New Eng J Med Vol 350
2362 The American medical press is deeply worried about the epidemic of obesity in children, with good reason: the ‘metabolic syndrome’, which is used to describe obesity, insulin resistance and hypertension in middle-aged adults is now increasingly seen in teenagers, some of whom show an almost limitless capacity for eating fast food (see JAMA: 2828).
2558 Being male puts you at reduced risk of getting venous thromboembolism, but at 3.6 times higher risk of recurrence compared with women.
2582 Palliative care for patients with non-cancer diagnoses can be very challenging, as shown by this excellent discussion of a man dying from heart failure with Alzheimer's and osteoarthritis.
2663 The wart treatment we have been waiting for: alpha-lactalbumin-oleic acid kills the papilloma virus while leaving healthy skin intact.
Lancet Vol 363
1840 ‘They don't like it up 'em!’ — Corporal Jones was quite right. Men facing transrectal prostate biopsy often find the injection of local anaesthetic as painful as the procedure itself.
1849 Cervical cerclage (the Shirodkar suture) does not prevent mid-trimester miscarriage, even in high-risk women with short cervixes.
1854 A well-conducted UK trial showing that ‘Most patients with chronic venous ulceration will benefit from the addition of simple venous surgery.’ That's a lot of patients: get referring!
1925 A triumph for general practice — the 40% reduction in stroke seen in the last 23 years, probably due to better control of risk factors such as hypertension and atrial fibrillation.
2015 Chronic inflammation predisposes to cardiovascular events, so rheumatoid arthritis is a coronary risk factor. As one would expect, atorvastatin 40 mg reduces the risk — with the unexpected bonus that it also helps the rheumatoid symptoms.
2022 Blockers of the angiotensin II receptor (ARBs, or sartans) are pleasantly free of side-effects, but unfortunately may also be less good at reducing blood pressure than other drug classes (valsartan compared with amlodipine).
2105 Cholinesterase inhibitors for Alzheimer's disease are very expensive and do not reduce the need for institutional care: this study of donepezil shows we need better drugs. Hurry up!
JAMA Vol 291
2705 A study of the presenting symptoms of ovarian cancer, which are common and non-specific — for example, back pain, bloating, constipation. Only their persistence gives a clue, and by then it is usually too late.
2713 By contrast, prostate cancer these days often presents too early, in the form of an elevated PSA and positive biopsies, which nevertheless cannot predict spread or progression. I read this report of a 21-year Scandinavian study as an argument against PSA screening, as I do a similar one in Arch Intern Med (164: 1227), but in both cases the authors use it as an argument in favour.
2746 Never miss an instalment of JAMA's marvellous series, ‘The Rational Clinical Examination’. Here it addresses the vital question, ‘Is this child dehydrated?’ — and the answer is ‘yes’ if there is poor capillary return, loss of skin turgor and/or an abnormal respiratory pattern.
2947 More bad news about oestrogen replacement therapy (alone or combined): far from warding off cognitive decline, it may increase it.
2978 Interesting insights from an erectile dysfunction study at an obesity clinic in Naples. If the Neapolitan male allows his BMI to get above 28.7, he runs a risk that when things get dolce, he will be able to far niente.
Other Journals
How many of us know how to assess clinical competence objectively? A large randomised US study in reported in Ann Intern Med (140: 874) — essential reading, since we will increasingly train foundation year doctors as well as students and registrars. Primary prevention of type 2 diabetes is discussed on page 951; and the important contribution of depression to outcome in various chronic diseases is the subject of an editorial on page 1054.
A paper in Pediatrics 113: 1776 caught Theophrastus' jaundiced eye (he has Gilbert's disease), as it praises the role of bile acids in neurovascular protection. Indeed, a further search reveals that having an elevated bilrubin is associated with fewer cardiovascular events in adults.
If your Latin is good, Folia phoniatrica et logopaedica (56: 182) contains a review about the effects of adenoidectomy and tonsillectomy on speech and nasal resonance. Actually, it is written in English.
Plant of the Month: Echinacea purpurea
One of the best and most reliable late summer perennials: quite useless as a cold remedy, though (Arch Intern Med 164: 1237).
- © British Journal of General Practice, 2004.
