Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7131 Volume 316 This week in brief Saturday 21 February 1998 New ways of diagnosing Creutzfeldt-Jakob disease are emerging Hysteria can be diagnosed with confidence Low dose temazepam improves sleep at high altitude Prothrombotic condition combined with pill use increases risk of cerebral sinus thrombosis Low Lp(a) lipoprotein values may help explain low mortality in drinkers Community based course could be used in many medical schools New ways of diagnosing Creutzfeldt-Jakob disease are emerging The diagnosis of Creutzfeldt-Jakob disease is based on clinical and electroencephalographic criteria. Surrogate markers in cerebrospinal fluid can also aid diagnosis. On page 577 Otto et al report that a highly sensitive serum assay for brain specific S100 protein can be used to distinguish Creutzfeldt-Jakob disease from other diseases which cause dementia (sensitivity 77.8%, and specificity 81.1%). New variant Creutzfeldt-Jakob disease is possibly related to the causative agent of bovine spongiform encephalopathy. In view of the public health implications, the accurate ascertainment of cases is vital but difficult. On p 593 da Silva et al describe using single photon emission computed tomography with HMPAO to identify two cases of new variant Creutzfeldt-Jakob disease. They stress that the tomography findings are not diagnostic, but that abnormalities particularly in the setting of normal electroencephalography or cerebral magnetic resonance imaging should raise the suspicion of new variant Creutzfeldt-Jakob disease. Highly specialised "diagnostic" techniques can then be targeted at these patients. Hysteria can be diagnosed with confidence In the 1960s Slater reported a high incidence of neurological and psychiatric disease in patients with hysteria; this has made doctors wary of diagnosing hysteria. Crimlisk et al (p 582) have reproduced Slater's work in a group of 73 patients from the same hospital with unexplained motor symptoms. Six years after initial admission only four patients had new diagnoses that accounted for their initial symptoms. Overall psychiatric morbidity was high. These results suggest that after careful investigation, hysteria can be diagnosed with confidence. Low dose temazepam improves sleep at high altitude Many people sleep poorly at high altitude, but hypnotic and sedative drugs are generally considered to be contraindicated because they are thought to impair arterial oxygen saturation. However, in a study done at a base camp on Mount Everest (altitude 5300 m) Dubowitz (p 587) found that low doses of temazepam improved the quality of sleep without affecting oxygen saturation, possibly because they reduced the number of periods of desaturation. Prothrombotic condition combined with pill use increases risk of cerebral sinus thrombosis Women who use oral contraceptives and carry a hereditary prothrombotic deficiency have an increased risk of deep vein thrombosis. On p 589 de Bruijn et al compared 40 women with cerebral sinus thrombosis with population data from the Netherlands. Prevalences of current use of oral contraceptives and the presence of a prothrombotic factor (protein C, S, or antithrombin deficiency or factor V Leiden mutation) were compared and odds ratios calculated. The age adjusted odds ratio for the association of sinus thrombosis with the use of oral contraceptives was 13 but became about 30 in the presence of a hereditary deficiency. This result does not justify negative advice about oral contraceptives, however, as the risk of cerebral sinus thrombosis is small. Low Lp(a) lipoprotein values may help explain low mortality in drinkers Lp(a) lipoprotein is an independent risk factor for coronary heart disease. Paassilta et al (p 594) examined concentrations in 300 Finnish men and related them to their drinking habits (teetotallers and those drinking <39 g alcohol/week, 40-132, >132). They found higher concentrations in the teetotallers than in the drinkers, with no differences in HDL or LDL cholesterol values. Community based course could be used in many medical schools Responding to the General Medical Council's recommendation for community based learning for medical students, Lennox and Petersen (p 596) developed a new course for third year students at Leicester University that enables students to understand the lifestyle, perceptions, and priorities of patients, and also the roles of other community agencies. Questionnaire feedback (from students, patients, and community organisations) was positive. The authors believe the course could be used in other medical schools. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline