BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7491 (Published 23 November 2011) Cite this as: BMJ 2011;343:d7491

Surgery for pilonidal sinus traditionally involves wide excision under general anaesthetic, with months of secondary wound healing and long delays returning to work. A Swiss team describes its success performing minimally invasive sinusectomy in 257 patients over nine years. The overall recurrence rate was 7%, and the median time to return to work was just seven days. With experience they were able to perform most of these procedures under local anaesthetic in day case surgery settings (Surgery 2011;150:996-1001, doi:10.1016/j.surg.2011.06.019).

Does insomnia increase the risk of heart attack? A large prospective study of adults followed up for a first acute myocardial infarction for over 11 years concludes that difficulties getting to sleep, staying asleep, or feeling unrested after sleep are associated with a moderate increase in the risk of such an event. Combining all the variables suggests a dose dependent association between sleep difficulties and risk of acute myocardial infarction. Difficulty …

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