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BMJ No 7093 Volume 314 This week in BMJ Saturday 24 May 1997 Testicular biopsy is associated with increased risk of testicular cancer in cryptorchidism Intensive insulin treatment improves prognosis for diabetics with myocardial infarction Sleeping on mattresses used by others may increase risk of cot death Girls have an excess neonatal mortality in South India Early antibiotics provide little benefit in acute otitis media Testicular biopsy is associated with increased risk of testicular cancer in cryptorchidism Cryptorchidism can lead to testicular cancer, and the effect of orchidopexy on the risk of malignancy is uncertain. Swerdlow et al (p 1507) followed a cohort of over 1000 boys with cryptorchidism treated at one hospital up to 45 years ago. During follow up, 12 testicular cancers occurred in these patients, with a relative risk of 7.5 compared with men in the general population. There was no evidence of decreased risk of malignancy with younger age at orchidopexy, but a large increase in risk when testicular biopsy had been performed during orchidopexy. Intensive insulin treatment improves prognosis for diabetics with myocardial infarction Although the prognosis after myocardial infarction has improved recently, this does not apply to diabetic patients, possibly because of poor metabolic control. On p 1512 Malmberg reports research on over 600 diabetic patients with myocardial infarction to test if improved metabolic control improves the prognosis. All received standard antidiabetic treatment, but half also received an initial insulin-glucose infusion followed by subcutaneous insulin treatment during follow up. Over five years the mortality was reduced from 44% in the control group to 33% in the treatment group. This corresponds to a relative reduction in mortality of 28%, equivalent to one life saved for every nine patients treated with the insulin regimen. Sleeping on mattresses used by others may increase risk of cot death Changes in sleeping position for infants have resulted in a major reduction in the rate of the sudden infant death syndrome. On p 1516 Brooke et al report a case-control study in Scotland during 1992-5. Their results confirm that parents' smoking and infants sleeping prone are risk factors. Smoking showed a dose response, and the risk increased with bed sharing. A new finding was an increased risk for infants who routinely slept on a mattress previously used by others, although the risk for mattresses totally covered by polyvinyl chloride was not established. Girls have an excess neonatal mortality in South India During the past three decades, death and birth rates have declined in India, and it is uncertain how many pregnancies a women has to have to achieve the desired number and sex of children. In a community based study in rural Tamil Nadu, Nielsen et al (p 1521) found that women give birth for the first time relatively late and have a limited number of children. The reduced number of children may collide with the wish of many families to have at least one son. An excess neonatal mortality among girls constitutes about one third of the perinatal mortality. It seems to be linked to preference for sons and must therefore be addressed through a holistic societal approach. Early antibiotics provide little benefit in acute otitis media There is wide variation in the use of antibiotics for early treatment of acute otitis media in children, and on page 1526 Del Mar et al describe their meta-analysis to establish what benefits or harm antibiotics provide. They found that antibiotics did not influence resolution of pain within 24 hours of presentation. At 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by about 40%. Antibiotics reduced contralateral acute otitis media; had little influence on subsequent attacks of otitis media or deafness; and were associated with a nearly doubled risk of vomiting, diarrhoea, or rashes. The authors conclude that early antibiotics provide only modest benefit: to prevent one child experiencing pain by 2-7 days after presentation, 17 must be treated. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline