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 7129 Volume 316 This week in brief Saturday 7 February 1998 Silicone breast implants do not increase risk of connective tissue disease Vitamin A reduces severity of dysentery in acute shigellosis Use of unlicensed or off label drugs is widespread in children in hospital Medical students with the most clinical experience do not perform best in final exams There is little evidence to support common interventions for shoulder disorders More patients with suspected myocardial infarction now receive aspirin Silicone breast implants do not increase risk of connective tissue disease Anecdotal reports have suggested that silicone breast implants may cause immunological disorders. In a nationwide study of over 7000 Swedish women with breast implants and a control group of over 3000 who had undergone breast reduction surgery, Nyrén et al (p 417) found no excess risk for connective tissue disease. Among the women with implants, 29 were hospitalised for connective tissue disease compared with the 25.5 expected from national hospital discharge rates. Among the women who underwent breast reduction, the figures were 14 and 10.5 respectively. When the two groups of women were compared directly those with implants had a slightly lower risk of connective tissue disease. Vitamin A reduces severity of dysentery in acute shigellosis Shigellosis causes ulceration of the colonic epithelium, resulting in bloody mucoid diarrhoea. Vitamin A's reported role in restoring mucosal integrity and in stimulating the immune system prompted Hossain et al (p 422) to carry out a randomised double blind controlled trial to examine its effect in acute shigellosis in Bangladeshi children. An oral dose of 200,000 IU of vitamin A, given as an adjunct to antibiotic treatment, reduced the severity of dysentery by 32%. Deaths from overdoses rise when injecting drug users leave prison Prison is a period of relative abstinence from injecting drug use, and when drugs are used they are less pure than on the outside. The resulting loss of tolerance means that drug users risk overdose if they revert to former levels of drug use when released. Seaman et al (p 426) linked the prison and medical histories of 316 HIV infected drug users in Edinburgh and found that the overdose death rate (1 death per 1000 recently released days) was eight times higher in the fortnight after release than over the next 10 weeks. Even if HIV negative injectors have a lower overdose rate than HIV positive injectors, these overdose deaths still outnumber suicides in Scottish prisons by 3:1. The authors suggest that prisons should evaluate intereventions to reduce these deaths. Patients with testicular cancer do not benefit from adjuvant psychological therapy Psychological therapy is considered to be an important part of management for patients with cancer. Studies demonstrating its efficacy are not always methodologically sound and few have reported the psychosocial characteristics and outcomes of those who agree to participate and those who decline to participate in trials of psychological intervention. Moynihan et al (p 429) report that most patients with testicular cancer declined to participate in their randomised trial of adjuvant psychological therapy. They also found that men who were randomised to have psychological therapy did not appear to benefit by the end of one year. Men who declined psychological support seemed to do better than those who participated in the trial. Reagent strips cannot diagnose asymptomatic bacteriuria in early pregnancy Bacteriuria in pregnancy can lead to pyelonephritis, premature labour, and preterm rupture of the membranes. On p 435 Tincello and Richmond examine the performance of urine reagent test strips in detecting asymptomatic bacteriuria in women attending their first antenatal clinic. They found that the sensitivity of the test (33% at best in the patients studied) is too low for the strips to be useful in evaluating urine specimens in this group of women, although they are cost effective in patients with symptoms. GPs and specialists do not learn from each other The professional relationship between general practitioners and hospital consultants has had its ups and downs. On p 442 Marshall examines in a qualitative study based in the South and West region how the two main branches of the medical profession teach and learn together. He found several barriers to effective educational interaction, the most important being a mismatch between what general practitioners want and what specialists are providing in educational terms. He concludes that if education became a truly interactive, two way process then generalists and specialists would have a greater understanding of each others' roles. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline