NEJM 3 May 2007 Vol 356

For those who don’t want – or can’t remember – to take a bisphosphonate tablet once a week, there is the option of spending a quarter of an hour once a year having an infusion of zoledronic acid. So why not compare the oral with the intravenous treatment in a group of patients with osteoporosis? Is it ethical to use an intravenous placebo in these at-risk patients, and prejudge the outcome of the trial by calling it Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly? The marketing department of Novartis Pharma clearly had no qualms. The stuff works very well, as this study advertises (sorry, I mean demonstrates) – it prevents fractures at all sites over three years and probably beyond. But whether we should be lining up our practice nurses to give it to old ladies is an issue not determined by this study.

In the Byzantium of Yeats,
A starlit or a moonlit dome disdains
All that man is,
All mere complexities,
The fury and the mire of human veins.

It ‘s a bit different in the Byzantium (Istanbul) of today, where a team of Turkish cardiologists carried out this study of the fury and the mire of coronary arteries. They infused them with streptokinase following percutaneous coronary intervention and found that this improved myocardial perfusion but did not affect ventricular size or function. If you want to experience a sudden increase in cardiac output, you would do better to read the whole of Yeats’ astonishing poem.

It’s one of the standard doctrines of surgery that undescended testes can lead to testicular carcinoma. And this is true: even if you fix them in the scrotum before puberty, there is twofold risk (hazard ratio 2.2) and if you leave it till after 13, that goes up to fivefold (HR 5.4). However, the run of the balls is generally favourable: only 56 cancer cases after orchidopexy in 210 thousand patient-years of follow-up in the Swedish Cancer Registry.

We’ve probably all come across or heard of patients with type 1 diabetes who have suffered brain damage due to hypoglycaemia. Could this be happening all the time at a subclinical level? The answer from this 18 year cohort study is a firm and welcome no. 1144 patients, many of whom had recurrent severe hypoglycaemia, showed no evidence of a substantial long-term decline in cognitive function.