New Eng J Med Vol 351–352
2498 Levodopa remains the mainstay of treatment for Parkinson's disease, but does it accelerate the disease, as some imaging studies have suggested? Fortunately not: this big cohort study shows that it slows clinical progression.
2581 A big, randomised prospective trial showing that statistically, repeat caesarean section is safer than trial of labour. But it takes 588 extra caesareans to prevent one serious adverse event.
2611 Acute infection raises the risk of myocardial infarction, but fortunately a search of the UKGP Research Database shows no link with vaccination.
20 One of the best markers for the risk of cardiac events due to inflammation is C-reactive protein (CRP), which is lowered by statin treatment. Here are two studies that demonstrate that the degree of CRP lowering with statins predicts their protective effect, at least as well as measuring LDL-cholesterol.
Lancet Vol 364–365
2097 A worrying report of increased rates of cancer in children and adolescents throughout Europe since 1970: fortunately, far outpaced by rates of cure.
2188 You may think that oral antibiotics knock spots off topical treatments for acne, but this trial in mild-moderate acne showed equivalence for benzoyl peroxide/erythromycin topicals, which are unaffected by propionobacterial resistance.
29 Here is the study we so badly needed on recurrent sudden unexplained infant death. It completely refutes the ‘expert’ evidence that has sent several parents to jail: only about 15% of such episodes are likely to be homicides.
60 Tamoxifen has saved innumerable lives following surgery for oestrogen-receptive breast cancer, but its day is done. In this context, as in many others, aromatase inhibitors, such as anastrozole in this trial, have proved more effective and better tolerated.
167 For asthma and chronic obstructive airways disease, we have long used theophylline, a non-selective phosphodiesterase (PDE) inhibitor with a narrow therapeutic range. This review describes a whole batch of new, specific PDE4 inhibitors waiting to capture this huge market — but will they be any better?
JAMA Vol 292–293
2735 Old-fashioned X-ray tomographs of squashed breasts remain the standard screening test for breast cancer, but MRI must surely be better. Yes — but it still produces too many false positives to avoid the need for confirmatory biopsy.
2771 A review of the ABCD criteria for melanoma — valid and useful: even better if you add on E for evolving.
2849 A study of hypertensive treatment in older women. Give them thiazides and β-blockers: you will do their bones a favour too. But avoid calcium channel blockers.
2984 Arsenic increases your risk of lung cancer, and so does having the wrong genes: but the effect is tiny if you don't smoke.
3012 We have all seen dying people hang on for some special event, and then let go. This study shows that birthdays, Thanksgiving, and Christmas do not have this effect: perhaps the thought of eating more turkey lessens the will to live?
43 Wanting to lose weight? Atkins, Ornish, Weight Watchers, Zone — a fat lot of difference: the result depends on how hard you try.
77 Predicting pre-eclampsia is now possible by measuring a mid-term drop in urinary placental growth factor. What you do about it is another matter.
Other Journals
We've all been hurriedly taking patients at cardiac risk off COX-2 inhibitors, but could we be doing more harm than good? Arch Intern Med (164: 2472) trawls evidence from the UKGP Research Database and finds an increase in myocardial infarction in the weeks after withdrawal of NSAIDs: whether this is COX-specific is not known. Ann Intern Med (141: 901) describes a US study of acupuncture for osteoarthritic knee pain, and is followed on page 911 with a British study of acupuncture for neck pain. Neither showed any useful benefit. 142: 37 reviews the trials of vitamin E for the prevention of cardiovascular disease and cancer. High doses actually increase all-cause mortality. Adeno-tonsillectomy has fallen out of fashion, but Arch Disease Childhood (90: 19) looks at the trials and detects a small benefit. On page 74 there is a systematic review of adding intravenous magnesium to the treatment of acute childhood asthma: it is probably worthwhile. Gut (54: 6) asks ‘Will worms really cure Crohn's disease?’ Trichuris suis appears safe and effective as skoletherapy (from Greek skole, worm). And in the Christmas CMAJ (171: 1443) there appears an unmissable study — ‘Incidence of and risk factors for nodding off at scientific meetings’.
Plant of the Month: Abeliophyllum distichum A straggly shrub worth growing for its scented white forsythia-like flowers at this time of year.
- © British Journal of General Practice, 2005.
