BMJ  2003;327:E114 (4 October), doi:10.1136/bmjusa.02050005 (published 23 August 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

The challenge for coronary imaging is to develop techniques that will identify which plaques are stable and which unstable. A review in ( Heart 2002;87:195-197[Free Full Text]) claims that big advances have been made in the past decade but adds that the non-invasive techniques—magnetic resonance coronary angiography, electron beam computed tomography, and multisliced computed tomography—lack sufficient and consistent image quality to replace conventional coronary angiography. Several years' more research seem to be needed.

A comparison in Sweden of laparoscopic and open surgery for the treatment of esophageal reflux found that treatment failure and patient dissatisfaction were twice as common in the patients who had had the laparoscopic procedure ( British Journal of Surgery 2002;89:225-230[Medline]). The study was based on questionnaires sent to patients four years after operation. The authors strongly recommend that someone should carry out a randomized clinical trial.

Echinacea is an increasingly popular complementary medicine and is widely available over the counter. In Australia there is growing evidence for allergic type reactions to echinacea in atopic individuals. Some sources now suggest that there may be a cross reactivity between echinacea and other environmental allergens in people who have not previously taken it ( Annals of Allergy, Asthma, and Immunology 2002;88:42-51).

A nurse led chronic pain clinic set up to help general practitioners in Belfast, Ireland, revealed that 54% of patients taking regular non-steroidal anti-inflammatory drugs were at risk of gastropathy from their medication. These patients were over 60 or had a history of gastroesophageal reflux or gastric or duodenal ulceration ( International Journal of Clinical Practice 2002;56:21-25[ISI][Medline]). Some patients may have entered the high risk group simply through aging—a factor that practice based repeat prescription reviews may miss.

Minerva recently learned that the radiation used for a plain abdominal radiograph is equal to that of 50 chest films. Abdominal radiographs are often requested for patients with acute non-specific abdominal symptoms and signs, but they make little impact on further management. Of 131 abdominal films requested on the day of admission and prospectively analyzed in one district general hospital, only 12% conformed to the Royal College of Radiologists' guidelines. Just 7% had an influence on clinical management ( Postgraduate Medical Journal 2002;78:94-96[Abstract/Free Full Text]). Safety aside, there's also the question of wasted resources.

Sudden cardiac death accounts for around 30% of cardiovascular mortality in developed countries, so any data on its prevention are valuable even if they may not be very new. A literature review in the ( European Heart Journal 2002;23:277-285[Free Full Text]) highlighted the protection given by eating at least two large helpings of fatty fish each week. The other acknowledged protective factor is a low intake of saturated fat; it can be replaced with olive oil. On antioxidants and a moderate intake of alcohol the verdict is "not harmful."

Vexing as it must be for orthopedic surgeons who want to try the latest design, patients treated with the old Charnley total hip replacement and followed for 20 years report excellent results. A study from the United States which began in 1976 found that the original prosthesis was still in place in 312 of 353 hips at the time of death or at the latest follow up ( Journal of Bone and Joint Surgery 2002;83A:1840-1848). Of 91 hips in 82 patients who had survived for at least 20 years, 85 were voted as satisfactory by the patients.

Embolizing uterine arteries to treat symptomatic fibroids is catching on. Of 114 consecutive women with embolization treated in a UK hospital, 91% said their symptoms had resolved or improved after treatment. Contrary to established wisdom that suggests that fibroids with a diameter greater than 8.5 cm predict failure with this technique, 56% of the women in this series had fibroids greater than 8.5 cm ( British Journal of Obstetrics and Gynaecology 2002;109:129-135).

The day of the week that you have a myocardial infarction has a greater effect than your clinical needs on how long you spend in the hospital ( Heart 2002;87:216-219[Abstract/Free Full Text]). Looking at 2541 consecutive patients admitted to three coronary care units over a 12 month period, the authors found that patients admitted later than Tuesday were likely to spend up to four more days in the hospital than those admitted on a Sunday or Monday. The main reason was that few patients were discharged at weekends.

Hairdressers aren't breathing easy. Swedish researchers found that hairdressers were 30% more likely to have asthma than the general population, after smoking status, hay fever, and where they lived were controlled for ( Occupational and Environmental Medicine 2002;59:119-123[Abstract/Free Full Text]). The risk was slightly, but not significantly, higher for hairdressers who carried out hair bleaching treatments and used hair spray—indicating, the authors say, an association between asthma and exposure to hair bleach or spray.

View larger version (79K): [in this window] [in a new window]   A 55 year old man with known chronic obstructive pulmonary disease was treated with standard doses of levofloxacin and prednisolone for two weeks for an infective exacerbation of his illness. At the end of the two weeks he sustained a full rupture of both Achilles tendons when he crouched down to put a video in his machine. The injuries were treated conservatively with below-knee casts. Tendon injuries are a known important complication of treatment with quinolone antibiotics, especially in elderly people and when used in conjunction with corticosteroids. Under these circumstances quinolone antibiotics should be used with caution. S Weller, general practitioner, Petersgate Medical Centre, Scawthorpe, Doncaster DN5 9PQ, UK

 

Back pain is estimated to affect up to half of all children. Learning good back care techniques at school reduced the prevalence of back and neck pain in a group of 198 children after an intervention of six sessions lasting an hour and taught by a physical therapist ( Spine 2002;27:299-305[Medline]). Children were educated on how to sit, take off shoes, pick up a pen, and handle a school bag. The authors say that back education should be introduced early into the school timetable. Minerva is left wondering how she should pick up her pen.

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