The currently accepted treatment for anyone suspected of having
had an acute myocardial infarction is an immediate dose of 160 mg of
aspirin. Yet a study in Rhode Island (Annals of Internal
Medicine 1997;127:126-9) found that only 253 of 463 patients
seen in the emergency room were given aspirin, and in half of those to
whom it was given the delay was more than an hour.
Among the four high mortality cancers (lung, colorectal, breast,
and prostate) colorectal cancer is the only one that has become
substantially more curable in the past 25 years as a result of better
detection. So Minerva was depressed to read yet another account
(Journal of Epidemiology and Community Health
1997;51:453-8) of a colonoscopy screening programme in
relatives of patients with cancer of the colon in which only 30% of
those offered testing accepted the invitation. Out of 233 relatives
screened, two had cancers and 24 had adenomatous polyps.
A controlled trial in Italy of the use of intramuscular immune
serum globulin in sex partners of patients with hepatitis C is reported
in Archives of Internal Medicine (1997;157:1537-44).
Only one of the 450 given the active treatment seroconverted, as
against six given the placebo, in whom sequence homology studies
provided strong evidence of sexual transmission.
Mortality in England and Wales from cancer of the cervix fell by
1-2% a year between 1960 and 1988, but the decline accelerated in the
early 1990s, so that by 1995 the total number of deaths was 1329 as
against 2004 in 1986 (British Journal of Obstetrics and
Gynaecology 1997;104:876-8). This dramatic improvement was
associated with an increase in coverage by the screening programme from
42% in 1988 to 85% in 1995.
Minerva has been sent details of a Scotsman who died recently
aged 86 of complications of hepatitis C acquired from his treatment
with factor VIII for his haemophilia. He must have been one of the
oldest patients with haemophilia, kept alive by the treatment that
eventually killed him.
A dramatic night of thunderstorms in 1994 led in many parts of
England to a 10-fold increase in the numbers of patients attending
hospital emergency departments with acute asthma. Examination of the
effects of other thunderstorms (Thorax 1997;52:680-5)
before and since has found that most caused only a small (25%)
increase in hospital admissions for asthma. Exceptional storms are
exceptional and need to be combined with high pollen counts to produce
dramatic effects.
Almost half the 3,000 men and women over the age of 65 questioned
in a study reported in the Medical Journal of Australia
(1997;167:72-5) had lower urinary tract symptoms (sometimes known as
LUTS). Most of the symptoms were mild; and an editorial in the same
issue (62-3) advised reassurance of most men who were not seriously
bothered. They can be told that mild symptoms are unlikely to represent
a threat to health and that intervention is unlikely to improve the
outcome.
Disorders of the temporomandibular joints are common; some
investigators have found symptoms or signs in around half the people
they studied. A review in the European Journal of Orthodontics
(1997;19:249-58) suggests that these disorders may be linked
with "open mouth" postures. Oral health requires that the teeth
should kept in contact for much of the waking day. The article says
nothing about the advisability of chewing gum, which seems to be nearly
continuous in some occupations such as professional cricket.
How much of an advance is laparoscopic appendicectomy? Further
evidence against its use comes from a randomised controlled trial in
Denver (Archives of Surgery 1997;132:708-12). This
concluded that patients treated by the old style open operation spent
no longer in hospital and recovered just as quickly - but they spent
less time in the operating theatre, and open appendicectomy was
cheaper.
Effective antiviral treatment of HIV infection reduces the
amount of the virus detectable not only in the blood but also in the
semen (AIDS 1997;11:1249-54). A study in Switzerland
found that all the treated patients who lost detectable HIV RNA in
their blood also had no detectable HIV RNA in their semen. Further
research is needed, but these findings suggest that treatment may make
men non-infectious to their sexual contacts.
The MRCP technique is not just a way of passing
postgraduate examinations; the acronym also stands for magnetic
resonance cholangiopancreatography, a non-invasive method of imaging
the biliary and pancreatic duct systems (Gut
1997;41:135-7). The images obtained are said to compare well with
those from endoscopic imaging. At the very least, magnetic resonance
imaging may help to identify those patients who are likely to have
abnormal findings at endoscopic retrograde cholangiopancreatography.
Several research studies have suggested that environmental noise
may be a risk factor for coronary heart disease. A study of blue collar
workers reported in Archives of Environmental Health
(1997;52:292-8) found that young men exposed to noise louder
than 80 dB had higher serum cholesterol concentrations than men exposed
to little noise. Annoyance by the noise seemed to have an additional
additive effect on the cholesterol concentration.
The recent epidemic of diphtheria in the newly independent
states of the former Soviet Union had some curious features,
says Eurosurveillance (1997;2:59-68). Around 70% of the
cases were in adults, though the underlying cause of the outbreak was
said to be failure of child immunisation. All the reported cases in
other eastern European countries were also in adults, but the disease
did not spread to the West. Clearly a lot has still to be learnt about
the epidemiology of infections in the post-immunisation era.
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