Journals Watch - Stomach cancer and autism

Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers

Gastrectomies for gastric cancer - Arch Surg 2008; 143: 769-75
Like most GPs, I have always thought of gastric cancer as having a very poor outcome. This retrospective study, therefore, makes optimistic reading, but only if the cancer is caught early enough to be operable.

Stomach cancer: gastrectomy can lead to excellent short- and long-term results

The outcomes of 400 cases, treated by gastrectomy in the Catholic University School of Medicine, Rome, were studied. Of these, 312 were potentially curative and 88 had palliative procedures. The palliative cases experienced more post-operative complications: 37.5 per cent versus 24 per cent, and perioperative mortality of 6.8 per cent versus 3.5 per cent. The five- and 10-year survival rates in the 'curative' cohort was 61.8 per cent and 47.3 per cent respectively, and in the palliative 12.8 per cent and 0 per cent.

The authors conclude that gastrectomy, in experienced hands, can lead to excellent short- and long-term-results. Unfortunately, early diagnosis remains a big challenge.

Epidemiology of fetal alcohol syndrome - Arch Dis Child 2008; 93: 732-7
The objective was to describe the epidemiology of fetal alcohol syndrome seen by Australian paediatricians by active national case findings between January 2001 and December 2004. Details of all possible cases were submitted, and 92 fitted the accepted criteria.

A significant increase in the incidence was seen as the study period progressed.

On analysis, 53.3 per cent were male, 35.7 per cent preterm, 64 per cent had low birth weight, and a large number, and 78.3 per cent were exposed to other drugs.

The median age at diagnosis was 3.3 years (range: birth to 11.9 years). High levels of growth retardation and CNS dysfunction were also found.

The researchers state that this is a unique prospective data set that highlights the complexity of this condition, and the need for awareness and openness about alcohol issues in pregnancy.

Disability and mortality among ageing runners - Arch Intern Med 2008; 168: 1,638-46
We often tell our patients that exercise is good for them, and it seems that we are right.

The objective of this Californian longitudinal study over 21 years was to assess the effect of reasonably strenuous exercise on morbidity and mortality at older ages.

An annual questionnaire was sent to 538 members of a national running club and 423 healthy controls, all aged 50 or over, starting in 1984. Topics such as current exercise and BMI were covered, and also disability, which was measured by the Health Assessment Questionnaire disability index, scored from zero (no difficulty) to three (unable to perform).

Disability was higher for controls than for runners, and increased in both groups with age, but at a faster rate in controls. At 19 years into the study, 15 per cent of the runners had died, compared with 34 per cent of controls. It seems, therefore, that the health gains from exercise really are life-long.

Topical ciclosporin for the treatment of dry eye disease - Arch Ophthalmol 2008; 126: 1,046-50
I was not aware of this indication for ciclosporin, however, this study was set up to look at its effect on mild as well as more severe eye dryness that was not responding to conventional treatment.

In this prospective clinical study, 158 patients unresponsive to artificial tears were split into three groups (mild, moderate and severe) and treated with ciclosporin drops. Effectiveness was assessed by a variety of methods, including Schirmer's test and the Ocular Surface Disease Index rating scale. The main outcome measure was improvement in disease.

In the mild, moderate and severe groups, 74, 72.4, and 66.7 per cent showed improvement, respectively. The best results, though in smaller numbers, were found in those with severe disease. All grades of disease showed a significant response.

Eye contact and autism in two-year-olds - Arch Gen Psychiatry 2008; 65: 946-54
Babies look into the eyes of other humans almost from birth, but this behaviour is very much reduced in autistic children. The objective of this small, but interesting study was to quantify the preferential attention to the eyes of others in what is at present the earliest age of diagnosis of autism, about two years old.

A group of 15 two-year-olds with autism, 36 typically developing children, and 15 with developmental delay were each shown 10 video clips in which an actress looked directly into the camera, talking to the children as a care-giver would. The outcome measure was the percentage of time each child spent fixing on the eyes, mouth and body.

Attention focused on the eyes was significantly diminished in the autistic children and correlated with their degree of disability. The authors concluded that this could be used as a tool to assist early diagnosis.

Dr Glenesk is a GP trainer in Aberdeen and a member of our team who regularly review the journals

The quick study

  • Gastrectomy provides good long-term results for gastric cancer.
  • Fetal alcohol syndrome cases increased between 2001 and 2004 in Australia.
  • Disabilities were less common in those over 50 who exercise.
  • Eye dryness symptoms were improved by ciclosporine treatment.
  • Autistic two-year-olds focused less on the eyes when looking at a face than other children of that age.

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