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This week in BMJ Saturday 3 May 1997

Hyperglycaemia independently predicts poor survival after stroke
Heat probe helps in managing gastric ulcers with spurting haemorrhage
What is a healthy body weight?
Steroid injection or manipulation is better for shoulder complaints than physiotherapy
Social factors influence colic

Hyperglycaemia independently predicts poor survival after stroke

Hyperglycaemia predicts poor outcome after acute stroke, but whether it independently influences outcome or is a stress response is unknown. Weir et al (p 1303) studied plasma glucose concentrations after acute stroke in 811 patients followed up for an average of 1.7 years. Survival analysis showed that a glucose concentration over 8 mmol/l predicted poorer survival. This effect remained after adjustment for age, stroke severity, and stroke subtype, suggesting the high glucose concentrations were unlikely to be solely a stress response. The authors say that a randomised trial of active treatment of hyperglycaemia is warranted in stroke and such treatment might reduce mortality by 6%.

Heat probe helps in managing gastric ulcers with spurting haemorrhage

Endoscopic injection of adrenaline stops haemorrhage in peptic ulcer disease, but rebleeding occurs in 15-20% of patients. In a randomised controlled trial of 276 patients with actively bleeding ulcers, Chung et al (p 1307) compared the use of adrenaline alone with adrenaline injection followed by heat probe tamponade to improve haemostasis. Outcome as measured by initial endoscopic haemostasis, rebleeding, need for surgery, need for blood transfusion, length of stay, ulcer healing, and mortality in hospital did not differ between the groups. In those with spurting haemorrhage, however, the dual treatment significantly reduced requirement for surgery and length of stay. The authors recommend dual treatment in such patients, even if bleeding is initially controlled by adrenaline injection.

What is a healthy body weight?

The prevalence of obesity (body mass index (kg/m²) >30) has almost doubled in men and women in England and Wales over the past decade. On p 1311 Shaper et al use data from the British regional heart study of 7735 middle aged men to determine the relation between body mass index and cardiovascular risk factors, risk of mortality, and incidence of heart attack, stroke, and diabetes over 15 years. The study concludes that a healthy body mass index in middle aged men is around 22.

Steroid injection or manipulation is better for shoulder complaints than physiotherapy

Winters et al (p 1320) investigated the effect of corticosteroid injection, manipulation, and physiotherapy on the duration of shoulder complaints in patients treated in general practice. Those with complaints originating from the synovial structures were treated by injection, manipulation, or physiotherapy. Those receiving injection recovered most quickly, and only 17% dropped out (v 51% in the physiotherapy group and 59% in the manipulation group). Patients with a shoulder girdle disorder were treated by manipulation or physiotherapy. In patients with a shoulder girdle disorder the duration of complaints was significantly shorter after manipulation than after physiotherapy, and only 20% dropped out (v 45%).

Social factors influence colic

Infantile colic prompts parents to seek help from health professionals. On p 1325 Crowcroft and Strachan report findings from a population based study of 76,747 infants. Mothers more often reported colic if they were in an older age group, of lower parity, in a non-manual occupation, in an older age group at completion of education, in a more affluent district, or breast fed the infant. In a multivariate analysis maternal age, parity, and socioeconomic factors remained significant, but the effect of breast feeding was reduced. Dietary factors, including cows' milk protein, are unlikely to be an important cause of colic, and dietary change should not be the first intervention suggested.