Since Boeing started building aircraft, its designers have had
to raise the assumed weight of each passenger by 9 kg. The volume of
the British Medical Bulletin (1997;53(2):229-450) on
obesity quotes that figure and follows it with the effects on a person
of shedding those 9-10 kg. Overall mortality is cut by 20-25%, the
serum total cholesterol concentration falls by 10%, and the risk of
diabetes is cut by half.
Around 85% of children with congenital heart lesions
survive into adult life. Cardiologists qualifying nowadays rarely have
been trained to cope with adults with corrected congenital heart
disease, say two editorials in Heart (1997;78:12-5). The
clinical problems posed may be formidable, especially in pregnancy.
Unfortunately, says the journal, the risks of pregnancy are difficult
to assess because there is no dataset and so evidence based cardiology
cannot be practised.
In the past 30 years in industrialised countries the incidence
of asthma has risen substantially, and the same is true of atopic
dermatitis (British Journal of Dermatology
1997;137:1-8). One factor is relevant to both conditions: the epidemic
of infestation with house dust mites. Measures to control the mite
allergens - reducing humidity, using synthetic bedding covers, and
using chemical warfare against the mites - should help in both
conditions.
A debate article in Annals of the Royal College of
Surgeons of England (1997;79:264-7) argues for and against the
assertion that intermittent claudication should not be treated
surgically. No one disputes that stopping smoking, losing weight, and
lowering blood pressure and serum lipids are the best treatments for
most patients: the question is how many really benefit from the
"outstanding" long term results of bypass operations for aortoiliac
disease.
Pressure from cost conscious managers is one reason why much
clinical work is being delegated to generalists and auxiliaries, so
Minerva was cheered by an editorial in Chest
(1997;111:1478) calling for recognition that specialists are usually
rather good at their jobs. Does anyone really believe that training and
experience do not improve the quality and efficiency of clinical
skills?
Patients with polymyalgia rheumatica commonly complain of aches
and stiffness in the shoulders. A study in Italy that used magnetic
resonance imaging (Annals of Internal Medicine
1997;127:27-31) found that all 13 patients with polymyalgia but none of
the normal controls had inflammation of the subacromial and subdeltoid
bursae in association with synovitis of the glenohumeral joints.
Patients infected with HIV who have very low CD4 counts quite
often have eosinophilia (American Journal of Medicine
1997;102:449-53). Investigation of 42 such patients found that the
common explanation was a skin disorder. None of the patients had
evidence of allergic reactions or parasites. The usual extensive
investigations for asymptomatic eosinophilia seem not to be justified
in patients with AIDS.
The English sweating sickness appeared from nowhere in 1485 and,
after five separate summer epidemics, disappeared for good in 1551. Its
symptoms were sudden in onset, with profuse sweating, prostration, and
death or recovery within 24 hours. An examination of the evidence in
Medical History (1997;41:362-84) concludes that the most
likely cause was an arbovirus infection, though this would not explain
the apparent cases of human to human transmission
Minerva has been sent a copy of FACT, or
Focus on Alternative and Complementary Therapies, a
journal produced by the department of complementary medicine at the
University of Exeter. Its sceptical approach is apparent from the
titles in the contents list, which are peppered with
"unsatisfactory," "unconvincing," "may," and question
marks, with a few "promising" and "positives." The editors must
be right to argue that pointing out flaws in published research helps
to make readers more critical.
Minerva has been sent a copy of FACT, or
Focus on Alternative and Complementary Therapies, a
journal produced by the department of complementary medicine at the
University of Exeter. Its sceptical approach is apparent from the
titles in the contents list, which are peppered with
"unsatisfactory," "unconvincing," "may," and question
marks, with a few "promising" and "positives." The editors must
be right to argue that pointing out flaws in published research helps
to make readers more critical.
A stomach chilling review of toxic (as opposed to
infective) poisoning from edible fish (Journal of Accident and
Emergency Medicine 1997;14:246-51) ends with some advice for
travellers to areas such as the Caribbean: never eat Moray eel or other
scaleless fish; avoid particularly big specimens; do not eat the head,
liver, gonads, or viscera; and if you become ill get medical
help.
In the Netherlands a lot of young children are injured by
the spokes of the rear wheel when they are being carried as passengers
on bicycles (Injury 1997;28:267-9). One hospital in
Utrecht saw 59 children with spoke injuries in one year, 17 of whom had
fractures. These injuries are preventable if bicycles are fitted with
guards - and injuries are less severe if child passengers wear shoes.
Further evidence that people with big heads are less likely to
develop Alzheimer's disease has come from a study of 649 Manhattanites
(Neurology 1997;49:30-7). Eighty four were found to be
demented. In both sexes those in the lowest fifth for head size were
two to three times more likely to be demented than those in the top
fifth.
A massive trial in 4589 healthy nulliparous women found no
evidence that taking calcium supplements affected the development
of pre-eclampsia, pregnancy associated hypertension, or adverse
perinatal outcomes (New England Journal of Medicine
1997;337:69-76). An editorial comments that recent trials of aspirin
have been equally disappointing; in both cases early hopes from small
trials were disappointed by larger studies. The conclusion must be
that more attention should be paid to the underlying mechanisms.
Another source of perennial disappointment is the attempt to
develop a vaccine against malaria. Twenty years after the first trials
established the feasibility of the project an editorial in the
Journal of Clinical Pathology (1997;50:535-7) concludes
that there is still no vaccine likely to be introduced into control
programmes in the foreseeable future. Most of the 500 million people
who develop clinical malaria each year live in sub-Saharan Africa -
where most of the two to three million deaths occur.
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