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BMJ No 7132 Volume 316
Minerva Saturday 28 February 1998
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A 68 year old man who had had his right eye enucleated for
malignant melanoma 18 years previously presented with recent onset of
weight loss and jaundice. He had also had chronic lymphatic leukaemia
for the previous six years. A liver scan confirmed multiple hepatic
metastases. Clinical examples of the old aphorism "Beware the man
with jaundice and a glass eye" are now rarely seen.
T P
George,
senior house officer, Department of Medicine, Torbay Hospital, Torquay TQ2 7AA |
The brain abnormalities that are found on magnetic resonance
imaging in patients with schizophrenia are reviewed in the
British Journal of Psychiatry (1998;172:710-20). A 3%
reduction in the whole brain volume is accounted for mainly by
reductions in the size of the temporal lobes and the
amygdala/hippocampal complex. The lateral ventricles are enlarged.
Findings such as these raise more questions than they answer, and
Minerva will want to know what happens next.
On a typical day in Britain 6000 people sprain their ankles. A review
in the Journal of Bone and Joint Surgery (1998;80B:11-2)
says that most recover fully after non-operative management and early
rehabilitation. Even if the clinician overlooks a macroscopic tear of
the anterior talofibular ligament, delayed repair may be expected to
give good results. A very few patients injure the subtalar ligament
complex, which may lead to chronic instability of the joint, but even
this condition may be treated successfully.
Minerva enjoyed reading a short article in The
Remedy (1997;6:132) outlining the evidence that honey may have
acquired its reputation as a treatment for dyspepsia because of its
antibacterial action against Helicobacter pylori. That
may be the reason, the author suggests, that in Edward Lear's poem the
owl and the pussy cat took a supply of honey with them: apparently
domestic cats suffer from Helicobacter related
dyspepsia.
Anticipation is the increase in severity or decrease in the age at
onset as a disease is passed through generations. The process seems
quite common in familial Crohn's disease (Gut
1998;42:170-4). A study in Belgium and France identified 57
parent-child pairs, and in 48 of these the child had been younger than
the parent at the time of diagnosis. Ascertainment bias could not,
however, be ruled out in a retrospective study.
Adults with cystic fibrosis have an increased risk of osteoporosis for
many reasons - pancreatic insufficiency, reduced absorption of calcium
and vitamin D, reduced physical activity, delayed and reduced
production of sex hormones, and treatment with corticosteroids
(Annals of Internal Medicine 1998;128:186-93).
Examination of 70 patients referred for lung transplantation found that
all had low bone densities; their mean kyphosis angle was 44|SD, and on
average they were estimated to have lost 5.85 cm of height. Sixty two
had vertebral compression fractures.
Thirty Finnish women found to have ectopic pregnancies who wanted to
increase their chances of becoming pregnant again agreed to expectant
management. Follow up examination by hysterosalpingography found that
the tube was patent in 28 patients (Fertility and Sterility
1997;68:1043-6). Twenty one women became pregnant again, and in
20 the pregnancy was intrauterine, though unfortunately one miscarried.
Trials have repeatedly shown that patients who have survived an acute
myocardial infarction have their risk of death cut by treatment with
|gb blockers. Yet a recent analysis of treatment in 11 countries in
Europe (European Heart Journal 1998;19:74-9) found that
patients with no contraindications to |gb blockade were being
discharged without being given the treatment. The proportion varied
from country to country, with a range of 6-38. Women were less likely
than men to be given the treatment.
Is there any point in surgeons sending the gall bladders they remove
for pathological examination? A paper in the British Journal of
Surgery (1998;85:208) suggests there is not. An audit of 1078
gall bladders removed in one hospital showed that only in six was an
adenocarcinoma found, and in all six of these the diagnosis had been
suspected either before or during surgery. Simple cholecystectomy is
the treatment for all non-malignant lesions, so is a pathologist's
examination needed?
Old people pass a greater proportion of their urine at night than do
younger ones, and in some cases this rather than enlargement of the
prostate may account for nocturnal frequency in men. Giving frusemide
in late afternoon might be expected to change the pattern of formation
of urine, and in a randomised placebo controlled trial (British
Journal of Urology 1998;81:215-8) some (but by no means all) of
the men taking the active drug reported an improvement in their
symptoms.
Minerva enjoyed looking at a pictorial history of the Royal Army
Medical Corps published to celebrate its centenary. The Royal
Army Medical Corps 1898-1998; Reflections of One Hundred Years of
Service by Colonel J S G Blair OBE TD and Major-General A C
Ticehurst is available from the RAMC Museum, Keogh Barracks, Ash Vale,
Aldershot, Hampshire GU12 5RG (price £10). All profits from the sale
will benefit the museum.
Between 1985 and 1994 in Frankfurt 50 girls who were constitutionally
tall were treated with conjugated oestrogens to reduce their final
height (Archives of Disease in Childhood
1998;78:148-51). The estimated reduction in height achieved was
5.2 cm, with the best results coming in girls in whom treatment was
started before the age of 13. The main side effect was gain in weight.
The city of Regina in Canada has a water supply with a fluoride
concentration of 0.1 mg/l, while Saskatoon, 320 km away, has fluoride
added to its water to raise the concentration to 1 mg/l. A study of
women aged 18-25 in the two cities (Canadian Journal of Public
Health 1998;88:388-91) found that those living in Saskatoon had
higher bone mineral densities in their lumbar spines, but no
differences were found in the densities in the proximal femur. These
findings provide further evidence that any benefits from fluoride occur
in the axial skeleton only.
Research in the Netherlands on blue collar workers
(Addiction 1998;93:231-41) looked at alcohol consumption
and absence from work and found that people who were stressed at work
were less likely to take time off for sickness if they drank moderately
than if they were abstainers or heavy drinkers - another J shaped curve
linking alcohol consumption with health.
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