Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7128 Volume 316 Minerva Saturday 31 January 1998 A woman who had been treated for acute lymphoblastic leukaemia at the age of 2 went on to develop epilepsy at the age of 33. Computed tomography showed striking widespread cortical calcification, a finding associated with cranial irradiation. We were surprised to find that the patient had not received any radiotherapy. She had been treated with intrathecal methotrexate. The intracranial calcification was thought to be due to mineralising microangiopathy secondary to intrathecal methotrexate; it tends to progress and enlarge with time. Helen Oxenham, specialist registrar A Zeman, consultant neurologist Western General Hospital, Edinburgh EH4 2XU Submissions for this page should include the signed consent to publication from the patient Empirical treatment with an antibiotic without serological testing is the recommended management for a patient with a rash resembling erythema migrans and a high probability of having Lyme disease, says a review in Annals of Internal Medicine (1998;128:37-48). The review argues that it is the doctor's estimate of the probability that a particular patient has Lyme disease that determines whether withholding treatment, testing, or giving empirical treatment is the optimal strategy. Patients with psychiatric disorders often use cannabis: in a small survey reported in the Scottish Medical Journal (1997;42:171-2) half of those admitted to a psychiatric unit who were asked about the drug admitted to using it. One third of these were taking other drugs as well. Cannabis may decrease the side effects of neuroleptic drugs, but it may also interfere with their action, and the report warns that its use may be harmful to people with mental illness. Vigorous shaking of an infant may lead to fatal brain damage, and it now seems that this may also happen in adults. A case report in the American Journal of Forensic Medicine and Pathology (1997;18:312-4) describes a Palestinian man aged 30 who collapsed under interrogation in Israel and died. Necropsy showed an acute subdural haemorrhage and bruising of the chest and shoulders. The investigators admitted having shaken the man violently. Lung cancer is still the most common cancer in the United States so the search is continuing for a means of early diagnosis, ideally while the lesion is still in a premalignant phase. Among the options considered "promising" in a recent round up in the Journal of the National Cancer Institute (1997;24:1838-9) were cytometric examination of sputum samples, spiral computed tomography of the whole chest, and positron emission tomography to display glucose uptake. De la Caffiniere introduced his thumb prosthesis in 1971 for patients with painful arthritis of the joint at the base of the first metacarpal. A polyethylene cup is recessed into the trapezium and snap fitted to a cobalt chrome metacarpal component (Journal of Hand Surgery 1997;22B:695-8). A review of 71 patients, mostly with osteoarthritis, treated in one hospital found that the survival rate of the prosthesis was 89% after 16 years. Eight patients had needed revisions for loosening of the trapezial cap. This seems a good operation\Nbut no randomised trials have been done. In theory everyone knows that patients who have had their spleens removed need prophylaxis with immunisation and antibiotics to protect them against overwhelming infection. Guidelines exist; textbooks give details; yet a questionnaire survey of medical microbiologists in Britain identified 42 cases in which the spleen had been removed in two years, with a mortality of 45% (Journal of Infection 1997;35:289-94). Only one fifth of these patients had taken any chemoprophylaxis. Immunisation of infants with live attenuated measles vaccine is ineffective before the age of 9 months because of neutralisation by maternal antibodies. In developing countries one third of the deaths from measles occur in infants below that age. Research on rhesus monkeys (Journal of Infectious Diseases 1997;176:1445-53) has shown that immunisation with recombinant BCG vaccine expressing the full length measles virus nucleoprotein gives useful but not complete protection. This may lead to a means of protecting the smallest infants from a disease that remains an important cause of death in the first months of life. Autosomal dominant polycystic kidney disease can be diagnosed in the fetus by ultrasound examination in the second trimester and in some circumstances by genetic examination of a chorionic villus biopsy specimen. A report in the Journal of Medical Genetics (1998;35:13-6) describes five pregnancies in an affected family, three of which were terminated because of evidence of kidney disease, obtained in the last case by genetic testing. Analysis of 83 cases of this disease presenting in utero or in the first few months of life has shown that 43% of patients died before the age of 1 year. Spain continues to head the league table of countries in which holidaymakers contracted legionnaires' disease (Eurosurveillance 1998;3:6-8). The rate of infection among visitors to Spain is no higher than that among visitors to other countries such as Greece, but Spain gets many more visitors. Susceptibility is highest among elderly visitors. Tour operators can now be held liable if they knowingly place clients in hotels that may be a source of legionella infection. The link between multiple sclerosis and latitude has been known for 40 years, but it remains unexplained. A paper in Epidemiology (1997;8:642-5) suggests that the answer may be simple: the higher the latitude the lower the exposure to ultraviolet light, which has been shown to be immunosuppressive, affecting particularly T cell activity and delayed hypersensitivity. The positive feature of this hypothesis is that it suggests one health benefit from environmental changes that are increasing the amount of ultraviolet light reaching the surface of the world. The BMJ is receiving more and more papers on aspects of information management, and we are looking for new advisers to help us select the best for publication in "information in practice." Any doctor, research worker, or information scientist with an interest in the practical side of managing information who would like to attend our monthly meetings should contact Alison Tonks at the journal before Friday 13 February (email atonks@compuserve.com). Click here for further details. The current epidemic in Western countries of hepatitis C leading to cirrhosis is expected to result in a steady rise in new cases of hepatocellular carcinoma, and new treatments are being investigated in an attempt to improve the prognosis. Transarterial chemoembolisation before surgery (Annals of Surgery 1997;226:688-703) has been shown to reduce the extent of the disease and sometimes to produce complete necrosis of the cancer. This radical pretreatment is being claimed to improve survival after treatment of the cancer either by resection or by liver transplantation. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline