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BMJ 2006; 333 doi: 10.1136/bmj.333.7571.744 (Published 5 October 2006)
Cite this as: BMJ 2006;333:744

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  1. Alison Tonks, associate editor (atonks@bmj.com)

    Sentinel node biopsy improves outcome in people with medium thickness melanomas

    Sentinel node biopsy should become the standard of care for people with medium thickness melanoma, according to an editorial. A large trial (pp 1307-17) has shown that sentinel node biopsy, coupled with immediate lymphadenectomy if positive, helps control regional recurrence for everyone, and improves survival among patients with nodal metasatases.

    Credit: N ENGL J MED

    Patients who had the biopsy had longer disease-free survival over five years than patients who were observed and offered lymphadenectomy only when their diseased nodes became obvious clinically (78% v 73%; hazard ratio for death 0.74; 95% CI 0.59 to 0.93). Sentinel node biopsy didn't prolong overall survival, but among the 16% of patients with nodal metastases, those who had the biopsy followed by immediate surgery survived significantly longer than those who had to wait for their surgery until their lymph nodes got big enough to palpate (72% five years survival v 52%; hazard ratio for death, 0.51, 0.32 to 0.81). During a median wait of 16 months, their tumours progressed and the mean number of malignant lymph nodes increased from 1.4 to 3.3 (P < 0.001).

    Credit: JAMA

    N Engl J Med 2006; 355:1370–1
    OpenUrlCrossRefMedline

    US emergency medical services are in crisis

    As the threat of terrorism becomes more real in the US, the emergency medical services required to deal with its aftermath are in serious decline, writes a professor of emergency medicine from Atlanta. His department and many others are overflowing, demoralised, and stretched beyond their capacity to cope with any kind of mass casualty event. Patients are being “boarded” in corridors and examination rooms waiting for beds, and overcrowded hospitals are increasingly turning away ambulances—at a rate of about one every minute.

    He blames the “upside down world” of federal funding for these well documented and worsening problems. Between 2000 and 2006 the government increased spending on bioterrorism “preparedness” from $237m (£126m, €187m) to $9.6bn, …

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