BMJ  2004;329:646 (18 September), doi:10.1136/bmj.329.7467.646

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What's new this month in BMJ Journals

Cataract surgery results are satisfactory after two years

A two year follow up of 92 New Zealand patients who underwent phacoemulsification for cataract has shown that 95% maintained "best spectacle corrected visual acuity" of 6/12 or better. This was despite 18 developing new systemic illness, as might be expected in this elderly cohort, and 10 experiencing new ocular disease such as glaucoma or the need for lid surgery. Overall, three quarters of patients were satisfied with their vision. As the long term result of cataract surgery is poorly documented, the investigators intend to keep these patients under review.

Br J Ophthalmol 2004;88: 1042-8[Abstract/Free Full Text]

Documented symptoms of brain tumours may be misleading

Investigators in Scotland were prompted by reading the diaries of the late Alan Clark to rethink the early symptomatology of brain tumours. (Clark described gradually increasing fatigue, problems with concentrating, and feelings of anxiety as well as intermittent headache.) They visited at home 92 patients with previously diagnosed glioma. The symptoms the patients and their relatives described were not always those detailed in the hospital records. Particular disparity was noted in the prevalence of cognitive loss, personality change, and fatigue—all underestimated in the documented history, especially fatigue. Many of the patients and their families criticised their doctors for delay. The authors call for prospective studies to determine the criteria needed for urgent referral to a neurological clinic.

J Neurol Neurosurg Psychiatr 2004;75: 1205-6[Free Full Text]

Unusual causes have unusual presentations A 21 year old telephonist, known to have Raynaud's phenomenon, presented with swollen right index and middle fingers without discoloration. This did not respond to flucloxacillin and a non-steroidal anti-inflammatory drug, nor to intravenous prostacyclin. After 12 days, pustules developed, from which Mycobacterium chelonae was cultured. Ciprofloxacin and clarthromycin, with incision and drainage, was successful. Ann Rheum Dis 2004;63: 1178-9[Free Full Text]

Rock and heavy metal music can damage your lungs

Researchers in Brussels report three young men who experienced sudden chest pain and dyspnoea while attending rock concerts or standing near an amplifier in a dance hall. All had developed pneumothorax. A fourth patient sustained the condition while listening to a 1000 watt base box situated in his car boot. Two had had a pneumothorax previously. The authors speculate that repetitive pressure changes in the high energy, low frequency sound range may tear alveoli or subpleural blebs, analagous to what happens in blast injury. They recommend asking specifically about exposure to loud music when treating patients with pneumothorax.

Thorax 2004;59: 722-4[Abstract/Free Full Text]

Bacillary dysentery may provoke irritable bowel syndrome

One to two years after recovering from bacillary dysentery, 8% of 295 Chinese patients were diagnosed with irritable bowel syndrome and 22% with functional bowel disorders—10 times and three times, respectively, the proportions in their sibling and spouse controls who had not had dysentery. In a separate cohort of patients with post-infectious irritable bowel syndrome, the investigators found raised intestinal mucosal interleukin 1 mRNA, which they postulate may be a marker of an enhanced inflammatory response.

Gut 2004;53: 1096-101[Abstract/Free Full Text]

Should we disinfect the umbilical stump at birth?

A baby girl developed a purulent umbilical discharge at 10 days of age. This progressed, despite topical fucidin, to generalised staphylococcal sepsis and septic arthritis. The organism was fucidin resistant. In the 19th century, recognition of Staphylococcus as a cause of pemphigus neonatorum led to the application of antiseptics to the umbilical stump at birth. Over the past 25 years, this practice has virtually disappeared from UK hospitals. A Cochrane review has concluded that, in the developed world, simple hygiene is just as effective, but the increasing prevalence of antibiotic resistant bacteria and the rapid bacterial exchange between hospitals and the community provoked by early discharge may be increasing the risk for serious sepsis. The doctors who treated this baby ask whether the cost effectiveness of umbilical disinfection and staff handwashing needs to be reassessed and guidelines devised.

Arch Dis Child Fetal Neonatal Ed 2004;89: F470[Free Full Text]

Adolescent cricketers risk a baseball injury X ray films of a 12 year old fast bowler with shoulder pain show widening of the lateral part of the proximal humeral epiphysis on the right. This lesion has been called "little league shoulder syndrome" because of its prevalence in adolescent baseball pitchers. The whip-like arm action produces repetitive traction strain at the cartilaginous epiphysis. Treatment is by rest. Curiously the six authors of the case report come from Germany, not usually thought of as a cricket playing nation. Br J Sports Med 2004;38: e14[Abstract/Free Full Text]

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