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BMJ No 7126 Volume 316
Minerva Saturday 17 January 1998
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A man aged 77 died of bronchopneumonia after many
years of severe idiopathic Parkinson's disease. At necropsy a striking
finding was black pigmentation of the cartilages. This included the
ribs and the intervertebral discs. There was greyish discolouration of
the pinnae and sclera. Ochronosis was excluded by the lack of
degenerative changes in the
C E Keen, Submissions for this page should include the signed consent to publication from the patient |
Data from the Framingham heart study, which began in 1948,
have shown that in men aged 45-65 the risk of ischaemic stroke was
lowest in those who ate the most fat (JAMA
1997;278:2145-50). An editorial in the same issue uses these
data to support the advisability of the Mediterranean diet, which has
high levels of monounsaturated fat, notably olive oil. Olive oil does
not increase the serum cholesterol concentration and so does not
increase the risk of coronary heart disease.
Genetic counselling should be offered to couples when one of
their children is found to have cystic fibrosis, but this does not
always achieve its aim of preventing them having further affected
children. An analysis of 42 families with two children with the disease
(Archives of Disease in Childhood 1997;97:501-3) found
that in 10 cases no offer of prenatal diagnosis had been made; in 24
cases the offer had been declined; and in eight cases the couples had
accepted prenatal diagnosis but had decided against
termination. Part of the problem seems to have been poor communication
between the doctors who should be providing the advice.
Danish merchant ships commonly employ both sexes as sailors,
navigation officers, and radio operators. Follow up of 6788 women
seafarers (Occupational and Environmental Medicine 1998;55:49-51) found that those in traditionally male jobs had a far
higher mortality than women working in the ships' galleys. Working in
tough jobs at sea seems to increase hazardous behaviour and make a high
risk lifestyle more likely - or possibly attracts women with these
characteristics.
One of the advisers to the BMJ is somewhat miffed
to have had a grant application to a research funding body turned down
by a standard letter explaining that the application had not been
firmly stapled together. Stapling probably deserves further study:
Minerva believes she can recognise papers that have been rejected by
one competitor journal because staple holes (but no staples) have been
left in the top left hand corner. When authors had secretaries
manuscripts were retyped before being sent to another journal.
General practitioners are encouraged to document obesity, but an
article in the British Journal of General Practice
(1998;48:890-4) argues that this is a waste of resources. Obese
patients know they are overweight, and most are aware that being obese
carries health risks. Measuring and recording the patient's exact body
mass index does little or nothing to help him or her lose weight.
It may be some consolation to Britons struggling with their New
Year resolutions to lose weight that one quarter of all Americans are
making the same effort. The New England Journal of Medicine
(1998; 338:52-4) warns doctors to be cautious about exhorting
patients to lose weight when they are only mildly obese. It suggests
that more attention should be given to prevention: "If the time
children now spend in front of the television eating junk food and
watching advertisements for more junk food was spent instead in
physical activity...."
Chronic pelvic pain is neither well understood nor well treated,
says a review in the British Journal of Obstetrics and
Gynaecology (1998;105:8-10). Gynaecological investigations
typically find nothing abnormal. The part played by psychopathological
factors is still uncertain. The conclusion is that the disorder is "a
major problem seeking solutions" - and that, of course, more research
is needed.
Traditional methods of child care may be attractive but may
sometimes be dangerous. The sarong cradle is widely used in South East
Asia to help get a child to sleep. It consists of a length of cloth
suspended from a spring to a ceiling anchor. The Singapore
Medical Journal (1997;38:517-9) describes 19 children aged
between 13 days and 29 months, all of whom had fallen out of their
cradles and sustained head injuries. None of the injuries was severe,
but the cradle has the potential to cause a tragedy.
Findings from the health and lifestyle surveys of 1984-5 and
1991-2 show that Britain is continuing to show polarisation by social
groupings (British Journal of Nutrition 1997:873-88).
The healthy middle classes who don't smoke and who drink alcohol in
moderation are the same people who eat a lot of fruit, salads, and
vegetables. However, despite the widening of the health divide some
trends are positive: most people are using more low fat spreads and
milk and are eating less fried foods including chips.
The search continues for an alternative to opioids: morphine has
so many drawbacks that doctors use it cautiously. Researchers in the
United States (Science 1998;279:32-3) believe that they
may be close to a real breakthrough with an acetylcholine receptor
blocker, ABT 594. This compound is chemically similar to nicotine and
to a chemical found in the skin of some tropical frogs. The new
analgesic is said to be as powerful as morphine, but because it acts on
other receptors it may prove not to be addictive.
Screening using serological tests for antibodies to reticulin or
endomysium will detect many people with unrecognised adult coeliac
disease and mild or atypical symptoms. A study in Finland
(Scandinavian Journal of Gastroenterology
1997;32:1129-33) found that combining serological tests with open
access endoscopy and small bowel biopsy led to a 10-fold increase in
the incidence of the disease and an overall prevalence of 270/100,000
people. This is in line with findings of other recent studies in Europe
suggesting substantial lack of recognition of a disease that may cause
prolonged poor health and is easily treatable.
In the 1930s Nazi Germany condemned tobacco as a genetic poison
and a cause of cancer and launched an aggressive antismoking
campaign (Bulletin of Medical History 1997;71:435-88).
German scientists had suggested a link between lung cancer and smoking
as long ago as 1912, and throughout the Nazi regime they published
research strengthening the association, but after the war ended, this
work was either forgotten or ignored.
A massive review of antenatal screening for Down's syndrome
(Journal of Medical Screening 1997;4:181-246) calls for
the establishment of around 35 screening centres in Britain, each
providing services for three or four maternity units. The procedure
should be offered to all pregnant women in the second trimester and
should use either triple or quadruple serum tests to identify women who
should have amniocentesis.
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