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OBJECTIVE: If maximum cytoreductive surgery benefits the survival of women with advanced ovarian cancer, the median survival time of groups of such women will improve as the proportion of women undergoing maximum cytoreductive surgery is increased. STUDY DESIGN: Fifty-eight suitable studies that encompass 6962 patients with advanced ovarian cancer were identified. Multiple linear regression was used to analyze the effects on median survival time of the following variables: the proportion of each cohort undergoing maximum cytoreductive surgery, the use of platinum-containing chemotherapy, the dose intensity of chemotherapy, the proportion of each cohort with stage IV disease, and the year of publication of the study. RESULTS: Maximum cytoreductive surgery was associated with only a small improvement in median survival time, but platinum-containing chemotherapy improved median survival time substantially. Increased dose intensity also conferred a useful survival benefit. CONCLUSION: Cytoreductive surgery probably has only a small effect on the survival of women with advanced ovarian cancer. The type of chemotherapy used is more important. (Am J Obstet Gynecol 1992;166:504-11.)

The major problem that patients with atrial fibrillation (rapid, but incomplete and uncoordinated heart contraction) are treated for is rapid heart beat. However, recent studies have shown that these patients also tend to have cyclic bradycardia, slowing of the heart rate, with night-time pauses of heartbeat for up to four seconds. Digoxin, the drug most commonly used to treat atrial fibrillation, tends to aggravate the phenomenon of bradycardia. Xamoterol is a drug with effects that are similar to adrenalin, but is not as powerful. Thus, at times when no adrenalin is secreted, it can enhance heart activity, but can block the same activity when adrenalin is present. This stabilizing activity of xamoterol may be useful in moderating heart function in patients with atrial fibrillation. The effects of xamoterol, digoxin, and a placebo treatment upon 13 patients with chronic atrial fibrillation and cyclic bradycardia were evaluated. Twelve patients completed the study. Patients treated with xamoterol had significantly fewer symptoms such as palpitation, dizziness, and breathlessness than those treated with digoxin. Xamoterol significantly reduced the maximum heart rate during exercise and tended to increase the time that exercise could be tolerated, although this was not a statistically significant effect. Compared with digoxin, xamoterol significantly reduced circadian variability in heart rate, and compared with placebo, increased the lowest minimum heart rate and decreased the maximum heart rate. Xamoterol also significantly reduced the incidence of pauses in the heart beat. The results suggest that xamoterol is effective in treating patients with mild, but not severe, heart failure with chronic atrial fibrillation. (Consumer Summary produced by Reliance Medical Information, Inc.)