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BMJ No 7133 Volume 316
Minerva Saturday 7 March 1998
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A boy aged 18 months presented with the sudden onset of
dysuria and the inability to pass urine unless he stood on one leg. An
abdominal radiograph showed a large bladder stone. Despite his young
age the boy had found that standing on one leg overcame the obstruction
to emptying the bladder - an example of children's innate capacity to
adapt to physical inconvenience. He underwent surgical removal of the
bladder stone and the renal stones. The diagnosis of cystinuria was
later confirmed. The three discs on the radiograph are poppers on the
child's vest.
Linda Hutchinson, Submissions for this page should include signed consent to publication from the patient |
Guidelines issued by the Centers for Disease Control recommend
that peripheral intravenous catheters should be replaced every three
days. Research in Switzerland (Archives of Internal
Medicine 1998;158:151-6) has challenged this advice. An
evaluation of 665 catheters in 451 patients showed that complications
occurred with 156 catheters but that no increase was seen in phlebitis,
catheter related infection, or obstruction after the second day. The
conclusion is that these hazards do not become more common when
catheterisation is prolonged and that the recommendation that
catheters should be changed routinely should be reassessed.
In-line skates are now so popular that it is not surprising that many
children are being brought to hospital having fallen while using them.
A survey in Dublin of 110 patients with such injuries (Injury
1997;28:377-9) found that 79 had sustained fractures, almost
all of which were of the bones of the arm or wrist. Only 27 of the 110
had been wearing protection for their arms - a much lower proportion
than that reported from the United States, where the sport began.
In the winter of 1944-5 the Netherlands was devastated by a severe
famine. Follow up of 700 women born in Amsterdam during the famine
(American Journal of Public Health 1997;87:1962-6) found
that they had had 1334 children. No detectable effects were seen on the
surviving children of exposure of their mothers to famine while they
were in utero, though there was an excess of perinatal deaths.
Patients who have repeated episodes of deep vein thrombosis and
pulmonary embolism are often treated by insertion of a filter into the
vena cava. A controlled trial in France has now cast some doubt on the
value of this treatment (New England Journal of Medicine
1998;338:409-15). Patients were assigned to have or not to have a
filter and to have anticoagulation with low molecular weight heparin or
unfractionated heparin. In the first 12 days of the study the patients
given filters did better than those without, but with longer follow up
this group had a higher incidence of recurrent deep vein thrombosis. No
difference was seen in mortality. Commenting on the study, the journal
(463-4) observes that after more than three decades of use of filters,
research studies of their value are overdue.
Twenty eight years after the Swann committee recommended that
antibiotics used in human chemotherapy or those that promote cross
resistance should not be used as growth promoters in farming, the
practice continues: a report in Science (1998;279:996-7)
says that between 1992 and 1996 Australia imported an average of
582 kg of vancomycin for medical use and 62,642 kg of the animal
equivalent for use by farmers. Yet in Sweden the use of antimicrobials
for growth promotion has been banned since 1986 without affecting
productivity.
A prospective study of 594 Danish women with Turner's syndrome
(Journal of Clinical Epidemiology 1998;51:147-58) found
an increased incidence of fractures, diabetes mellitus, ischaemic heart
disease, hypertension, and stroke. Their health pattern in middle adult
life resembles that of postmenopausal women, and this may account in
part for their shortened life span.
During the last decade of the 19th century as many as half the troops
in the British army in India were admitted each year to hospital for
treatment for venereal infections (Sexually Transmitted
Infections (formerly Genitourinary Medicine)
1998;74:20-6). Most were under the age of 30 and unmarried, and those
who were married had left their wives at home. Within a decade,
however, the number of admissions was cut by 90% by a combination of
better treatment for syphilis, health education, and the supply of
prophylactic packages containing disinfective materials.
Adrenocorticotrophic hormone was first used as a treatment for some
types of epilepsy in 1950, but it became superseded by later
anticonvulsant drugs. Doctors in Edinburgh have recently used the
hormone to treat 23 children with intractable epilepsies
(Developmental Medicine and Child Neurology
1998;40:82-9). They conclude that adrenocorticotrophic hormone "is
not an outmoded anticonvulsant but is an exciting compound which may
provide the key to possible future developments in natural
anticonvulsant substances."
With biological weapons in the headlines, Minerva was interested to
read in Medicine Conflict and Survival (1997;13:301-13)
that in the second world war Britain had stockpiled five million cattle
cakes infected with anthrax as a possible retaliation to any attack
from Germany in which germ warfare was used. Since the international
ban in 1972 the only countries known to possess biological weapons are
Iraq and Russia, but at least eight others are thought to have some
weapons of this kind, which are easy to make and cheap.
Is the general physician making a comeback? An editorial in the
Medical Journal of Australia (1998;168:104-5) claims
that he or she is doing so: the newly formed Internal Medicine Society
of Australia and New Zealand has 500 members who believe that
generalists with a broad base of knowledge still have much to offer,
especially for patients with concerns unrelated to the specialty
providing their care. Minerva is sympathetic to the idea but is
sceptical about the amount of evidence available to support
it.
Treatment of patients with primary biliary cirrhosis with
ursodeoxycholic acid leads to biochemical improvement and prolonged
survival. A surprising finding from the clinical trial that showed the
value of the treatment (Mayo Clinic Proceedings
1997;72:1137-40) was that it also delays the development of
oesophageal varices. The mechanism for the action remains obscure.
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