American Airlines has supplied its "long distance over
water" aircraft with automatic external defibrillators, and 2300
cabin staff are being trained in their use. An editorial in
Aviation Space and Environmental Medicine
(1997;68:365-7) explains that aircraft are already in radio
contact with a "physician on call" system. The airline believes
that taking this action may save lives and will expose it to a lower
risk of litigation than doing nothing.
Fewer than one third of patients with sickle cell disease or
with |gb thalassaemia have a relative who can provide an HLA identical
bone marrow donation. The alternative is to use unrelated cord blood as
the source of donor stem cells (Journal of Pediatrics
1997;130:695-703). At least 200 patients have been treated with
this technique, but it is still uncertain whether the use of cord blood
cells overcomes all the problems of HLA incompatibility.
The treatment of epilepsy with drugs still leaves much to be
desired, says a review in the Southern Medical Journal
(1997;90:471-80). The review recalls that in the 1920s the
observation was made that people who fasted often stopped having
epileptic seizures, and treatment was tried with a ketogenic diet, high
in fat and low in protein and carbohydrates. This worked, but patients
disliked the diet and many preferred to go on having seizures.
A circular from Unesco landed on Minerva's desk addressed
to Abstracts of World Medicine, a BMA journal that
ceased publication in 1971. Before being too critical, other publishers
might look at their own circulation lists.
One fifth of children attending two London hospitals for
treatment of their congenital heart disease have never seen a dentist
(Archives of Disease in Childhood 1997;76:539-40), as
against 3% of controls. Yet cardiologists continue to give children
"heart cards" to take to their dentists, giving advice about
antibiotic prophylaxis. Clearly many parents and children have failed
to understand the possible links between dental problems and
endocarditis.
Now that multiple drug treatment has become established as
the optimum regimen for people with established HIV infection, should
it be given to patients who have been diagnosed as having an acute
primary HIV infection? A grand rounds article in JAMA
(1997;278:58-62) suggests that this may offer a possibility of cure: if
HIV replication can be suppressed to undetectable numbers for 18-36
months the virus may be eradicated.
"Eighteen years of research have produced considerable
paranoia, but little insight and no prevention," says an editorial in
the New England Journal of Medicine (1997;337:44-6)
commenting on the latest research report to find no association between
electromagnetic fields and childhood cancer, especially leukaemia.
Unfortunately, too many of the studies have produced results which
might best be described as weakly equivocal.
Maastricht is clearly a great place for treaties, meetings, and
so on: the European Helicobacter Pylori Study Group has just published
its Maastricht consensus report (Gut 1997;41:8-13) on
diagnosis and treatment. The report recommends that the infection
should be eradicated in patients with peptic ulcers, low grade gastric
lymphomas, and gastritis with severe abnormalities and after resection
for gastric cancer. Eradication treatment should be based on a proton
pump inhibitor and two of clarithromycin, a nitroimidazole, and
amoxycillin.
Both professional and amateur forensic scientists have been
fascinated by the saga of the mummified "Iceman" discovered in the
Alps in 1991. Investigations in Vienna have shown that the body spent
several months submerged in water before the process of desiccation
began (Chemistry European Journal 1997;3:1032-7).
Floating face down in the water, the body would have been partially
exposed to the elements, and some of the damage to the face may have
been due to the corpse being dragged over rock as the water receded.
Raised concentrations of creatine kinase and its myocardial
isoenzyme are pointers to recent myocardial infarction, but these
enzymes are also present in raised concentrations in patients receiving
haemodialysis for renal failure. A refinement of the enzymes test uses
subforms of the myocardial isoenzyme. Unfortunately
(Nephron 1997;76:296-99), all forms of the
myocardial enzymes are raised in renal failure - a finding
that might lead to an erroneous diagnosis of a heart attack in some
circumstances.
More than 90% of Americans are concerned about the links
between sunlight and skin cancer (and wrinkling), but 68% still
thought they looked better and felt better when they had a suntan
(Mayo Clinic Proceedings 1997;72:461-6). Public health
campaigns have improved knowledge and increased anxiety but had little
impact on behaviour - and the upward trend in the numbers of new cases
of malignant melanoma shows no sign of slowing down.
In 1884 the American surgeon William Halstead read of the
local anaesthetic effect of cocaine and began experiments with the drug
that led to his becoming addicted (Annals of Surgery
1997;225:445-58). He was treated by being switched to morphine,
but he remained dependent on morphine for most if not all of the
30 years in which he was chief of surgery at Johns Hopkins and the
leading academic surgeon in the United States.
Most studies of hormone replacement therapy provide data on only
a few years' experience, so Minerva was interested in a report from
Denmark (British Journal of Obstetrics and Gynaecology
1997;104:702-7) on 73 women who were enrolled in a trial in 1985 and
have been followed up since. After eight years the bone mineral density
in the lumbar spines of the women taking the hormones had increased
by 12% over the baseline value and was 15% higher than that in
untreated controls. Six of the women in the control group and one in
the treated group had had fractures.
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