This week in the BMJ
Volume 332, Number 7554, Issue of 10 Jun 2006Off-pump CABG may be better than conventional CABG
Off-pump CABG may be better than conventional CABG
Off-pump coronary artery bypass grafting (CABG) has similar rates of graft patency to conventional bypass surgery using cardiopulmonary bypass. Al-Ruzzeh and colleagues (p 1365) looked at 168 patients who needed primary isolated CABG and randomised them to conventional or off-pump technique. The authors evaluated graft patency after three months and found that in the conventional group angiographic patency was 92.7% and in the off-pump group it was 92.1%. However, patients in the off-pump group needed a shorter stay in hospital and their neurocognitive function was better preserved at six weeks and six months.
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Amoxicillin for CAP—three days, or longer?
Stopping amoxicillin treatment after three days is no worse than stopping it after eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia (CAP) who show substantial improvement after an initial three days of treatment. El Moussaoui and colleagues (p 1355) measured clinical and radiological success rates at day 10 and 28 in 119 patients who had been treated with intravenous amoxicillin for three days, then five days oral amoxicillin or placebo. The success rates were similar. A shorter treatment may help contain the growing resistance rates of respiratory pathogens.
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Some personality traits may affect risk of chronic disease
People's belief that the onset and progress of disease is caused by their behaviour may be linked to a reduced risk of myocardial infarction but not of stroke and cancer. High "time urgency" may be associated with a reduced risk of cancer but not of cardiovascular disease. Stürmer and colleagues (p 1359) analysed the presence of chronic diseases in more than 5000 adults 7-10 years after those people had completed a questionnaire on psychological traits, lifestyle, and comorbidity. Most personality traits that were assessed did not have a major impact on incidence and mortality from cardiovascular disease or cancer.
What colour is bilious vomit?
To recognise intestinal obstruction, it is more informative to ask parents about the colour of their newborn's vomit rather than whether it contains bile, say Walker and colleagues on page 1363. They carried out a questionnaire study to identify the colour that parents, general practitioners, nurses, and postnatal midwives thought represented bile and found no clear consensus. Of the 41 mothers of babies and infants questioned 23 did not know that green indicated bilious vomit, nor did 12 of 47 general practitioners. This may result in avoidable delays in surgical referral, say the authors.
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How to manage thyrotoxicosis
Thyrotoxicosis can readily be diagnosed with serum thyroid function tests in patients with heat intolerance, palpitations, anxiety, fatigue, and weight loss. To formulate a treatment plan, though, the aetiology must be determined, says Pearce on page 1369. This clinical review on thyrotoxicosis revisits how to diagnose the thyroid disease, which occurs in about 2% of women. It looks into the treatment options for the different forms of overt hyperthyroidism with low, normal, and raised radioactive iodine uptake, and discusses whether to treat subclinical thyrotoxicosis.
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