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BMJ No 7131 Volume 316
Minerva Saturday 21 February 1998
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A 56 year old taxi driver was seen in this department for
recurrent right sided olecranon bursitis. He spent most of his 12 hour
driving day with his right elbow propped on the door of his cab. His x
ray film showed an olecranon spur, which is a recognised but not often
seen complication of persistent trauma to or pressure on the olecranon
process.
S I Yeo
G H
Kingsley
Department of
Rheumatology, |
Most children with cystic fibrosis now survive into adulthood,
and over the past five years the numbers of patients attending adult
specialist cystic fibrosis clinics have increased by about 50%
(Thorax 1998;53:3-4). Many of these units get
financial help from the UK Cystic Fibrosis Trust and other charitable
sources, but NHS planners seem to have made no provision for the rise
in numbers of adult patients that can now be confidently predicted.
Much can be done for these patients, but without funding of specialist
units their care may drift into non-specialist hands.
Measuring the amount of haemoglobin in blood samples is one of the most
basic clinical investigations, and a simple, cheap, reliable method is
needed for use in developing countries, rural hospitals, and other
settings that lack clinical laboratories and often electric power. The
World Health Organisation's Collaborating Centre for Haematology
Technology in London believes it has developed such a test
(Journal of Clinical Pathology 1998;51:21-4). The method
compares the colour of blood placed on a standard type of paper with
six colour shades in a device called the WHO Colour Scale. Pilot tests
in Britain, South Africa, Thailand, and Switzerland have shown that the
method gives good results at a cost about one tenth that of traditional
photometric analysis.
Homo sapiensis believed to have originated in Africa
about 200 000 years ago. A review in the British Journal of
Nutrition (1998;79:3-21) argues that the rapid expansion of
the cerebral cortex that made possible the development of language and
the manufacture of complex tools required a unique environment with
abundant fish to provide the brain specific nutrition. This was found
in the Rift Valley with its freshwater lakes.
A few Rh negative women continue to become sensitised to RhD despite
the administration of anti-D immunoglobulin after births,
miscarriages, and terminations of pregnancy. A working group of
obstetricians and haematologists has now recommended (British
Journal of Obstetrics and Gynaecology 1998;105:129-34) routine
administration of anti-D immunoglobulin to all Rh negative women during
pregnancy at 28 and 34 weeks. The report concludes "there is no
economic or ethical justification to withhold prophylaxis in this
group."
Why Britain should have such a high frequency of breast cancer is
puzzling, and researchers have offered many possible suggestions. A
paper in the Journal of Epidemiology and Community
Health (1998;52:105-10) rejects any link with dietary fat. A
case-control study drawn from women attending two breast screening
programmes found few nutritional differences between women with breast
cancer, those with benign breast disease, and those with normal
breasts. The only non-calorific nutrient that showed differences was
iron, which was negatively associated with risk.
Around 60% of women in Thailand are employed, and many work very long
hours. A study of 907 women who had planned their pregnancies found
(Occupational and Environmental Medicine 1998;55:99-105)
that those who worked 70 or more hours a week had taken longer to
become pregnant than those working shorter hours. This association
remained true even after allowance had been made for the effects of
fatigue in reducing libido and sexual activity.
Follow up of a vast total of 220 806 women treated for breast cancer
in the United States (Annals of Internal Medicine
1998;128:114-7) found an increased risk of cancer of the oesophagus in
those treated by radiotherapy. After 10 years the relative risk for
squamous carcinomas was 5.42, and for adenocarcinoma it was 4.22.
Since the time of Semmelweis washing the hands has been known to be an
effective means of reducing the spread of infection from person to
person. A study in New Zealand has now shown (Epidemiology
and Infection 1997;119:319-25) that drying the hands after
washing dramatically reduces the transfer of bacteria. Dry, clean hands
are reasonably safe.
In the first half of this century radiotherapy was widely used to treat
conditions as various as acne and eczema, hirsutism, infertility,
tuberculous lymph nodes, and benign bone lesions. The first issue of
Cancer (1948;1:3-29) published one of the early warnings
of the danger of radiation causing sarcomas of bone, and this year it
has reprinted the article (1998;82:8-34). In the past 30 years hundreds
of cases have been reported: goodness knows how many have gone
unreported.
Substantial improvements in the treatment of patients with burns
have invalidated the traditional formulas for estimating the chances of
survival. Research in Boston has now established the importance of
three risk factors: age greater than 60, burnt area greater than 40%
of the body surface, and inhalation injury (New England Journal
of Medicine 1998;338:362-6). The new mortality formula predicts
0.3%, 3%, 33%, and about 90% mortality depending on whether none,
one, two, or three risk factors are present.
Does monitoring ambulatory blood pressure provide clinicians with
a more sensitive predictor of mortality and morbidity than casual
measurements of blood pressure in the surgery or outpatient clinic? An
editorial in Heart (1998;79:115-7) concludes that, for
most patients, ambulatory monitoring has no clear advantage over
"careful conventional office blood pressure measurements obtained in
a quiet non-stressful environment by a well trained doctor or nurse."
Unfortunately, as the editorial admits, all too often junior doctors
measure blood pressures badly.
Three men and one woman in a family in Northern Ireland had
episodes of spontaneous pneumothorax, but investigation showed no
evidence of connective tissue disorders such as Marfan syndrome or
Ehlers-Danlos syndrome (Thorax 1998;53:151-2). In
families with what appears to be an inherited pattern of pneumothorax
the mode of inheritance seems to be autosomal dominant.
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