Journals Watch - Varicose veins, suicide and AAA

Too busy to read all the journals? Let Dr Katrina Ford keep you up to date with the latest research.

research looked at conventional and new varicose vein treatments
research looked at conventional and new varicose vein treatments

Recovery after varicose vein surgery Br J Surg 2009; 96: 1262-7
Ultrasound-guided foam sclerotherapy (UGFS) is a minimally invasive alternative to conventional surgery for the treatment of varicose veins. This questionnaire-based survey involved 332 patients who had UGFS and 53 who had conventional surgery for varicose veins at a UK teaching hospital.

The study was limited by the fact that patients were not randomised to treatment. However, there was no major selection bias as NHS referrals were allocated by administrators based on capacity to offer treatment. The survey relied on patients' subjective and self-reported assessment of symptoms and factors such as bruising.

The groups were comparable in terms of age, sex, symptoms, proportion with bilateral or recurrent varicosities and extent of disease. Compared with the group undergoing traditional surgery, those who underwent UGFS had significantly less pain, a reduced analgesia requirement and decreased time off work.

I would be happy to recommend this treatment option to patients.

Immobilisation after intrauterine insemination BMJ 2009; 339: b4080
This Dutch randomised controlled trial evaluated the effectiveness of 15 minutes immobilisation versus immediate mobilisation following intrauterine insemination (IUI) of sperm.

They found that remaining in the supine position for this length of time resulted in increased pregnancy and live birth rates.

The participants were subfertile women aged 18-43 years and underwent three cycles of IUI. A total of 391 couples undergoing IUI for unexplained, cervical factor or male factor subfertility were randomised to immediate mobilisation (the control group, 192 couples) and 199 couples were allocated to 15 minutes of immobilisation.

Ongoing pregnancy rates in the immobilised cohort were significantly higher than in the mobilisation group (27 per cent versus 18 per cent).

Live birth rates were higher in the immobilisation group, 27 per cent versus 17 per cent, again a statistically significant result.

This simple intervention to maximise chances of conception can be easily applied. It would be interesting to evaluate if pregnancy rates after normal coitus are increased by this method.

Primary care contact prior to suicide Br J Gen Pract 2009; 59: 825-31
Between 20 and 76 per cent of suicide victims consult their GP in the month prior to death. This study, based in the north-west of England, investigated the frequency and nature of GP consultations in the year before a patient's suicide. GP records were retrospectively reviewed in 247 cases of suicide and interviews were carried out with the GP in 159 cases.

The median number of consultations in the year prior to death was seven. A total of 47 per cent of patients were seen in the month before suicide and 34 per cent were also seen by mental health services during this time.

In the cases reviewed, 54 per cent consulted about psychological symptoms, and 23 per cent of final consultations were regarding physical health.

No relationship was seen between the reason for final consultation and whether this consultation occurred in the month before death.

Only 15 per cent of GPs reported that their patient had expressed suicidal thoughts or intentions at this time, with 26 per cent saying that they were concerned for their patient's safety.

Surprisingly, in only 64 per cent of cases, where the GP expressed concern about their patient's safety, mental health services were contacted.

Alarmingly two GPs reported their referrals were not acted upon and an additional four GPs offered referrals that were declined by their patients.

AAA Screening in patients with established IHD Br J Cardiol 2009; 16: 231-5
It has long been known that IHD increases co-morbidity and mortality in patients with abdominal aortic aneurysm (AAA).

This UK-based, prospective observational study investigated whether patients undergoing coronary angiography present an accessible and significant cohort for AAA screening.

A total of 106 consecutive patients who had undergone coronary angiogram then underwent an ultrasound examination of the aorta, with the sonographer being blinded as to the results of the first investigation.

Out of 104 successful scans, 73 were in men. Six men and 11 women had normal coronary arteries with no aneurysms. Of the 87 patients with IHD, eight males had aneurysms of 3cm and above. The mean diameter was 4.2cm. Aneurysmal change was found in a further two men and two women.

Screened individuals with IHD had an average age of 62.2 years for men and 68 years for women. The small numbers in this study do not give sufficient power to sway national policy but investigators concluded that screening patients with IHD has a higher yield than expected by the National Programme.

Body mass index and Barrett's oesophagus in women Gut 2009; 58: 1460-6
Raised BMI is associated with gastro-oesophageal reflux disease, and previous studies have suggested an association between BMI and Barrett's oesophagus.

Here the authors looked prospectively to examine the influence of BMI on the risk of developing Barrett's oesophagus in women.

This study concerned 15,861 participants from the Nurses' Health Study without a history of cancer, who underwent upper GI endoscopy for any reason between 1986 and 2004.

Compared with women with a BMI of 20-24.9, women who were overweight did not have an increased risk of Barrett's (odds ratio 0.92, 95 per cent CI:0.66-1.27) while those with a BMI of 30 or above, did have an increased risk (odds ratio 1.52, 95 per cent CI:1.02-2.28).

Although both sexes report gastro-oesophageal reflux symptoms with equal frequency, this symptom is not the only variable implicated in the pathophysiology and indeed the central, visceral fat distribution in obese men, compared with more peripheral subcutaneous fat deposition in women, is thought to be a factor.

  • Dr Ford is a locum GP in Worcestershire and a member of our team who regularly review the journals.

The Quick Study

  • Ultrasound-guided foam sclerotherapy for varicose veins is less painful than conventional surgery and results in a shorter recovery period.
  • Intrauterine insemination pregnancy rates are improved by immobilisation for 15 minutes post insemination.
  • Mental health patients who commit suicide often consult with their GP in the month prior to death and risk assessment is important at these meetings.
  • Ischaemic heart disease patients may benefit from AAA screening with ultrasound.
  • Obese women are more at risk of Barrett's oesophagus than women with a BMI of under 30.

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