BMJ  2005;330:1094 (7 May), doi:10.1136/bmj.330.7499.1094

Minerva

Creaking lower backs seem to run in families. Japanese researchers now suggest that the mechanism of lumbar disc degeneration involves a genetically mutated protein found in the cartilage of affected individuals. This protein interacts with a growth factor previously associated with connective tissue disorders and which is therefore likely to play a critical role in the progression of disease in intervertebral tissues ( Nature Genetics 2005, advanced online publication 1 May, doi:10.1038/ng1557).

Paediatric anaesthetists often break paracetamol suppositories to achieve an approximate dose for children of different ages and weights. In a recent study, however, laboratory tests show that, although the suppositories contain a uniform dose of the active drug throughout, dividing them leads to poor accuracy in getting to the target dose. The authors suggest that only intact suppositories should be used ( Anesthesia and Analgesia 2005;100: 1303-5[Abstract/Free Full Text]).

Proof that exercise early in life may help to stave off osteoporosis comes from a study of Norwegian premenopausal athletes. Low bone mineral density was two to three times as common in a matched non-athletic group of women as in the athletes (although low bone mineral density was found in both groups). Weight bearing exercises and medium and high impact sports may therefore protect young women at risk of bone loss, such as those with menstrual or eating disorders ( British Journal of Sports Medicine 2005;39: 282-7[Abstract/Free Full Text]).

Death from mesothelioma in the United Kingdom continues to be linked with high exposure to asbestos; the workers most affected are metal plate workers and vehicle body builders. But also now affected are those who have worked in occupations with lower exposure (so called secondary exposure), such as plumbers, gas fitters, and carpenters. The annual UK death rate rose from 153 deaths in 1968 to 1848 deaths in 2001 ( Occupational Medicine 2005;55: 79-87[Abstract]).

Another sort of cancer linked to occupation is testicular cancer, to which carpenters and cabinet makers may be prone. After data from the United States suggested a link, German researchers explored a population based case-control study that comprised 269 testicular cancer cases and 797 controls ( Journal of Occupational and Environmental Medicine 2005;47: 299-305[CrossRef]). People who worked as carpenters or cabinet makers had an odds ratio of 0.84 (95% confidence interval 0.45 to 1.56) of developing testicular cancer, but cabinet makers who had worked at least 15 years ago had an increased odds ratio of 5.81 (95% CI = 1.2-28.09).

One of the extracts of Ginkgo biloba leaves, EGb 761, looks promising in the cancer arena. A hugely complex scientific demonstration of the effects of EGb 761 on oral cavity cells confirms that it inhibits cell proliferation and induces apoptosis (programmed cell death). As one of the most difficult problems in treating oral cavity cancers is the tendency for the treatment to produce a second primary tumour that then causes death, Ginkgo biloba may prove to be a useful chemopreventive agent against oral cavity cancer ( Oral Oncology 2005;41: 383-9[CrossRef][ISI][Medline]).

About a quarter of all those who are HIV positive in the United States don't know they have become infected. In Clinical Infectious Diseases ( 2005;40: 1037-40)[CrossRef][ISI][Medline], AIDS researchers argue that HIV testing should now be offered routinely to anyone who is sexually active and not be restricted to high risk populations or to settings where the prevalence is known to be increased. They say the challenge now is about identifying people who do not know they are infected with HIV, rather than about preventing progression of HIV disease in people already known to be infected.

Despite a growing trend for menopausal women to take flaxseed supplements, a placebo controlled trial of flaxseed as a dietary supplement reports mixed results. After a year of supplementation, flaxseed produced a favourable—but not clinically significant—reduction in both total and high density lipoprotein cholesterol levels, compared with a wheatgerm placebo. But both flaxseed and wheatgerm reduced menopausal symptoms, and bone mineral density was similar in both groups ( Journal of Clinical Endocrinology & Metabolism 2005;90: 1390-7[Abstract/Free Full Text]).

People with acute ischaemic strokes usually have the head of their bed raised to about 30°, to reduce any potential raised intra-cranial pressure. But a pilot study of different bed end positions shows that dropping the head of the bed from 30° to a horizontal position resulted on average in a 20% increase in the velocity of the residual arterial blood flow in the affected artery. Any potential neurological improvements brought on by lying flat, however, will have to be weighed against the possibility of prompting cardiopulmonary problems in that position ( Neurology 2005;64: 1354-7[Abstract/Free Full Text]).

A 33 year old man fell 7 m, landing on his left foot. He sustained an intra-articular displaced fracture of his left calcaneus with moderate swelling and no other injuries. Owing to delays in the radiology department, the patient discharged himself and continued weight bearing on the left limb. He was readmitted later that evening with a severely swollen left foot and leg and severe fracture blisters. These are caused by a strain on the overlying skin by fracture displacement, leading to a dermal-epidermal separation. Although delays often cannot be helped, this case illustrates what can happen if a patient ignores the usual advice to raise the limb and apply ice and to avoid weight bearing on the affected limb. Atif A Malik (Atif01{at}hotmail.com), senior house officer, Arun Kumar, specialist registrar, Richard A Samarji, consultant, Department of Orthopaedic Surgery, Manchester Royal Infirmary, Manchester

 

Flucloxacillin is an extremely commonly prescribed broad spectrum antibiotic, not usually associated with serious side effects. So a case report of eight children treated with intravenous flucloxacillin for bone and joint infections who then became neutropenic is a reminder that even commonly used drugs should be treated with caution. None of the children developed long term problems as a result of the antibiotic, but the authors urge closer monitoring and more careful dosing when prescribing the drug ( Journal of Paediatrics and Child Health 2005;41: 48-51[CrossRef][ISI][Medline]).

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Rapid Responses:

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antibacterial spectrum of flucloxacillin

chanolean shashindran
bmj.com, 6 May 2005 [Full text]

Spectrum and hospital use of flucloxacillin

Samuel Coenen, et al.
bmj.com, 11 May 2005 [Full text]

Acute blistering in a neglected calcaneal fracture - due to acute oedema, not bone displacement

Neil H Cox
bmj.com, 18 May 2005 [Full text]