New Eng J Med Vol 352
1977 The American vogue for radical prostatectomy causes unease in those of us who would prefer to take a slower route to incontinence and impotence. This study shows a slight superiority over watchful waiting in early prostate cancer.
2049 For an accurate picture of renal function, cystatin C is the blood test most likely to replace nitrogenous waste products: here it proves better than creatinine in predicting death and cardiovascular events in the elderly.
2082 Do we really need to offer pneumococcal vaccine to all our patients with asthma? Yes, because this study shows that they are at twice the risk of invasive pneumococcal disease.
2174 Between 1997 and 2000, coronary artery bypass grafting provided better outcomes than stenting in the US; but we don't know if this applies to drug-eluting stents and the latest techniques of CABG.
2184 Another reason to put statins in the water supply: they might halve the risk of colorectal cancer, according this case-control study of an unselected population in Israel.
2379 Vitamin E, shown elsewhere to decrease survival, proves useless at slowing cognitive decline in Alzheimer's. And donepezil is little better.
2398 If you had an aortic aneurysm, would you go for open or endovascular repair? Outcomes at 2 years are the same, although endovascular repair has fewer short-term complications.
Lancet Vol 365
1687 A mind-bogglingly thorough meta-analysis of chemotherapy and hormonal therapy for early breast cancer, already out of date due to new drugs. But there's a very useful chart of cancer trends in Western countries on page 1714.
1728 Colorectal cancer will increasingly be treated with laparoscopic surgery, provided the patient is properly selected and the surgeon is experienced.
1779 Yet another reason to put statins in the water supply: the Heart Protection Study shows that they are cost-effective over a wider range of cardiovascular risk than previously thought.
1849 In a New York study, free nicotine patches helped people to stop smoking.
JAMA Vol 293
2257 In the same fortnight that the BMJ and Lancet both published good randomised trials showing that vitamin D did not protect against fractures in risk groups, this meta-analysis shows results that are ‘compelling for general vitamin D supplementation in the range of 700–800 iu/d for elderly persons.’
2343 Gluten allergy is much commoner than we thought — about 1 in 100 when looked for using anti-tissue transglutaminase: some of this may be attributable to exposure to gluten before the age of 4 months, according to this Danish study.
2372 Serotonin reuptake inhibitors taken in pregnancy may cause jitteriness in the neonate, but rarely anything more serious, according to this useful review of the literature.
2391 Another key paper in the marvellous ‘Rational Clinical Examination’ series — learn how to identify a stroke correctly in 1 minute.
2776 An update on the treatment of tuberculosis, rounding off a whole issue devoted to this once and future killer.
Other Journals
Arch Intern Med (165: 978) contains an intriguing case-control series from Denmark which seems to show that all NSAIDs (not just coxibs) carry a risk for myocardial infarction, with rofecoxib among the highest, and celecoxib the lowest. Pages 997–1048 contain studies showing that male health professionals will do well to eat dairy products, drink more than 7 units of alcohol a week, and take exercise. Although the ‘number-needed-to treat’ (NNT) was devised to help shared decision-making with patients, a randomised trial shows that it makes little difference (page 1140). And on page 1147, a depressing survey of adherence with antihypertensive and lipid-lowering therapy shows that patients (in the US, anyway) rarely take more than two medications consistently. Ann Intern Med (142:) 805 shows that rifamixin, a non-absorbed antibiotic, prevents traveller's diarrhoea in Mexico: Montezuma denied his revenge. On page 832, a paper pointing out that although adults are whooping, internists are not listening: pertussis is a very common cause of persistent cough. ‘Diazepam with your dinner, sir?’ is the typically provocative title of Bruce Charlton's piece on safer alternatives to alcohol as a social anxiolytic in QJM (98: 457). As for the harms of our other favourite addictive drug, tobacco, there seems to be no end: the latest is accelerated progression of multiple sclerosis (Brain 128: 1461). Scanning too much medical literature can lead to Dreaming (14: 240); early clay tablets show that the interpretation of dreams was a thriving industry 5000 years before Freud.
Plant of the Month: Lilium ‘Pink Perfection’
A huge purplish lily with an intoxicating scent, worthy of Oscar Wilde's buttonhole.
- © British Journal of General Practice, 2005.
