This week's journal reviews on Doctors.net.uk
Journal Watch is a service provided to summarise some of the most popular medical journals.
Doctors.net.uk has a panel of specialist advisers responsible for reviewing a range of journals of general medical interest and some more specialised publications.
General Journal Watch is written by Dr Druin Burch, Consultant in Internal Medicine
This week's journals include....
Carotid stents versus endarterectomy
The International Carotid Stenting Study trial of stents versus surgery accounts for almost two thousand randomised patients. It came up with a finding in keeping with most other trials on the same topic: stenting performs worst. Peter Rothwell's editorial on page 957 hammers home the point. As well as noting that endarterectomy is, itself, of uncertain benefit, it points out that better medical treatments to prevent stroke have altered the balance of harms and benefits since the trials that support stenting were done.
Near patient testing for malaria
If you can look down a microscope at blood, then doing a specific blood test that'll light up when positive for malaria, like a pregnancy test does in the presence of chorionic gonadotrophin, adds little. If you can't, it adds more. This study from the Gambia comes to a common sense conclusion and may be useful if you happen to work in the developing world. If you do, I pray you're not depending on trials from the British Medical Journal for your knowledge of medical progress. They amount to little.
Steroids for infantile haemangiomas
During his early life, our son bore three large haemangiomas on his scalp, suspiciously matching the places where an incompetent obstetric registrar had performed three separate and entirely pointless attempts at blood sampling. During his early months, which were not blessed with hair, other children would point at his bald and afflicted head, clearly worried. "Ouch?", I remember one of them saying. The red splotches have now vanished almost entirely, as is their natural history, but in a proportion of infants, they can cause problems serious enough to warrant treatment, often in the form of steroids. This paper attempts to work out how the drug might act, coming up with an explanation based largely on subduing vascular endothelial growth factor expression.
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