NEJM 21 Dec 2006

Now children, who can remember from last week’s lesson what is the best biomarker for death or cardiovascular events? Don’t tell me you’ve forgotten already. Well, never mind, in the general population you can tell just as much by working out the (expanded) Framingham score, according to this paper from the Framingham Offspring Study. They looked at the added value of various biomarkers such as CRP, homocysteine, aldosterone, fibrinogen, D-dimer and, oh yes, B-type natriuretic peptide. Remember now? The best biomarker? All together now, children – BNP! Lovely. But even BNP has little predictive value over and above basic things like smoking, BP and diabetes in the general population.

Which antibiotic should colorectal surgeons use when opening the bowel electively? I don’t suppose many readers really need to know, but for the record, ertapenem, a long-acting carbapenem, looks like a good choice, judging from this paper which compared it with another parenteral antibiotic you’ve never heard of, cefotetan. The down side of all these antibiotics is that the more effective they are at eliminating the normal gut flora, the more they encourage Clostridium difficile.

Positrons are positively charged particles of antimatter which are rapidly eliminated by collision with electrons, producing gamma radiation. The Universe was 10-43 of a second old when positrons first appeared, and minute asymmetries between them and their paired electrons gave rise (after a further 13 billion years) to the entire visible Universe. Positron emission tomography depends on the proximity of a Big-Bang machine to the patient, producing positron-emitting isotopes of short half-life (e.g.18F, approx 110 minutes). The study here shows that PET can distinguish between mild cognitive impairment, Alzheimer’s disease, and normal cognitive function; but sadly I cannot see myself making use of these findings, since the primary care trust has turned down our request for a new cyclotron.

Teaching surgical skills – changes in the wind