Minerva

Minerva

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6938.1248 (Published 07 May 1994) Cite this as: BMJ 1994;308:1248

Research on the hereditary spastic mouse has suggested that botulinum toxin might be useful in preventing contractures in children with cerebral palsy, and a pilot study in Belfast (Developmental Medicine and Child Neurology 1994;36:386-96) found that those given injections of the toxin had reduced tone in the treated muscles. Some of the children also walked better. Whether long term treatment will prove possible remains to be seen: antibodies have been formed against the toxin in patients treated for torticollis.

Patients who have had an attack of extensive ulcerative colitis are at increased risk of colonic cancer and in some clinics are screened by repeated colonoscopy. A review in “Gut” (1994;35:587-9) of 12 studies found that eight cancers had been detected by 3807 colonoscopies - such a disappointing return that the review recommends taking multiple biopsy specimens at a single colonoscopy eight to 10 years after the first attack. After that, follow up should be guided by symptoms.

Concern about the steady increase of strains of bacteria resistant to multiple antibiotics is being increased by the apparent lack of interest in the pharmaceutical industry in developing new antibiotics (Science 1994;264:362-3). One of the reasons for this reluctance is that over 100 antibiotics are currently approved in the United States, and any new drug will have to fight to obtain a small share of a crowded market. Most companies have switched their research interests to antiviral and antifungal drugs - which are potentially more profitable.

Some drug categories are under-researched for other reasons, however. Obesity is one of the great health problems in the United States, but it seems that drug treatment is unacceptable to the medical establishment. In any event, according to “The Sciences” (May/June 1994:38-43) no new appetite suppressant has been approved by the Food and Drug Administration since 1972.

Furthermore, the response to reports of drug resistance in tuberculosis need not be just to cry out for new drugs: some of the old lessons should be relearnt. A study in Texas (New England Journal of Medicine 1994;330:1179-84) has shown that when patients (including homeless people and injecting drug users) were given drugs for tuberculosis under direct observation by health workers the frequency of development of drug resistance was cut from 14% to 2% and the relapse rate was cut from 21% to 5%.

Lesions may develop in the mucosal lining of the stomach in response to stimuli as various as burns, trauma, alcohol, and drugs; but some tolerance develops, according to a review in “Digestion” (1994;55: 131-8). Studies in patients with repeated exposure to non-steroidal anti-inflammatory drugs shows that the extent of the mucosal damage decreases as the treatment is repeated. And the same seems true of other stimuli such as stress.

Research on gastric irritability of that kind explains why most doctors, when asked to suggest the risk factors for dyspepsia, would offer smoking, alcohol, and analgesics. A questionnaire study in Minnesota (Gut 1994;35:619-24), however, found no evidence to support these beliefs. Dyspepsia was more common in young people and in women, and few of those questioned took aspirin in high doses, so the findings may have been atypical.

After the atomic bombs were dropped on Hiroshima and Nagasaki in 1945 the United States and Japan agreed to set up a long term research project to monitor the effects of the radiation exposure on the health of survivors. A report in “Science” (1994;264:338) notes that as the 50th year of the project approaches it may have to be wound down because the United States government seems unwilling to find the money to continue its support - despite a clear commitment in a treaty signed by the two nations.

A study of 2198 infertile couples (Canadian Journal of Public Health 1994;85:28-32) found that tubal infertility was associated with low family income. Pelvic inflammatory disease has the same association. No explanation is offered in the paper, and Minerva is not aware of one.

Figure1

A woman aged 72 presented with a three day history of abdominal pain and a boggy swelling with crepitus in the left thigh. At laparotomy an extraperitoneal perforation of a squamous cell tumour of the bladder was found to be communicating with an infected urinoma in the adductor compartment of the left thigh.

Two thirds of adults with cystic fibrosis are attending specialist clinics and they have more intensive care and better symptom control and are more satisfied than those who do not (Thorax 1994;49:300-6). The annual cost of running a clinic for 150 patients is pounds sterling 1.5m: since the NHS reforms this money has had to be obtained from multiple purchasers, some of whom may run out of funds towards the end of the financial year. Is this really a reform?

Women who drink around 10 units of alcohol a week weigh 3-4 kg less than those who drink none despite the energy provided by the alcohol itself. Research reported in the “American Journal of Clinical Nutrition” (1994;59:805-9) suggests that the explanation may be that alcohol increases the metabolic rate. In heavy drinkers this action may be augmented by energy wastage from liver damage.

Most of us may believe that the elephant man, Joseph Merrick, suffered from neurofibromatosis; but, apparently, since 1988 neurologists have agreed (Science 1994;264:188) that a more likely diagnosis is the much rarer Proteus syndrome. This should mean that patients with neurofibromatosis are no longer labelled as having elephant man disease.

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