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This Week in JAMA
November 17, 1999

This Week in JAMA

JAMA. 1999;282(19):1795. doi:10.1001/jama.282.19.1795

Edited by David H. Mark, MD, MPH, and Richard M. Glass, MD

Early Outcomes of Fetal Surgery for Myelomeningocele

Neurologic damage associated with myelomeningocele may occur in part because of exposure of neural tissue to the intrauterine environment, and alteration of cerebrospinal fluid circulation by drainage through the open defect may lead to hindbrain herniation and hydrocephalus. Bruner and colleagues reportArticle that the incidence of both hydrocephalus requiring ventriculoperitoneal shunt placement and hindbrain herniation was significantly reduced among 29 patients with fetal myelomeningocele surgically repaired between 24 and 30 weeks' gestation compared with 23 matched control patients, but the rate of preterm birth increased. In a case series of 10 patients with fetal myelomeningocele, Sutton and colleagues foundArticle that hindbrain herniation assessed by serial magnetic resonance imaging improved within 3 weeks of myelomeningocele closure performed at 22 to 25 weeks' gestation in 9 surviving newborns. In an editorialArticle, Simpson comments that fetal surgery for myelomeningocele is still an experimental procedure until associated obstetric complications are reduced and data about long-term functional outcomes become available.

Myelomeningocele of a fetus in the 28th week of gestation is centered in a hysterotomy in preparation for surgical repair. The uterus has been exteriorized and most of the amniotic fluid has been temporarily removed. See article listed below.
Determinants of Live- and Multiple-Birth Rates in IVF

In this analysis of 35,554 in vitro fertilization (IVF) procedures, Schieve and colleagues found that live-birth rates decreased as maternal age increased and also varied significantly with the number of embryos transferred. Maximum live-birth rates were achieved with fewer embryos transferred when extra embryos were cryopreserved (an indicator of embryo quality). Multiple-birth rates varied with maternal age and the number of embryos transferred, but were not related to embryo quality. For any given number of embryos transferred, the risk of multiple births increased as maternal age decreased.

See Article

Glucose Self-monitoring Without Fingersticks

By measuring the concentration of glucose that is extracted through the skin by iontophoresis, a new device worn like a wristwatch offers the possibility of glucose self-monitoring without frequent fingersticks by persons with diabetes mellitus. Tamada and colleagues report that glucose measurements by this device over 12 hours were highly correlated with conventional glucose measurements of fingerstick blood samples among 92 adults with diabetes mellitus and were accurate even at low glucose levels. Measurements by the device lagged behind blood glucose measurements by about 18 minutes.

See Article

Computer-Based Disease Surveillance, Diagnosis

Two articles in this issue of THE JOURNAL explore the usefulness of computer-based technologies in medicine. Effler and colleagues foundArticle that an automated electronic reporting system significantly improved the completeness and timeliness of reporting for 5 notifiable conditions to a state health department by 3 clinical laboratories compared with the conventional manual system. In a second study at 3 academic medical centers that included fourth-year medical students, residents, and faculty, Friedman and colleagues foundArticle that consultation with computer-based diagnostic decision support systems increased diagnostic accuracy, especially among students.

Oxygen-Carrying Fluid Fails to Improve Resuscitation

Diaspirin cross-linked hemoglobin (DCLHb), a purified and chemically modified human hemoglobin solution, is an oxygen-carrying fluid that could be used immediately for resuscitation of trauma patients without cross-matching. In this randomized trial, DCLHb infusion was used as adjunctive therapy in the initial hospital resuscitation of patients with severe traumatic hemorrhagic shock. Sloan and colleagues found that morbidity and mortality at 28 days and mortality at 48 hours were significantly higher among the 52 patient who received DCLHb compared with 46 patients who received saline infusions.

See Article

A Piece of My Mind

"Urine ladder-nested automated polymerase chain reaction revealed Escherichia coli that was pan-resistant to antibiotics by segmental genomic sequencing." From "Millennial Child."

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Medical News & Perspectives

DNA microarrays, paired with sophisticated computer software, can distinguish molecular differences between two identical-looking cancers.

See Article

10 Years, 10 Lessons

Ten lessons for evidence-based technology assessment from 10 years of experience at the Agency for Health Care Policy and Research.

See Article

US HTA Agency Needed

A national health technology assessment (HTA) agency would improve quality, timeliness of technology assessments.

See Article

JAMA Patient Page

For your patients: A primer on infertility and assisted reproductive technology.

See Article