Heavy use of cannabis can affect motivation, but there is no
need to evoke an amotivational syndrome to explain the narrowed
interests, loss of motivation, and reduced achievement seen in some
heavy cannabis users, says an editorial in the British Journal
of Psychiatry (1997;171:107-8). These are simply the symptoms
of chronic cannabis intoxication. Heavy use is unlikely to cause
structural damage to the brain, because the drug acts on a specific
receptor.
Old people who survive an attempt at suicide are likely to try
again. A study of 100 patients over 65 referred to a liaison
psychiatric service (British Journal of Psychiatry
1997;171:42-6) and followed up an average of 3.5 years later found that
42 had died, 12 from repeat suicides and five from delayed effects of
their first attempt. Thirty seven of the 58 survivors were still
receiving active psychiatric treatment.
The Chingford study has been investigating the health of 1003
middle aged London women since the late 1980s. Its data show that those
women currently using hormone replacement treatment are less likely
than the others to have osteoarthritis affecting their hands or knees
(Annals of the Rheumatic Diseases 1997;56:432-4). No
benefit could be found in women who had taken hormones in the past but
had stopped them three or more years before their joints were assessed.
Children and teenagers with one leg longer than the other
benefit both physically and psychologically from surgery to lengthen
the shorter limb. The standard technique requires an osteotomy and
traction to extend the callus. A report from Hong Kong (Annals
of the Royal College of Surgeons of England 1997;79:280-6)
says that dual energy x ray absorptiometry gives the
best data on changes in the bone mineral content of the callus and
hence on the speed at which the bone can be stretched.
In both world wars military hospitals were set up for Canadian
servicemen at Lord Astor's estate at Cliveden, and in 1946 the second
hospital was presented to the people of Britain as the Canadian Red
Cross Memorial Hospital, Taplow. The first patient was admitted in
1947, and the 50th anniversary of the hospital has been marked by
publication of its history by Dr Barbara Ansell (9 Beaumont Road,
Windsor SL4 1HY) and her colleagues. Despite its enormous achievements
in research into childhood rheumatism the hospital now stands "empty,
derelict, waiting to be pulled down," but those who worked there
remember it with great affection.
Twelve months after a call for an end to the use of pulmonary
artery catheters in monitoring critically ill patients a consensus
statement has appeared in Critical Care Medicine
(1997;25:910-25). The experts acknowledge that a lot of research is
needed to provide high quality evidence but offer reassurance, saying
that there "is no basis for a moratorium on use of the catheters"
while the evidence is collected.
A number crunching analysis of 38 931 patients with colorectal
cancers has identified several associations that may make screening
more effective (Cancer 1997;80:193-7). At present,
sigmoidoscopy and barium enema are the most cost effective screening
strategies for adults at average risk. The paper suggests that the
first choice for white men (who tend to have distal cancers) should be
sigmoidoscopy, while black women, who tend to have proximal tumours,
should have a barium enema as the first choice.
Lung cancer should possibly be included among the cancers that
are more common in people infected with HIV. Data from a hospital in
New York (British Journal of Surgery 1997;84:1068-71)
indicate that in patients with HIV infection the lung cancer develops
at an earlier age than usual and seems to behave more aggressively.
Lung cancer may be underdiagnosed in these patients, in whom serious
lung infections are so common.
Fraud is being recognised ever more frequently among research
workers, and attention is now being directed to parafraud - illogical or
improper behaviour towards other people's views or publications
(Science and Engineering Ethics 1997;3:121-36)
Scientists often blame "pressure to publish" for dubious behaviour,
but what that really means is that their desire to advance their
careers may make them act in an intellectually dishonest fashion.
Patients whose seizure disorder seems to be exacerbated by
stress may benefit from psychological techniques, says a review in the
Journal of Neurology, Neurosurgery and Psychiatry
(1997;63:137-42). Further research is needed to compare cognitive
behavioural methods with those that have a more direct
neurophysiological rationale, such as electroencephalogical
feedback. Whatever methods are used, however, the patients'
perceptions of their ability to affect the number of seizures they have
may be an important factor.
Dengue may seem an obscure tropical disease of which readers of
the BMJ know little, but one third of the world's
population live in areas in which dengue is endemic, and tens of
millions are infected each year. The disease affects many islands in
the Caribbean (West Indian Medical Journal
1997;46:38-41), including Cuba, Jamaica, and Trinidad, where increasing
efforts are being made to control vectors.
Home | Current issue | Past issues |
Classified ads | Career Focus | Feedback
Collections |
About this site | About the BMJ | BMA | Medline
|
