Journals watch: Malignant melanoma and obesity

Running short of time to read the journals? Allow Dr Gwen Lewis to be your guide to the latest findings

Alternative therapies for depression in children 

Med J Aust 2006; 185: 368–72 

This literature search looked at the effects of 13 different complementary and self-help treatments in patients with depression aged under  18 years.

These treatments included St John’s wort, vitamin C, omega-3 fatty acids, light therapy, massage, art therapy, bibliotherapy, distraction techniques, exercise, relaxation and sleep deprivation. 

Evidence for almost all  was limited and of poor quality, and the only treatment which proved at all helpful was light therapy in winter depression.

We will just have to wait for our young patients to be seen by the child and adolescent mental health team. 

Sentinel-node biopsy in malignant melanoma

N Engl J Med 2006; 355: 1,307–17 

Patients with a primary cutaneous malignant melanoma were randomly assigned to wide excision and post-operative observation of regional lymph nodes with lymphadenectomy if nodal relapse occurred, or to wide excision and sentinel-node biopsy with immediate lymphadenectomy if nodal micrometastases were detected on biopsy.

Among 1,269 patients, the five-year melanoma specific survival rates were similar in both groups. In the sentinel node biopsy group, 16 per cent were found to have micrometastases and underwent lymph node excision, but it was the presence of these micrometastases which was the most important prognostic factor for survival with increased survival rates in those who underwent immediate lymphadenectomy.

Obesity and pregnancy

BJOG 2006; 113: 1,126–33 

This US review looked retrospectively at the effects of obesity on both the mother and the foetus. Obesity increases the likelihood of fertility problems and an increase in assisted conception with all its complications. 

During pregnancy, obesity increases the risk of gestational diabetes, gestational hypertension and pre-eclampsia. In the morbidly obese, there is a significant increase in pre-term delivery. The risk of delivery by Caesarian section, and its associated comorbidities, are increased with potential problems during anaesthesia.

Resolving tennis elbow without treatment

BMJonline doi:10.1136/bmj.38961.584653 

I have never been a fan of carrying out  joint injections in tennis elbow, therefore I was  very pleased to read this study. 

The researchers compared three treatments  for the condition (physiotherapy, corticosteroid injections, or wait and see) in 198 patients aged 18 to 65 years.  

They found that although steroid and local anaesthetic injections produced relief of symptoms at six weeks post-treatment, recurrence rates were higher and outcome poorer than in the groups who had eight sessions of physiotherapy and home exercises, or those who had no active treatment. The improvement was measured in terms of global improvement, grip force and the assessors rating of severity at baseline, at six weeks and at 52 weeks. Almost all cases of tennis elbow resolved spontaneously with no treatment within 12 months.

Urinary incontinence in women

Fam Pract 2006; 23: 497–506  

Women attending GPs’ surgeries were asked to complete a questionnaire about any incontinence problems they might have had during the preceding month. Of the 3,273 women who responded, 21 per cent mentioned stress incontinence, 3.5 per cent mentioned urge incontinence, and 21 per cent reported mixed stress and urge incontinence. Nine per cent mentioned that their symptoms were moderate or severe. Fifty-three per cent had not consulted a GP or nurse. Almost half of all women suffer from incontinence, but only a minority seek help.

Paying for sex

Sex Transm Infect 2006; 82: 364–7 

It has been reported that the number of men paying for sex has doubled between 1990 and 2000.

In this study, 2,665 men attending sexual health clinics in the UK were surveyed. Of these, 10 per cent admitted to having paid for sex, with over half of the episodes taking place abroad. 

The mean age was 34.7 years. Most of the sex was unprotected vaginal sex. None of the men became HIV positive. The most common infection was chlamydia. 

- Dr Lewis is a GP in Windsor, and a member of our team who regularly review the journals 

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