BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6955.680 (Published 10 September 1994) Cite this as: BMJ 1994;309:680

Women develop lung cancer at an earlier age than men even though they begin smoking at a later age, smoke fewer cigarettes, and are exposed to fewer occupational carcinogens (American Journal of Epidemiology 1994;140:185). Furthermore, more women than men with lung cancer are lifelong non-smokers. The implications for the next century are all too clear.

Japan has never licensed the use of steroid hormones as oral contraceptives, though many women take as contraceptives hormone preparations approved for menstrual disorders. A review in “Science” (1994;265:1048-51) quotes a recent comment by an American journalist in Tokyo: “Japanese feminists sound as if they think repetitive abortions are less dangerous for women's health than the pill.”

A vast study by E G Knox of 9406 cases of childhood leukaemia and non- Hodgkin's lymphomas found 264 pairs or larger clusters. When these were plotted on large scale maps they showed several associations with geographical features, including both churches and railway lines (Journal of Epidemiology and Community Health 1994;48:369-76). The link with railways seems likely, says the report, to be due to their association with oil and petrochemical installations. Minerva will continue to watch and wait for the answer to the longstanding mystery of leukaemia clusters.

And another longstanding mystery she would like to see unravelled is the cause of multiple sclerosis and its virtual absence in the black population of Africa. A report in the “Journal of Neurology, Neurosurgery, and Psychiatry” (1994;57:1064-9) by the veteran researcher Geoffrey Dean and his colleagues describes 12 black patients in South Africa and Zimbabwe with the disease. Dean drew attention to the geographical gradient in the incidence of multiple sclerosis in 1949: it has yet to be explained.

Over 30 months no fewer than 68 children attended the burns unit of the St Lawrence Hospital in Chepstow with scalds received in their baths (Archives of Disease in Childhood 1994;71:156-8). Most were under 5, and 38 had simply fallen into water that was too hot. In 10 cases the hot water tap had been turned on by a sibling. The report calls - yet again - for legislation to require a lower setting for thermostats in domestic hot water systems.

After the first wave of uncritical enthusiasm for laparoscopic abdominal surgery doubts are beginning to surface. One drawback is that the surgeon no longer carries out a general exploratory laparotomy - yet the diagnostic yield of that traditional procedure was as high as 13% in some series. Two patients described in the “Annals of the Royal College of Surgeons of England” (1994;76:315-6) developed symptoms from abdominal cancers 12 and 18 months after laparoscopic cholecystectomy.

These doubts are reinforced by surgeons in Belgium (Annals of Surgery 1994;220:146-54) who argue that laparoscopic fundoplication for oesophageal reflux has fewer advantages than have been claimed over open operations: hospital stay may be just as long, and patients are sometimes disappointed by the scarring from their multiple cannula incisions.

Intrapleural instillation of high doses of streptokinase in saline has proved an effective treatment for empyema. The current issue of “Thorax” (1994;49:852-9) reports two small series with high success rates; an accompanying editorial calls for controlled trials to sort out the treatment options, including an arm with early surgical intervention.

A family outbreak of diarrhoea due to infection with Salmonella enteritidis phage type 4 was traced to home made ice cream made with eggs bought from a supermarket (Epidemiology and Infection 1994;113:21-9). The Communicable Disease Surveillance Centre warns that people should continue to be cautious about using raw or lightly cooked eggs. Incidentally, a raspberry sorbet with a pH of 3.74 proved to be lethal to a large inoculum of the bacteria.


One up, one down. This 20 year old man with Marfan's syndrome has lens dislocation in opposite directions. The clinical impression that lens dislocation occurs upwards in Marfan's syndrome and downwards in homocystinuria has been verified in large case series. As this patient shows, however, the conditions are distinguished by all the clinical features and homocystine assay rather than by the direction of lens dislocation alone. Ectopia lentis is a valuable sign to look for since it occurs early in both conditions. The diagnoses are important because serious complications can be prevented after early recognition.—T GILLOW, C MORTON, A MOREFIELD, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 7DG

When police stopped 175 people for dangerous driving in Memphis, Tennessee, they tested for cocaine and cannabis those who seemed not to have been drinking alcohol. Twenty had positive results for cocaine, 50 for cannabis, and 18 for both (New England Journal of Medicine 1994;331:518-22). Overall, half the reckless drivers who were not intoxicated with alcohol were intoxicated with something else: traffic police should, perhaps, widen the scope of their routine testing for evidence that people driving abnormally may be under the influence of some drug.

The rarity of inflammatory bowel disease in married couples has been considered to be evidence against any link with environmental factors, but more cases are being collected together. A report in “Gut” (1994;35:1316- 8) describes 10 couples in northern France and Belgium: in nine of the 10 neither had had symptoms before their marriage. The 10 couples had 18 children; five (four in the same family) developed Crohn's disease.

The fruits of the yellow oleander (Thevetia peruviana) are poisonous owing to the presence of glycosides with a digitalis-type action (St Lanka Prescriber 1994;2:3-4). Even one fruit may be a fatal dose for a child, but prompt treatment with atropine may be lifesaving.

Standard teaching is that the risk of hyperuricaemia is increased in people who drink alcohol, but a report in “Alcohol and Alcoholism (1994;29:411- 3) from Spain found no association between alcohol intake and the serum concentration of uric acid in 312 healthy men and women undergoing annual medical checks. The type of alcoholic drink consumer may possibly be the explanation - there is more guanosine in beer than in other drinks.

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