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Press releases Saturday 1 February 1997
Embargo: Friday 31 January 00.01 Hrs

Informed consent must include information on orgasm

[Surgery, drugs and the male orgasm :Editorial]

Doctors cannot assume that male patients have given informed consent to surgery or drug treatments unless the possible effects on orgasm have been discussed. This is the message of an editorial, published in this week's BMJ, which admits that very little is known about the male climax.

At present there is no reliable treatment for men who lose their ability to experience orgasm. What is known is that penile erection, ejaculation and orgasm are mutually independent events which can be dissociated from each other.

A greater willingness to speak candidly about sexual functions means that more men with orgasmic dysfunction are being recognised. Sometimes loss or change in the sensation of orgasm follows surgery for example on the prostate gland. Certain drugs, such as serotonin reuptake inhibitors (SSRIs) used to treat depression, may affect male orgasm. Urologists Mr William Dunsmuir and Mr Mark Emberton point out that SSRIs will abolish orgasm, independently of ejaculation, in up to one fifth of men.

Not all male patients requiring surgery or drug treatments are warned of any possible side effects on future orgasm. The authors describe a large study of prostatectomy patients in which about half of the sexually active men reported absent or altered orgasmic sensations following treatment. "A proportion of these men expressed their disappointment and on occasions anger at not having been warned of this side effect". The authors state that whatever the mechanism resulting in the loss of orgasm after operations "it is probably reasonable to assert that informed consent cannot be assumed unless the effects of surgery on orgasm have been discussed with the patient."

Contact:
Mr Mark Emberton

Tel: 0171 636 8333
bleep 2178
Fax: 0171 637 7076

or

Mr William Dunsmuir

Tel: 0181 672 1255
Fax: 0181 784 7015

A decade after Bhopal local people have breathing problems

[Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey]

Many people died as a result of exposure to gas after the 1984 Union Carbide disaster in Bhopal, India. A paper in this week's BMJ shows that 10 years after the gas leak, local people are still suffering with breathing difficulties.

Researchers from the UK and United States visited local residents in Bhopal to examine if they experienced respiratory illness. They found that the nearer the people lived to the gas leak site, the more frequently they had symptoms. Adults living within two kilometres of the factory all showed symptoms. Much of the disease was probably due to irreversible obstruction in small airways in the lungs. This is the first long term study of illness in Bhopal. Previous investigations have not examined disease beyond two or three years after the industrial disaster.

Contact:
Dr P. Cullinan

Imperial College
London

Tel: 0171 351 8328
Fax: 0171 351 8336
e-mail: p.cullinan@ic.ac.uk

Doctors issue warnings on the transfer of sick patients

[Regional intensive care unit transfer teams are needed: letter]

A warning of the potential dangers involved in transferring critically ill patients between hospitals comes in a letter from the President and Secretary of the Intensive Care Society (ICS) in this week's BMJ.

Since December 1996 a national bed bureau has existed to locate intensive care beds for critically ill patients, but finding a suitable bed is only part of the solution. Dr Peter Wallace, President of the ICS and Dr Paul Lawler, Secretary write: "The patient being transferred should occupy the equivalent of an intensive care unit bed in a vehicle and during transfer he or she requires the full capabilities of an intensive care team. Currently most patients who are transferred in Britain are accompanied by a trainee from the on call anaesthetic rota at the referring hospital."

They quote one study which found that a third of all transfers were undertaken by a junior doctor in anaesthetics with less than six months experience. They believe regional intensive care unit transfer teams are needed.

Contact:
Dr Paul Lawler

Tel/Fax: 01642 854 643

Some children suffer from "glue ear" more than half their lives

[Duration and recurrence of otitis media with effusion in children from birth to 3 years: prospective study using monthly otoscopy and tympanometry]

Some children are more susceptible to "glue ear" than others and have more separate episodes - rather than longer lasting episodes - especially in their early years. A paper in this week's BMJ reports that an appreciable minority of young children have the disease more than half the time.

Sarah Hogan and colleagues at Oxford visited 95 children in their homes every month from birth to age three years. They tested the infants for otitis media with effusion (inflammation of the middle ear in its chronic stage, sometimes called "glue ear") . "Seventeen of the children had the condition for more than half of the first three years of their lives. The children who experienced less of the ear condition had much longer symptom free gaps between episodes. At the other end of the range, children who had otitis media in more than 45 per cent of tests had an average of nine weeks free of "glue" effusion before succumbing to the condition again. Episodes involving only one ear lasted an average of six weeks, but when both ears were affected the episodes lasted an average of 10 weeks, typically followed by another nine week (average) symptom free period.

"Nearly one fifth of children had either unilateral or bilateral otitis media with effusion for more than half of the first three years of their life." Infants under two years were more susceptible to recurrent infection than children in their third year, so doctors are advised that "particular attention should be given to infants."

Contact:
Sarah Hogan

Tel: 01865 272 513 Fax: 01865 272 469 e-mail: sarah.hogan@physiol.ox.ac.uk

Should doctors tell patients with Alzheimer's disease of their diagnosis?

[Editorial and letters]

Telling a patient the diagnosis of Alzheimer's disease has important substantive benefits, claims an editorial in this week's BMJ. Professor Barnett S. Meyers of Cornell Medical Center, New York, says physicians, patients and family members who share the responsibility for coping with the illness all require access to diagnostic information.

Giving patients information about their condition provides an opportunity for them to take part in important health care and financial planing decisions while they have the capacity to do so. Patients need to know when and why to limit activities such as driving which has been found to be impaired in patients with mild Alzheimer's disease.

In the same issue Dr Karl Rice and colleagues report on current practice among geriatricians and psychiatrists in telling patients of an Alzheimer's disease diagnosis. Severely demented patients were seldom told the diagnosis whereas their carers were usually informed. Where the patient suffered from mild dementia there was a wide variation in practice in whether or not the patient was told the diagnosis. Dr Richard Barnes believes that the majority of patients would benefit from knowing their diagnosis and suggests that the best way to achieve this is probably to allow the relatives to act as proxy for the patient. They should be given full information so that a joint decision can be made about telling the patient.

Contact:
Prof. Barnett S. Meyers

New York

Tel: 001 914 997 5970
Fax: 001 914 997 5723

Dr Karl Rice

Tel: 01495 350 000
Fax: 01495 352 280

Dr Richard Barnes

Tel: 01704 547471
Fax: 01704 530714

New vaccine for hepatitis B protects health care workers

[Immune response to a new hepatitis B vaccine in health care workers who had not responded to standard vaccine: randomised double blind dose-response study]

Hepatitis B is a major medical problem throughout the world and health care workers are particularly at risk. Vaccination offers protection, but up to 15 per cent of healthy people do not respond to currently licenced hepatitis B vaccines. A paper in this week's BMJ offers hope of protection for these "non responders",

A new type of vaccine was given to 100 health care workers who had previously failed to respond after at least four doses of conventional hepatitis B vaccine. After a single dose, 69 of them developed immunity. Systematic vaccination of people at risk of exposure to the virus has been the main method of controlling hepatitis B which is transmitted primarily by blood to blood contact.

Contact:
Dr Jane Zuckerman

Tel: 0171 830 2999
Fax: 0171 830 2268
e-mail: j.zuck@rfhsm.ac.uk

EMBARGO: 00.01 HRS Friday 31 January 1997

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