BMJ No 7120 Volume 315
Minerva Saturday 29 November 1997
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This itemised quarterly telephone bill, 20 pages long, belongs
to a woman aged 80 with moderately severe dementia. She has substantial
deficits of short term memory and perseveration, and as a result she is
a frequent user of the telephone, with 1200 calls in one quarter - four
fifths to her daughter. This is an extreme example of a phenomenon
observed quite often in dementia..
A K Shah,
F Sebastianpillai, Submissions for this page should include the signed consent to publication from the patient |
Research on volunteers in the United States has established one
mechanism by which sunlight damages the skin: it causes a rise in
matrix metalloproteinases, enzymes that degrade the collagen in the
skin (New England Journal of Medicine 1997;337:1419-28).
Pretreatment of the skin with tretinoin inhibited this response to
sunlight, suggesting that this drug might be useful in treating skin
damaged by photo-aging and possibly in preventing the development of
premalignant lesions.
Some new initiative is needed: Australia claims to lead the
world in educating its population about skin cancer, and two thirds of
those questioned recently by telephone claimed that they "didn't
like to get a sun tan." More people are wearing hats and using
sunscreens (Medical Journal of Australia
1997;167:515-6). But the change in attitudes has slowed down, and just
as there are recidivist smokers so, it seems, will some people continue
to expose their skins to sunlight - which may be getting more damaging
year by year as ozone holes widen.
Wheezy bronchitis in childhood is not only clinically
distinguishable from asthma, its heritability is also clearly distinct
(Thorax 1997;52:953-7). That is the conclusion of a
study of the offspring of parents with the two conditions or with
neither. The prevalence of current wheezing was lower in the offspring
of parents with wheezy bronchitis than in the offspring of parents with
asthma. Curiously, the rate of current wheezing was intermediate in the
offspring of parents with no history of wheezing. All a bit confusing,
but no doubt further research will make matters clearer.
The Doyne lecture on tears, published in Eye
(1997;11:583-602), taught Minerva a great deal about dry eyes.
These may be due to a deficiency of tears or to excessive evaporation.
Treatment with tear substitutes is being augmented by techniques to
conserve the tears by punctal occlusion and the provision of protective
spectacles.
Outbreaks of infection with Salmonella
enteritidis associated with raw eggs continue to occur in most
countries in Europe but not in Sweden, where eggs and egg laying flocks
are free of salmonella (Eurosurveillance 1997;2:86-8).
Regulations introduced in Sweden in 1961 control the quality of egg
laying hens, their lineage, and their feed. Any hens imported are
quarantined for 15 weeks, during which time they are tested for
salmonella on four occasions; those in which the results of the test
are positive are destroyed.
An observational study of 100 consecutive laparoscopic adrenal
procedures (three biopsies; 97 adrenalectomies) has concluded that this
is now the procedure of choice for adrenalectomy except in patients
with invasive carcinomas or with tumours over 15 cm. The report in
Annals of Surgery (1997;226;238-47) admits that no
randomised trial has been done, but uses historical controls to show
that the minimally invasive technique is associated with less blood
loss and a shorter hospital stay.
Varicella vaccine has been available in the United States since
1995, where it is recommended for all infants at 12-18 months. So far
only a fifth have taken up the offer (JAMA
1997;278:1529-30). The problem is that the disease is widely perceived
as minor, though it may be lethal in adults, and doubts persist about
the length of the immunity given by immunisation in childhood. A
further complicating factor is that the effect of vaccination on zoster
is unknown. Nevertheless, the journal's editorial gives unequivocal
support to infant vaccination.
A study of brain development in children in which magnetic
resonance imaging was used has provided controls for a follow up of
children diagnosed as having schizophrenia before the age of 12
(Archives of General Psychiatry 1997;54:897-903).
The children with schizophrenia were found to have a progressive
increase in the volume of their ventricles when compared with the
controls. This ventricular enlargement in children with schizophrenia
during adolescence was more marked than similar changes seen in adults
with the disease.
When Minerva was young she used sometimes to attend and enjoy
the BMA Junior Members Forum. It still meets once a year, and the next
occasion is on 18-19 April in London: subject, medical ethics. Working
groups will discuss topics including death and dying, drug use and
misuse, and assisted conception. The meeting enables 60 young doctors
within 12 years of provisional registration or 11 years of full
registration to exchange views in an informal setting - all paid for by
the BMA. Those interested should contact their local BMA office.
Among the standard treatments recommended for
osteoarthritis is injection of corticosteroids into the joints
affected. However, says an editorial in Annals of the Rheumatic
Diseases (1997;56:634-6), the evidence supporting the use of
such injections is relatively weak: none of the studies showing benefit
can be rated highly on measures of quality of design. Placebo
injections have proved equally effective in some studies. No doubt
rheumatologists will continue to use the treatment, but further efforts
are needed to identify the patients most likely to respond.
Many people believe that a boy's voice "breaks" at the
start of puberty. A longitudinal study of 26 boys in Cambridge
(Archives of Disease in Childhood 1997;77:445-7) found
that changes in the boys' voices occurred abruptly in late puberty as
assessed by Tanner staging (which fitted well with the Cooksey musical
classification of voice analysis). Changes in the voice correlated with
the size of the testes but not with the concentration of testosterone
in the saliva.
Surgeons who use starch dusting powder in their gloves are
warned that they risk their patients developing adhesions, starch
peritonitis, and retroperitoneal fibrosis (Annals of the Royal
College of Surgeons of England 1997;79:466-7). Most British
surgeons have switched to powder free gloves, but in the litigious
United States the proportion using starched gloves is 86%, and similar
high rates are found in most European countries. So who is right?
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