BMJ  2004;329:E313 (24 July), doi:10.1136/bmj.329.7459.E313

BMJ USA: Minerva

Minerva

Minerva

Childhood vaccination has been blamed for a long list of disorders. One example is type 1 diabetes mellitus, which has become more common in developed countries which have also been urged to adopt an ever growing number of vaccines for use in children. Now the New England Journal of Medicine ( 2004;350: 1398-1404)[Abstract/Free Full Text] has published the results of a vast study of 681 Danish children with 4,720,517 person years of follow up and found no link between diabetes and childhood vaccination.

Restless legs may be successfully calmed with pergolide, a drug more commonly used in higher doses to treat Parkinson's disease. Although nausea and headaches were more often reported in the pergolide group, the benefits of just six weeks' treatment were long lasting in a double blind, placebo controlled randomized trial ( Neurology 2004;62: 1391-1397[Abstract/Free Full Text]).

Colorectal cancer is the second leading cause of death related to cancer in the US. Only 10% of patients with this type of cancer are diagnosed before age 55 ( American Journal of Surgery 2004;187: 343-348[CrossRef][ISI][Medline]), and colorectal cancer in young patients seems to be more aggressive and to have poor pathology findings. Yet young patients diagnosed early (Dukes's stage A or B) have a better overall survival than older ones. The message is that clinicians need to be aware that this cancer can affect young people and that when diagnosed early, this is a cancer with good results available.

Meningiomas make up a fifth of primary intracranial tumors, but many are asymptomatic. An Austrian study recruited 532 women age 75 who agreed to undergo cranial MRI and were also examined by a neuropsychiatrist ( Cancer 2004;100: 1208-1212[CrossRef][ISI][Medline]). Nine of the 318 who completed the study were found to have meningiomas but chose not to be treated: at age 75, asymptomatic meningiomas are not an obligatory indication for surgery.

Athletes who chronically misuse anabolic steroids sustain longer term changes than perhaps they realize ( Heart 2004;90: 496-501[Abstract/Free Full Text]). Echocardiography and blood pressure measurements at rest and during exercise found that athletes who had long since stopped using steroids were left with a slight concentric left ventricular hypertrophy when compared with athletes who hadn't used steroids.

You've heard about face lifts and tummy tucks—now we've got voice lifts. It's the latest vanity surgery, another way surgeons have found to disguise the inevitable passage of time. Fat or collagen implants, which are typically used to help people who've lost the ability to speak due to illness or injury, are now being used to tweak vocal cords simply for cosmetic reasons ( Good Morning America April 22, 2004).

Currently, in the United Kingdom an emergency ambulance is dispatched when someone has a cardiac arrest. Is there any point in distinguishing those who are "dead beyond resuscitation" at the point of the call and then sending a non-urgent team? On the evidence from current systems, the answer seems to be no: 3% of patients who were deemed beyond help by the dispatcher turned out not to be. Allocating an "obvious death" code represents a significant risk ( Emergency Medicine Journal 2004;21: 367-369[Abstract/Free Full Text]).

In New York, some smaller pharmacies are luring people with AIDS to bring their lucrative prescriptions to them, in exchange for fax machines, hairdryers, beepers, and fare cards. The fax machines are supposed to help patients get their prescriptions. The beepers are used to encourage people to take their drugs on time. Arguably the fare cards could be used to help patients get to the pharmacy and back, but heaven knows how the hairdryers come into it ( Guardian April 20, 2004: 14).

Scientists have achieved something previously thought impossible—they produced live mice without using sperm or male chromosomes. They developed parthenogenetic mice (which grew to adulthood) by knocking out a key gene in the donor unfertilized egg. This affected "imprinting," the process by which one of the two copies of a gene are switched off, and shows that incorrect expression of imprinted genes is one of the major reasons why natural parthenogenesis in mammals has not been possible ( Nature 2004;428: 860-864[CrossRef][Medline]).

Next time you reach for your bottle of fizzy water, think about your heart. A study of postmenopausal women who were not obese and not taking hormone replacement therapy found that, compared with the control period, drinking carbonated water rich in sodium significantly decreased total cholesterol and low density lipoprotein by 6.8% and 14.8%, while high density lipoprotein increased by 8.7% ( Journal of Nutrition 2004;134: 1058-1063[Abstract/Free Full Text]). Blood pressure was not affected.

A 62 year old previously well man presented with backache over a period of two weeks. Pain was associated with parasthesia up to the ankle on the left side. He had had longstanding back pain and insulin dependent diabetes. On examination, the patient was afebrile, and local examination showed tenderness and spasm and sensory blunting from L3 to L5 dermatomes. The power in the toes was grade 3/5, and the ankle reflex was weak. Laboratory testing showed a raised white cell count, a C reactive protein concentration of 140 mg/L, and an erythrocyte sedimentation rate of 180 mm/hr. Magnetic resonance scans showed L2/L3 discitis with a paravertebral abscess. We carried out a decompression and gave the patient intravenous antibiotics for Staphylococcus aureus pyogenic discitis. P R Padala senior house officer J S Davies consultant, department of orthopaedics Worcestershire Royal Hospital, Worcester, UK

Allergic reactions to antibiotics may not be permanent. A review of 3.4 million records of UK patients who were prescribed penicillin from 1987 to 2001 found that less than 2% of the total reported a second allergic reaction. Somewhat surprisingly, almost 3000 of the 6000 or so who had reported an allergic response after a first dose of penicillin were later given a second dose. Just 57 (1.9%) had another allergic reaction ( Journal of Allergy and Clinical Immunology 2004;113: 764-770[Medline]).

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Longevity of Danish children

Andrew J Vickers
bmj.com, 23 Jul 2004 [Full text]

Re: Longevity of Danish children

Philip J Matheson
bmj.com, 26 Jul 2004 [Full text]