MJM Wardrounds

The two minute tutorials this week were:
Dr Queen: Incidence and prevalence of upper GI bleeding (4/4)
Dr Tuck: Statin use in cerebrovascular disease (4/4)
Dr Szulakowski: Behcet's disease (4/4)

These were all well presented, hence the full four marks for each. I find it difficult to choose the best, but it must be done: Dr Queen wins this week.

I was surprised at the overall mortality for upper gi bleeds at 14%; we went on to discuss the use of Rockall scores for grading the severity of GI bleeders. You can see an explanation of Rockall scores in the GI haemorrage section of Evidence Based On-call (click on the link and go to 'guides' then 'GI haemorrhage' then 'prognosis'. )

Despite Dr Tuck's efforts I am still unclear about the use of statins in cerebral infarction when the total cholesterol is below 5mmol/l. I will seek specialist advice on this.

Following the Behcet's talk and the ensuing discussion we decided to move to combination therapy for our patient with refractory Behcet's. The patient does not wish to use Thalidomide, so we will be combining cyclosporin with pentoxifylline and colchicine.

The week's reading was The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996 Feb 28;275(8):630-4. I will look out for rulers over the next few days! I will bring in some more stuff on JVPs next week and perhaps we can have a look for some real examples?

Minor learning points from the round.

1. I have hypersensitivity to the term 'chest infection'...never again may I hear it spoken of as a diagnosis ... And beware 'coffee ground' vomit too.
2. Faecal occult blood testing is used to identify occult blood loss and is unnecessary in overt blood loss.

Dr Szulakowski has found some papers to support his contention about vitamin B12 and cancer. I have asked him to put them in the comments section.

Dr Tuck has given me a paper on statins and cerebrovascular disease...I will let you know what I think next week (can't read it just yet because I have left it at work by mistake).

On 26th August we discuss your diagnoses for the Plague of Athens... impress us with your diagnosis... then convince us you are correct. Dr Jones will choose the best effort.

Don't forget your two minute tutorial....make it concise and precise. Don't pick too large a subject.