New Eng J Med Vol 350
991 At last some good news for those taking hormone replacement therapy: it protects against bowel cancer.
1005 The best way to measure risk in patients with chronic obstructive airways disease (COPD) is to combine measurement of the FEV1 with body mass index, 6–minute walking distance and a dyspnoea scale (together they form the BODE index).
1081 Another trial showing the superiority of aromatase inhibitors over tamoxifen in breast cancer — this time exemestane directly after primary treatment.
1104 The mysterious pathways of migraine involve calcitonin-gene related peptide, which can now be blocked with good effect.
1189 Alendronate is safe, well-tolerated and highly effective in preventing osteoporosis in post-menopausal treatment — nice treatment if NICE people will let you have it.
Lancet Vol 363
757 The Heart Protection Study used simvastatin at 40 mg in patients with vascular risk and demonstrated a reduction in stroke as well as other vascular events.
768 The only drug treatment to make any difference to stroke outcomes is very early thrombolysis: after 90 minutes, the benefits fall off steeply.
837 Subcutaneous egg retrieval: treatment for some nasty tropical parasite? Actually a technique for allowing women to conceive despite having radical cancer chemotherapy. You can cryopreserve their ovaries and then reimplant them under the skin: within 3 months they will produce hormones and eggs that you can fertilise.
915 Carotid endarterectomy is best performed within 2 weeks of a cerebrovascular event: this study also comes up with detailed risk–benefit analyses.
1006 Having an abortion does not increase the risk of breast cancer.
JAMA Vol 291
1071 Are we still under-prescribing statins? Here's a study showing that coronary atherosclerosis increases on a dose of 40 mg of pravastatin, but stops on a dose of 80 mg atorvastatin.
1114 Some fetal blood cells always find their way into the maternal circulation, and this paper identifies ways of detecting fetal DNA in maternal blood, opening the way to a new era of simplified fetal abnormality screening.
1213 Drink coffee and avoid diabetes: other nice ways to do it are to drink alcohol, take exercise, and eat dairy products.
1220 Women with coronary disease tend to do worse than men, including after coronary interventional procedures.
1333 A potentially useful way of relieving severe pain: patient-controlled transdermal fentanyl, by iontophoresis.
1358 Patients with chronic heart failure bounce in and out of hospital, and any intervention that helps them to understand their condition and its treatment helps to reduce readmission and improve quality of life. Here, it is comprehensive discharge planning: other studies have shown benefit from specialist nurse and/or community pharmacist involvement too.
1447 The latest of a long line of studies which show that hysterectomy usually has lasting physical and psychological benefits.
1456 You can try and avoid hysterectomy by using a levonorgestrel-releasing intrauterine system, and it sometimes works, although 42% of women in this 5–year study of menorrhagia ended up having the operation.
1464 Hypochondriasis can be treated successfully by cognitive behavioural therapy — so keep clamouring for it from your overspent primary care trust.
Other Journals
Tai chi is good for all sorts of chronic diseases, according to a systematic review in Arch Intern Med (164: 493). Page 623 brings good news for hypertensive men who drink moderate amounts of alcohol: it reduces cardiovascular and all-cause mortality. Smoking, on the other hand, has nothing to recommend it: we need more trials to help us select individualised treatments for our patients, like the one in Ann Intern Med (140: 426).
How good are you at executing simultaneous mental tasks? Spookily enough, functional MRI can now measure your ability to handle Monday morning surgery (Brain 127: 517): an essential appraisal tool for all training practices? We know that primary angioplasty is the best treatment for acute myocardial infarction, but how quickly can it be done? Every minute counts, according to a study in Circulation (109: 1223).
Bull Hist Med is a mine of delights if you have time to browse through it: try, for example, Medical history for the masses: how American comic books celebrated heroes of medicine in the 1940s (78: 148). Is it a bird? Is it a plane? No, Hank, it's a flying doctor.
Plant of the Month: Wisteria venusta
The white-flowered version is the one usually sold: wonderfully vigorous and free-flowering, providing great walls of fruit salad scent.
- © British Journal of General Practice, 2004.