From the journals, May 2004

New Eng J Med Vol 350

1953 Nearly half of all patients with the clinical syndrome of heart failure have a normal systolic ejection fraction — so much for echocardiography being the ‘gold standard’. So what is going on? This study of a small, atypical group of patients claims that it is primarily due to a failure of the ventricle to fill properly; but there are probably several other mechanisms that contribute to ‘diastolic’ heart failure.

2029 Most palliative care doctors claim that a wish for euthanasia is simply an appeal for better symptom control. Here is a thoughtful piece that argues otherwise.

2033 Homocysteine has got itself a bad name from being associated with cardiovascular disease. Here it is coupled with osteoporosis. But is it really bad, or has it just fallen into dubious company?

2123 A piece that bids us to measure blood pressure in all patients over the age of … 3 years. If they cry while you inflate the cuff, just give them a raspberry-flavoured Polypill Junior chew.

2159 ‘What a heel!’ they say as you inject local steroid for their plantar fasciitis: some alternatives are discussed in this review.

2239 Perfectly Stupid Attributes (PSA) – a test for prostate cancer that misses 15% of cancers at the usual cut-off value; and brings to light many others that would never harm the patient.

Lancet Vol 363

1432 ‘I say, Jeeves, been at the bone marrow again?’ Put some precursor cells from bone marrow into the brain, and off they go, turning into neurons, astrocytes and microglia.

1490 Evidence-based surgery is coming into its own with studies like this one of carotid endarterectomy: large, meticulously conducted, modest and practical in its conclusions.

1525 But will surgeons take any notice of the evidence? Looking at the effect of NICE guidelines on rates of wisdom tooth extraction and uncemented hip replacement, this study concludes no.

1579 A ‘systematic review of cannabis’ sounds like a planeload of teenagers arriving in Amsterdam. But no, man, this is a joint attempt to weed out the hash and light up the smart gear in the spliffrature, and it draws a well good conclusion.

1607 Could this be the best news yet for multiple sclerosis? A drug which cleared 40% of white matter lesions in 6 months — simvastatin 80 mg.

1724 Are randomised controlled trials the gold standard of evidence? If you like this kind of debate then there is plenty in this Lancet for you — another paper on page 1728, and an editorial on page 1660.

1751 Non-steroidal anti-inflammatory drugs (NSAIDs) probably kill as many people by tipping them into heart failure as by making them bleed: avoid the lot in heart failure, including rofecoxib. For celecoxib, await more news.

JAMA Vol 291

2086 Bacille Calmette-Guérin (BCG) is the bovine germ used to prevent tuberculosis for many decades: but does it work? An ethically dubious study from the 1940s randomised some Alaskans and American Indians to BCG, some to placebo: there was 50% less active TB in the active vaccine group over the next 50 years.

2100 Cone biopsy of the cervix by laser or diathermy increases the risk of preterm delivery.

2204 Does a parental history of cardiovascular disease really matter now that we can measure so many other risk factors? Yes, it does, says the oracle of Framingham.

2335 Bone marrow transplantation is close to dying and coming back to life, and the psychological and physical effects are profound and long lasting — at least 3–5 years, in this study.

2433 Aspirin prevents breast cancer — the hormone-responsive type, anyway; and the same probably goes for other NSAIDs.

2476 Palliative care for heart failure — a neglected area, so this piece is welcome.