This week in the BMJ

Volume 332, Number 7556, Issue of 24 Jun 2006

Treating carpal tunnel syndrome endoscopically may not be cost effective
Perioperative $beta$ blockade may not benefit patients with diabetes
Adding metformin doesn't increase number of ovulations in women with PCOS
Sure Start local programmes may have limited effects
Screening for trypanosomiasis in Angola

Treating carpal tunnel syndrome endoscopically may not be cost effective

In the treatment of employed patients with carpal tunnel syndrome,endoscopic surgery is associated with modestly less pain thanopen surgery up to three months after operation, but it doesnot get patients back to work any faster. Atroshi and colleagues(p 1473) randomised 128 employed patients aged 25-60 years withidiopathic carpal tunnel syndrome to either endoscopic or opencarpal tunnel release surgery. Both methods were equally effectivein relieving symptoms. The small benefit makes the cost effectivenessof endoscopic surgery uncertain, say the authors.

Credit: PHOTOS.COM

Perioperative $beta$ blockade may not benefit patients with diabetes

Perioperative $beta$ blockade in patients with diabetes undergoingmajor non-cardiac surgery may not significantly affect longterm mortality and cardiac morbidity. The DIPOM Trial Group(p 1482) randomised 921 diabetic patients aged > 39 yearsand scheduled for major non-cardiac surgery to either 100 mgmetoprolol or placebo, given from the day before surgery andcontinued for up to eight days. During a median follow-up of18 months, all cause mortality, acute myocardial infarction,unstable angina, or congestive heart failure occurred in 21%of the metoprolol group and 20% of the placebo group. Confidenceintervals, however, were wide, and the issue needs reassessment,conclude the authors.

Adding metformin doesn't increase number of ovulations in women with PCOS

Metformin does not increase the number of ovulations or pregnancieswhen added to clomifene citrate as first line treatment in infertilewomen with polycystic ovary syndrome (PCOS). Moll and colleagues(p 1485) allocated 228 such women to clomifene citrate plusmetformin or clomifene citrate plus placebo. The ovulation ratein the metformin group was 64% and 72% in the placebo group.Rates of ongoing pregnancy or spontanteous abortion showed nosignificant differences, and a significantly larger proportionof women in the metformin group stopped treatment because ofside effects.

Credit: NAJEEB LAYYOUS/SPL

Sure Start local programmes may have limited effects

The UK government's Sure Start local programmes to improve thehealth and development of socially deprived children < 4years and their families seem to have only limited effects,varying with degree of social deprivation. In a cross sectionalstudy, Belsky and collegues (p 1476), interviewed mothers andcognitively assessed children from English socially deprivedcommunities with and without Sure Start programmes. The programmesbenefited less socially deprived parents and their children,but they seemed to have an adverse effect on the most disadvantagedchildren.

Credit: LUCINDA MARLAND/ACAMY

Screening for trypanosomiasis in Angola

Community screening for human African trypanosomiasis with acard agglutination test alone can lead to a substantial overdiagnosis.Inojosa and colleagues (p 1479) actively screened > 14 000people using the agglutination test in northern Angola, an areawith low prevalence of the disease. Of the 76 people who hada positive reaction in serum titration of 1:8 or more, only10 had parasites detected in subsequent lymph node fluid orblood tests. Given the toxicity and cost of drugs used to treattrypanosomiasis, the card agglutination test should be usedin conjunction with a second confirmatory test to guide treatment,say the authors.