Lancet 21 Apr 2007 Vol 369

The clinical updates which now follow the editorials in The Lancet provide very useful summaries of current knowledge: here is a concise Australian account of stroke management. It’s particularly useful in clearing a path through the jungle of evidence about the timing and benefit of thrombolytic treatment.

If you’re lying in bed unable to walk because of an ischaemic stroke, you have a 75% risk of a deep vein thrombosis, so prophylaxis with heparin is a good idea. Prophylaxis with the low-molecular weight analogue enoxaparin is an even better idea, as demonstrated here in the PREVAIL trial, reducing the risk by a further 46% compared with unfractionated heparin.
We are now approaching the point where global eradication of wild polio is an achievable goal – and one we should be prepared to pay for achieving, according to the economic analysis on p.1363. When wild polio is a thing of the past, we may need to review the use of live oral vaccine, as I mentioned in connection with a Cuban study of inactivated vaccine last week. But for now, we need a better oral vaccine to tackle remaining pockets of polio virus in remote areas with a high prevalence of diarrhoeal illness in children. In Uttar Pradesh, a new monovalent oral vaccine proved three times as effective as the usual trivalent vaccine.

Our classic patient with ankylosing spondylitis developed it in 1946 and was treated by the leading London specialist of the day – with spinal radiotherapy. He has lived to tell the tale in his 80s, grinning as he struggles to hold his head up above his semicircle of bamboo spine. We must have more than 10 others (the prevalence is 0.1% to 1.4%) but they don’t spring to mind. It’s an enigmatic condition, now lumped together with several other spondyloarthritides which are often associated with HLA B27, including psoriatic arthropathy. The diagnosis remains clinical, with no elevation of CRP in half the patients. The “disease-modifying