N Engl J Med Vol 352
655 Given as soon as labour becomes painful, intrathecal fentanyl provides better analgesia than a conventional epidural and a lower rate of caesarean section.
676 Long ago, STD meant Subscriber Trunk Dialling, and VD clinics were advertised in the nation's lavatories. Treating the partner(s) was always the problem: the answer is to give the patient enough antibiotics to share out. The proof lies in reduced rates of reinfection.
692 There are at least four memory systems in the brain, and each has its own location and its own dysfunctions. Read this useful review, though I defy you to remember it all.
757 An effective oral cholera vaccine at last — great news for the developing world.
768 A human herpes virus causes sixth disease — and is given the number six, although for a different reason. It causes roseola, as opposed to slapped cheek syndrome, which is fifth disease. Is there a fourth disease? And what are the other three?
Lancet Vol 365
579 A fascinating and well-illustrated study of out-of-hospital antibiotic prescribing habits in Europe. British GPs are among the most sparing and conservative in choice, while the Dutch prescribe the fewest of all, and the French are the most profligate. Bacterial resistance is only loosely related to prescribing, as the editorial on page 548 explains.
663 You need a cool head to look after sick neonates. Head-cooling helmets (on the baby) improve outcomes in severe and perhaps in moderate neonatal encephalopathy.
755 A trial of FOOD for stroke patients sounds like a good idea, but three pragmatic trials of dietary supplementation after stroke showed little benefit. Enteral (PEG) feeding in dysphagic stroke patients does have some survival benefit, but quality of life is very poor (page 764).
773 A systematic review looks at the benefit of influenza vaccine in children older than 2 years — plenty from one vaccine, less from the other.
855 New macrolide antibiotics like clarithromycin and azithromycin are widely prescribed for chest infections in the US, and their arrival was followed by increases in macrolide-resistant S. pneumoniae. But then, following widespread pneumococcal vaccination, rates of resistance began to fall.
879 Sensorineural hearing loss in very young children is usually hereditary, and can be treated with cochlear implants, but in older children it is increasingly caused by personal listening devices. Turn that thing down, it's deafening!
JAMA Vol 293
810 A new urine test for bladder cancer – the nuclear matrix protein NMP22. In male smokers over 60 years, it's slightly better than PSA is for prostate cancer. So, if we need another lousy screening tool for urological cancer in men, here it is.
935 It may be useless for most other things, but surely HRT helps the female urogenital tract? Well, maybe in some situations, but rates of urinary incontinence are actually higher in users.
956 This study used a screening instrument for bipolar disorder that detected it in 10% of patients attending a general medical clinic. Beware making your depressed patients manic, it warns, although lithium for a tenth of the population seems a bit more hazardous.
1082 Why reduce homocysteine (Hcy)? The usual reasons are cardiovascular, but in this Japanese study two Hcy-reducing vitamins were used successfully to reduce hip fractures in stroke victims. They used folate and B12, but to do the job properly, add thiamine, pyridoxine, and perhaps riboflavin. And throw in some vitamin D to strengthen bone and muscle (see BMJ 2005; 330: 524).
Other Journals
Arch Intern Med (165: 393) finds that coeliac disease (which raises Hcy) is four times commoner in patients with thin bones. A cost-effectiveness analysis of combined aspirin and clopidogrel in Ann Intern Med (142: 251) is cautiously in favour of the combination. But on page 260 there is little comfort for the older doctor: a systematic review shows a negative correlation between clinical experience and quality of health care. And on page 310, statins hit another bogey — they are linked to nasal polyps. But things in the nose can help hay fever: Allergy (60: 529) experimented with prototype nasal filters in the parks of Sydney. Chest (127: 604) explores the worrying link between paracetamol use and asthma. If you have your left temporal lobe removed, you will find that music can still make you feel happy or sad, but not frightened (Brain 128: 628). A sort of Hitchcockectomy.
Plant of the Month: Magnolia × veitchii ‘Isca’
If you own a park and don't mind branches falling on people, this is perhaps the ultimate flowering tree, covered in vast, intensely scented goblets.
- © British Journal of General Practice, 2005.
