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 7130 Volume 316 Minerva Saturday 14 February 1998 Sentinel node biopsy has been advocated in axillary staging of breast cancer; a blue dye is injected into the tumour and is taken up by the node. A woman with a breast carcinoma had previously had her breast tattooed. On dissection of the axilla the sentinel node was clinically obvious, having taken up ink particles from the tattoo. Four other nodes sampled were free of pigment. The sentinel node correctly staged the axilla, all nodes being free of metastasis. Submissions for this page should include the signed consent to publication from the patient Lee Martin, specialist registrar, John Winstanley, consultant surgeon, Phillipa Bryson, house surgeon, Tim Helliwell, consultant pathologist Royal Liverpool University Hospital, Liverpool L7 8XP. Two rare diseases which coexist more often than would be expected by chance are coeliac disease and primary biliary cirrhosis. A study in south Wales found that 3% of 143 patients with coeliac disease had biliary cirrhosis and 6% of 67 patients with biliary cirrhosis had coeliac disease (Gut 1998;42:120-2). Both diseases are detectable by antibody testing, and effective treatments are available. The criteria for screening are, therefore, satisfied. The search continues for an effective oral treatment for impotence. A review in the British Journal of Urology (1998;81:122-7) looks at adrenergic receptor blockers, dopamine receptor agonists, serotonin blockers, nitric oxide precursors, and phosphodiesterase inhibitors and concludes that the death knell is sounding for pumps, injections, and implants - but the promising newer agents are still under trial. Children born to mothers who develop postnatal depression have various adverse psychological outcomes. Some of these are apparent when they start school at the age of 5 (British Journal of Psychiatry 1998;172:58-63). A study of 61 women who had become depressed after childbirth followed up 55 until five years later. When their children were assessed by their teachers the boys with depressed mothers, but not the girls, were rated as hyperactive and easily distractible. Vulvodynia, orchialgia, penile pain, and proctalgia fugax are just a few of the syndromes of urogenital and rectal pain that distress patients and puzzle their doctors (Pain 1997;73:269-94). Hardly ever is a specific cause identified, but the "literature attests to the organicity" of these syndromes. Cures are uncommon, but a multidisciplinary approach to pain relief is often successful. Arthroscopy is commonly perceived as a benign procedure, but a study in Canada (Archives of Internal Medicine 1998;158:47-50) found that 33 of 184 patients having arthroscopic surgery had developed deep vein thrombosis (diagnosed by venography). Only 20 of the 33 had symptoms, but nevertheless this is a high incidence, and the authors suggest that clinical trials should be carried out to discover whether patients would benefit from some type of prophylaxis. Hospitals that introduce carpets and soft furnishings with the aim of making patients feel more welcome may be hazarding the health of those with allergic asthma. A study in Manchester (Clinical and Experimental Allergy 1998;28:53-9) found that upholstered chairs contained large quantities of cat and dog allergens - apparently brought into the hospital on the clothes of pet owners. Patients with allergies to cats or dogs might have their symptoms exacerbated in these circumstances. Vacuum cleaning the chairs three times a week substantially reduced the load of allergens. College freshmen in Japan who had their blood pressures measured by medical students as part of an annual check up programme were found to have higher pressures when the examination was done by women rather than men (Heart 1998;79:104). The difference was substantial: 5 mm Hg in the mean systolic pressure. A tenth of the students examined by women had systolic pressures above 150 mm Hg, but all values fell below this level when a repeat examination was done by a man. As they gain in experience, hospital doctors become less likely to volunteer to carry out cardiopulmonary resuscitation on victims of cardiac arrest in the community (Resuscitation 1997;35:203-11). Presented with various scenarios, the doctors said that they were more willing to attempt mouth to mouth resuscitation on children than on elderly people. Their reluctance to resuscitate adults was said to be based mainly on anxieties about the risk of infection, especially with HIV. A year or two ago necrotising fasciitis was headline news and had the reputation of having an inescapable high mortality. A paper in the Southern Medical Journal (1997;90:1065-8) reviews the outcome in 43 patients suspected of having the condition. In all cases a biopsy was done under local anaesthesia and a specimen examined as a frozen section. In 12 the diagnosis was confirmed. All were treated successfully with immediate debridement and antibiotics. Polymyalgia rheumatica should not be assumed usually to have a favourable outcome, says a paper in the Journal of Rheumatology (1998;25:99-104). Follow up of 149 patients showed that treatment with prednisone needed to be continued for an average of 28 months, and this caused serious side effects including fractures in 13 patients. Seventeen went on to develop rheumatoid arthritis. This is potentially a nasty illness. Metastatic spread of a breast cancer to the bones has grim implications, but one fifth of women remain alive for as long as five years after the first evidence of lesions in the skeleton. A follow up of 367 women seen at Guy's Hospital in London (British Journal of Cancer 1998;77:336-40) showed that in 139 the disease remained clinically confined to the bones, and these women had the best prognosis. This group seems likely to be the most suitable for treatment with bisphosphonates. Peaches are the fruits to which allergy is most common in Spain. In a series of 70 patients seen in one clinic (Allergy 1998;53:78-82) the mean age at which symptoms began was 12. The most common symptoms were oral, but many patients also had contact urticaria and one quarter had systemic manifestations, including dyspnoea and dizziness. Heart transplantation used to be carried out mainly on patients who were "sick but stable" and waiting at home. The introduction of effective circulatory assist devices has changed the picture, and most patients now wait in intensive care units (Circulation 1997;96:4219-20). In 1994 in the United States the average cost of supporting a patient before transplantation was $24,000 (£15,000). Now it has risen to $217,000 (£135,625). Currently 168 hospitals in the US are approved to do heart transplant operations. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline