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Early Amniocentesis Riskier?

January 26, 1998

Amniocentesis in the first trimester of pregnancy is more dangerous to the fetus than in the second trimester, Canadian researchers report in the Jan. 23 Lancet. A multi-center team studied 4,374 high-risk pregnant women, half of whom received amniocentesis between the 11th and 12th gestational weeks and half between the 15th and 16th weeks.

They found that 7.6% of the fetuses were lost in the group that had early amniocentesis, compared to 5.9% in the second group. And 1.3% of those in the early group had clubfoot, compared to 1% in the later group. An editorial in the journal argued that if fetal analysis is required in the first trimester, chorionic-villus sampling should be the method of choice.

Alzheimer's Drug Proves Beneficial

A new study in the January issue of Neurology confirms that the drug donepezil is beneficial to people who have Alzheimer's disease. Dr. Lawrence T. Friedhoff of Eisai Inc. in Teaneck, N.J.--which sells the drug under the name Aricept--studied 473 patients with mild to moderately severe Alzheimer's. The patients received either donepezil in one of two dosages or a placebo.

Using standard tests of cognitive ability, they found that 80% of those receiving donepezil improved or showed no decline in cognitive abilities while taking the drug. When the donepezil was discontinued, their cognitive abilities declined to the same level as those of the patients who received the placebo.

New Source of Kidneys for Transplant Is Investigated

Surgeons may be able to increase greatly the supply of kidneys for transplants by using organs from dead people whose hearts have stopped beating, rather than relying solely on brain-dead donors with beating hearts, according to a report in the Jan. 22 New England Journal of Medicine. U.S. transplant surgeons have relied on organs taken from people who are brain dead but whose hearts are still beating because they thought those organs offered the best chance of success.

Dr. Yong W. Cho and his colleagues at UCLA studied the outcome of 229 transplants using organs from people whose hearts had stopped and compared them with 8,718 that used kidneys from people with beating hearts. After one year, they found that 83% of those who got kidneys from people whose hearts had stopped beating were still alive, compared with 89% of those who got kidneys from people with beating hearts, an insignificant difference.

At the end of 1996, more than 34,000 Americans were awaiting kidney transplants. Only about 8,600 kidneys were transplanted from dead donors that year.

Virtual Doctor? Success With Computer Rx

A computer that helps doctors prescribe antibiotics appears to improve the quality of care and save money too. A Utah hospital tried the system for a year in an intensive care unit and found that patients got better sooner and suffered fewer drug reactions.

Dr. R. Scott Evans and his colleagues at LDS Hospital in Salt Lake City described the system in the Jan. 22 New England Journal of Medicine.

The system used diagnosis information, blood counts, surgical data, temperature and other information, plus data on bacteria that were going around, to recommend which antibiotic to use and for how long. The system was used on 545 patients in one year and the result compared to patients in the previous year. Among the findings: With the computer, there were 35 instances of patients being prescribed drugs to which they had allergies, compared with 146 the year before. And the computer reduced the number of excessive dosages from 405 to 87.

The number of prescriptions that were inappropriate for the infection dropped from 206 to 12, and when doctors followed the computer completely, patient stays fell from an average of 13 days to 10 days, and their average hospital bills dropped from $35,283 to $26,315.

--Compiled by THOMAS H. MAUGH II

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