BMJ  2005;330:1353 (11 June), doi:10.1136/bmj.330.7504.1353

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What's new this month in BMJ Journals

Smoking causes visual loss in elderly people

Age related macular degeneration is the most important cause of visual loss in elderly people, with smoking a major risk factor. Among patients aged over 75 taking part in a UK Medical Research Council trial in 49 general practices current smokers were found to have twice the risk of age related macular degeneration as non-smokers. The benefit of stopping smoking was seen after 10 years but equality with non-smokers took 20 years. The authors estimate that the condition is attributable to smoking in 28 000 elderly people in the UK. As sight cannot be restored in this condition, the finding is yet another reason to discourage smoking.

Br J Ophthalmol 2005;89: 550-3[Abstract/Free Full Text]

Sildenafil restores potency in multiple sclerosis

Erectile dysfunction occurs in 50-75% of men with multiple sclerosis. A placebo controlled trial involving 218 patients at centres worldwide shows that 25-100 mg sildenafil as often as once daily is highly effective. In the test arm, 90% of men reported improvement in erections compared with 24% the placebo arm. The former reported a greater than fourfold improvement in sexual desire and over fivefold improvement in orgasmic function compared with controls. Adverse events were mild to moderate and as expected: headache, flushing, and dyspepsia were relatively frequent, but no patient discontinued treatment as a result.

J Neurol Neurosurg Psyvchiatry 2005;76: 700-5[Abstract/Free Full Text]

Retinal vein thrombosis from a herbal remedy A 55 year old woman with systemic lupus erythematosus and protein S deficiency developed sudden loss of vision from retinal vein thrombosis three days after taking a herbal remedy for menopausal symptoms. It contained black cohosh, dong quai, red clover, and Mexican yam. The authors say that the phytoestrogen in these ingredients may have been responsible and doctors need to warn patients with prothrombotic tendencies to avoid oestrogen based preparations. Postgrad Med J 2005;81: 266-7[Abstract/Free Full Text]

Risk of injury is high in international rugby players The 63 members of the England 2003 Rugby World Cup squad incurred 145 important injuries during a 63 week training and competition period. Limb injuries were most common and lasted an average of 14 days. Those which took longest to recover involved the anterior cruciate ligament and knee cartilage. Players in back positions had more injuries, but of less severity than forwards, and most were sustained in tackles, rucks, and mauls. Training injuries were mostly incurred in endurance running. As all players but one were still available for the World Cup, personalised condition training seems to be a successful injury management strategy. Br J Sports Med 2005;39: 288-93[Abstract/Free Full Text] Credit: TONY MARSHALL/EMPICS

Is your grommet really necessary?

A meta-analysis of randomised controlled trials of the insertion of ventilation tubes (grommets) for otitis media with effusion has shown that the beneficial effects are likely to be few and shortlasting in most children. A review of individual patient data in seven trials shows that those most likely to be helped are young children growing up in an environment with a high infection load (day care, nursery schools, etc) and older children who have had a hearing loss of 25 dB or greater for more than 12 weeks. No convincing trial evidence is available for subgroups with speech delay and behaviour or learning problems. Nevertheless, grommet insertion remains the most common surgical procedure performed on children in many Western countries.

Arch Dis Child 2005;90: 480-5[Abstract/Free Full Text]

Should doctors talk to relatives without consent?

A preregistration house officer (intern) writes that he was taught at medical school not to reveal information gleaned in a consultation without the patient's consent. But during clinical attachments he routinely saw clinicians talking to relatives without any apparent attempt to seek permission. In a brief essay, he tries to reconcile the approaches, concluding that what he has seen and heard seems to work well and cause less distress than keeping silent. Are the General Medical Council's current guidelines too simple, he asks, or does the behaviour he has observed represent poor practice?

J Med Ethics 2005;31: 266[Abstract/Free Full Text]

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