This week in the BMJ
Volume 328, Number 7453, Issue of 12 Jun 2004Use NSAIDs for renal colic
Use NSAIDs for renal colic
In patients with acute renal colic, non-steroidal anti-inflammatory drugs (NSAIDs) should be the drug treatment of choice. Reviewing 20 trials including 1613 patients with renal colic, Holdgate and Pollock (p 1401) found that patients taking non-steroidal anti-inflammatory drugs had slightly less pain and were less likely to need additional analgesia than those taking opioids. Those taking opioids were more likely to have vomiting or other adverse events.
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People with cleft lip and palate live less long
People with cleft lip and palate have an increased risk of mortality. Analysing data on 5331 people up to age 55 from the Danish cleft lip and palate register, Christensen and colleagues (p 1405) found that those with cleft lip and palate or with cleft palate alone were more likely to have died than the rest of the population or than people with cleft lip alone. The risk of suicide and all causes of death was higher in people with cleft lip and palate; mortality due to cancer was marginally higher.
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Enteral nutrition is better than parenteral in acute pancreatitis
Patients with acute pancreatitis do better when they have enteral nutrition. Reviewing 112 articles, Marik and Zaloga (p 1407) identified six trials in which 263 patients with acute pancreatitis were randomised to enteral or parenteral nutrition. They found that those who had had enteral nutrition, delivered through a nasojejunal tube, had significantly fewer infections or surgical interventions and were in hospital for a significantly shorter time than those who had had parenteral nutrition. Mortality or non-infectious complications were similar in the two groups.
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Admissions for chest pain are increasing
People in Scotland are more likely to be admitted with acute coronary syndrome than before. Examining trends in the population discharge rates in Scotland for acute myocardial infarction, angina, and chest pain, Murphy and colleagues (p 1413) found that the rate of hospitalisation for myocardial infarction declined by 33% between 1990 and 2000. Admissions for angina increased by 79%, for chest pain by 110%, and for acute coronary syndrome by 25%.
Does eradicating H pylori improve gastric symptoms?
Eradication of Helicobacter pylori does not increase or reduce symptoms of gastro-oesophageal reflux. Harvey and colleagues (p 1417) randomised 1558 patients with H pylori infection to receive active treatment or placebo and found that, two years after treatment, eradication had no effect on the overall prevalence of heartburn or reflux, nor on pre-existing gastric symptoms. In participants who had isolated reflux, treatment prevented the development of heartburn.
Epidural analgesia does not increase risk of caesarean intervention
Epidural analgesia is unlikely to increase the risk of nulliparous women having to have a caesarean section. Pooling data from seven trials, Liu and Sia (p 1410) found that women who had had epidural analgesia with low dose bupivacaine were more likely to have an instrumental vaginal delivery, but not a caesarean section. Women receiving epidural analgesia had a longer second stage of labour and needed oxytocin more often, but they had better pain relief.
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