Genital herpes was much discussed in the 1980s and early 1990s but seems (to Minerva at least)
to have faded from prominence in the popular media. Yet a major study in the United States
(New England Journal of Medicine 1997;337:1105-21) has found that in 1988-94 the proportion
of Americans over the age of 12 with antibodies to the virus was 21%. That is an increase of 30%
over the prevalence in 1976-80. The highest rates were in people aged 30-39. Overall, these
figures suggest that neither propaganda about safe sex nor antiviral drugs have had any impact on
the control of the disease.
A vaccine is available to give short term immunity to meningococcal infection due to serogroups
A, C, Y, and W135, but it is not recommended for the general population (Eurosurveillance
1997;2:69-71). The protection given by the vaccine lasts for only three years, it is poorly
immunogenic in children under 18 months, and it lacks a serogroup B component - and
meningococci of that group account for most cases of meningococcal disease in Europe and
North America. New vaccines are being developed that should solve some of these problems.
Current warnings of the dangers of exposing the skin to sunlight make a dramatic contrast with
medical practice in the first half of this century, when heliotherapy was widely recommended for
the treatment of infected wounds (Medical History 1997;42:455-72). Niels Finsen received a
Nobel prize for medicine for showing that tuberculosis of the skin could be cured by ultraviolet
light, and Auguste Rollier popularised a regimen of fresh air and controlled exposure to the sun
for the treatment of systemic tuberculosis in Swiss sanatoriums.
Infection with hepatitis C virus was more common in patients with B cell non-Hodgkin's
lymphoma than in controls in a study on Hispanic patients in California (Annals of Internal
Medicine 1997;127:423-8). This report adds to the weight of evidence that the virus plays a part
in the pathogenesis of some types of lymphoma, but some studies have failed to find an
association.
So far in Britain around 200 000 people have had knee replacement operations, and the annual
total is continuing to rise (Annals of the Royal College of Surgeons of England 1997;79:335-40).
Thirty seven different total knee replacement prostheses are in current use, six of which have
been introduced in the past 18 months. Only for five types of replacement knee are there data on
survival for 10 years or longer.
Around 9% of cancers of the prostate are associated with mutated susceptibility genes, and the
story has been taken a little further on with a paper in JAMA (1997;278:1251-5). A gene has been
located on chromosome 1 in the q 24-25 region. The article recommends that men from families
with three or more men with prostate cancer should start regular screening from the age of 40
onwards.
The same issue of JAMA (1256-61) reports attempts to identify susceptibility genes for multiple
sclerosis. So far, at least two regions, on chromosomes 6 and 19, have been identified as playing
a part in the aetiology of the disease.
The national audit of acute upper gastrointestinal haemorrhage in Britain recommended that
hospitals should introduce protocols for the management of patients with this condition. Follow
up showed (Gut 1997;41:606-11) that 41 of 45 hospitals studied had made the recommended
changes, but mortality was not affected. The authors conclude that most deaths due to upper
gastrointestinal bleeding are probably not preventable.
Some calculations made in the Netherlands suggest that people who spend most of their lives
exposed to air polluted with fairly low concentrations of fine particulate matter have their life
expectancy reduced by more than one year (Occupational and Environmental Medicine
1997;54:781-4). Minerva wonders what the medicolegal consequences may be of research along
these lines. If tobacco companies are being found responsible for the deaths caused by their
products, what about electricity generators and transport companies?
Ototoxicity from aminoglycosides is a matter of current concern because these drugs are still
used widely in many countries, not least for the treatment of tuberculosis. Ototoxicity occurs both
sporadically and in families. A paper in the Journal of Medical Genetics (1997;34:904-6) reports
on a South African family in which the ototoxicity was found to be due to a mitochondrial
disorder. Family members who have inherited this type of susceptibility to ototoxicity can now
be identified and offered treatment with other drugs.
Resection of the pancreas for cancer has a far lower mortality when performed in a specialist unit
than when done by a general surgeon, says a report in the British Journal of Surgery
(1997;84:1370-6). The postoperative mortality in the specialist units was 6%, whereas a regional
survey in the West Midlands recorded a mortality of 28%. Around 6000 people die from this
cancer each year in England and Wales: some at least of these deaths are preventable if specialist
surgery were made more widely available.
One of the drawbacks of vasectomy is the need for couples to continue to use ordinary
contraceptives until two consecutive azoospermic semen samples have been obtained. A study in
Edinburgh (British Journal of Family Planning 1997;23:77-9) has concluded that this
requirement cannot safely be relaxed. For early recanalisation to be safely excluded the two
negative test results should be recorded after an interval of 18 weeks after the operation. Earlier
testing would please the patients but has not been shown to be reliable.
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