, with a variety of drugs, but those drugs induce delusions, hallucinations and other psychotic symptoms in as many as 22% of patients. Often, the only alternative has been to reduce the patients’ drug dosage, which can result in the return of movement disorders.

A team headed by Dr. Joseph H. Friedman of Memorial Hospital of Rhode Island in Pawtucket reported in Thursday’s New England Journal of Medicine that clozapine reduced psychotic symptoms in most of the Parkinson’s patients treated, allowing them to remain on their anti-Parkinson’s drugs.

Lower-Cost Alternative to the Pap Smear

A simple test using acetic acid--the primary component of vinegar--could provide an inexpensive way to screen for cervical cancer in third world countries whose residents cannot afford Pap smears, researchers from Johns Hopkins University reported in Friday’s Lancet.

Only about 5% of women in developing countries are now screened for the disease, contrasted with 70% or more in industrialized countries. Cervical cancer is the leading cause of female cancer deaths in many areas of Asia, Africa and Latin America, killing 200,000 women each year.

Dr. Paul D. Blumenthal and his colleagues found that smearing the cervix with a dilute solution of acetic acid caused tissue harboring precancerous lesions to turn white. Studies in Zimbabwe showed that nurse-midwives who spread the solution on the cervix, then visually examined it, detected more than 75% of potential cancers.

Incidence of Liver Cancer on Rise in U.S.

Liver cancer is on the rise in the United States, having increased by 71% from the mid-1970s to the mid-1990s, according to researchers from the Veterans Affairs Medical Center in Albuquerque. A large percentage of liver tumors are attributable to hepatitis B and C infections, and the number of liver cancer cases is expected to increase until those infections are brought under control.

An estimated 4 million Americans are infected with hepatitis C, but the exact number is unknown because symptoms sometimes take as long as 30 years to develop. Most Americans with hepatitis C got it from blood transfusions in the 1960s and 1970s before the virus that causes it was identified.

Alcoholism is another major cause of liver cancer, but the incidence of alcoholism is declining, the researchers reported in Thursday’s New England Journal of Medicine. An estimated 14,500 Americans are expected to develop hepatocellular carcinoma, the most common form of liver cancer, this year. Only 5% are expected to survive for five years.