This is Journal Watch, a twice-weekly survey
of new medical research, produced by the
Massachusetts Medical Society, publishers
of The New England Journal of Medicine,
Health News, AIDS Clinical Care and Clinical
Care for Prostatic Diseases.
  Twice a week, our physician-editors summarize
clinical research from a group of about 50
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  Contents copyright 1996, Mass. Medical Society.

Journal Watch Summaries for Tuesday, October 22, 1996.

ADDING HEPARIN TO ASPIRIN OF LITTLE BENEFIT IN ACUTE
MI.
  BMJ 1996 Sep 14; 313:652-9.

TRANSMISSION OF HEPATITIS C VIRUS BETWEEN SPOUSES.
  Am J Gastroenterol 1996 Oct; 91:2087-90.

TREATMENT OF SINGLE CEREBRAL METASTASIS.
  Cancer 1996 Oct 1; 78:1470-6.

DT.-961022.

AN.-1.
HL.-ADDING HEPARIN TO ASPIRIN OF LITTLE BENEFIT IN ACUTE
MI.
NS.-Although the benefits of aspirin during the acute
phase of myocardial infarction are known, the role of
heparin remains uncertain. This meta-analysis of randomized
trials suggests that little additional benefit is gained by
adding heparin to aspirin for acute MI.
   Researchers identified 21 trials involving 5000 patients
that compared heparin with no antithrombotic therapy and six
trials involving 68,000 patients that compared heparin plus
aspirin with aspirin alone.
   Heparin in the absence of aspirin reduced mortality when
compared with no antithrombotic therapy (11.4 vs. 14.9
percent), representing 35 fewer deaths per 1000 patients, 10
fewer strokes per 1000, 19 fewer pulmonary emboli per 1000,
with 13 extra major bleeds per 1000 patients. The type of
heparin regimen used did not affect outcome.
   Heparin plus aspirin reduced mortality minimally when
compared with aspirin alone (8.6 vs. 9.1 percent), resulting
in only 5 fewer deaths per 1000 patients, 3 fewer
reinfarctions per 1000, 1 pulmonary emboli per 1000, with 3
more major bleeds per 1000.
   Comment: This analysis does not justify the addition of
heparin to the now routine use of aspirin for acute MI. It
suggests that heparin adds minimal benefit and a small risk.
--KI Marton.
AU.-Collins R; et al.
TI.-Clinical effects of anticoagulant therapy in suspected
acute myocardial infarction: systematic overview of
randomised trials.
SO.-BMJ 1996 Sep 14; 313:652-9.

AN.-2.
HL.-TRANSMISSION OF HEPATITIS C VIRUS BETWEEN SPOUSES.
NS.-Estimates of the likelihood of direct person-to-person
transmission of hepatitis C virus (HCV) have varied
considerably (see JW accession number 940513002, and Ann
Intern Med 1994;120:748). This study from Taiwan revisited
the issue.
   Researchers studied the spouses of 100 HCV-positive
patients. By a second generation assay, 17 spouses were
anti-HCV-positive; 15 of these also had HCV RNA in their
serum. For 11 of the 13 cases in which both members of the
couple had HCV RNA, the HCV genotypes were concordant,
suggesting (but not proving) transmission from spouse to
spouse. Couples married more than 20 years had a
significantly higher spousal HCV positivity rate than those
married for shorter durations (22 vs. 6 percent). Two other
factors were significantly correlated with HCV positivity
among spouses: frequency of {*filter*} activity in the marriage
and sharing toothbrushes.
   Comment: This study provides strong evidence that
transmission of HCV between spouses is not rare. Both {*filter*}
activity and other routes may be involved. --AS Brett.
AU.-Kao J-H; et al.
TI.-Transmission of hepatitis C virus between spouses: the
important role of exposure duration.
SO.-Am J Gastroenterol 1996 Oct; 91:2087-90.

AN.-3.
HL.-TREATMENT OF SINGLE CEREBRAL METASTASIS.
NS.-It is not uncommon for patients with cancer to develop
an apparently single cerebral metastasis. In this Canadian
trial, 84 such patients were randomized to receive either
radiotherapy alone or radiotherapy plus surgical resection.
   The most common primary tumors were non-small cell lung
(54 percent), colorectal (15 percent), and {*filter*} (12
percent), and nearly half the patients had evidence of other
extracranial metastases. Patients with leukemia, lymphoma,
and small cell lung cancer were excluded.
   On an intention-to-treat analysis, there was no
statistically significant difference in survival between the
two groups. In fact, while median survival was similar in
the two groups (about 6 months), there was a trend toward a
higher one-year mortality rate with combined therapy than
with radiotherapy alone (88 vs. 70 percent). Quality of life
scores during the interval between treatment and death were
similar in the two groups.
   Comment: Unlike this trial, two previous studies suggested
that the addition of surgery to radiotherapy prolonged
median survival by a few months. Whatever the reasons for
the varying results, surgical resection of a single cerebral
metastasis seems unlikely to have a major impact on quantity
or quality of life for most patients. --AS Brett.
AU.-Mintz AH; et al.
TI.-A randomized trial to assess the efficacy of surgery
in addition to radiotherapy in patients with a single
cerebral metastasis.
SO.-Cancer 1996 Oct 1; 78:1470-6.