MinervaBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6990.1342 (Published 20 May 1995) Cite this as: BMJ 1995;310:1342
Intracoronary ultrasound examination is being developed as an alternative to coronary angiography and may eventually replace it (British Heart Journal 1995;73:16-25). The miniaturised transducers can be used to image vessels as small as 1.00 mm or smaller; early experience suggests that ultrasound examination gives far more information about the condition of the arteries than does angiography. Since the technique is invasive it has some risks, but serious complications such as thrombosis and acute occlusion have been reported in only around 0.3% of patients investigated.
Surgeons in Sweden have been repairing inguinal and femoral hernias laparoscopically since 1992. A review in the “British Journal of Surgery” (1995;82:618-20) gives their experience with 175 patients and 200 hernias. Two patients developed bowel obstruction postoperatively, and there were seven recurrences, most of them while the surgeons were early on the learning curve. The drawbacks are the need for a general anaesthetic, the hazards of a pneumoperitoneum, and “a new panorama of iatrogenic intra-abdominal complications.” The authors join the voices calling for large scale randomised controlled trials.
When Minerva learns something new, interesting, and apparently important she usually puts references to it in her page on several occasions. The part played by herpesvirus in Kaposi's sarcoma is an example. Two more papers appeared this month (New England Journal of Medicine 1995;332:1181-5, 1186-91) reporting the presence of herpesvirus-like DNA in sarcomas—in people infected with HIV and in others without the infection. The epidemiological evidence, too, points to Kaposi's sarcoma being due to a sexually transmitted infection.
Travellers from Western countries to developing countries sometimes inquire about vaccination against rabies now that a safe vaccine is available. A review in the “Canadian Medical Association Journal” (1995;152:1241-2) puts the issue into perspective. In the past 70 years only one Canadian citizen has been diagnosed as having rabies acquired while travelling abroad. There is no justification for immunising adults not at risk through their occupation.
Nurses should be allowed to perform endoscopies, provided they have been properly trained and are adequately supervised, says a report of a working party of the British Society of Gastroenterology (Gut 1995;36:795). Nurse endoscopists are already established in the United States, and advertisements for nurses to perform flexible sigmoidoscopies are appearing in British journals. At this stage the working party recommends that nurses should not carry out endoscopy on sedated patients.
Is the endocrine function of the ovaries impaired after a hysterectomy, possibly because of changes in the blood supply? Probably not, according to a study from Denmark reported in the “American Journal of Obstetrics and Gynecology” (1995;172:891-5). Comparison of women who had had hysterectomies with controls aged 50-59 found no differences in bone density. None of the women was taking any form of hormone replacement therapy.
Measurement of the abnormal protein expressed by a mutated p53 suppressor gene in patients with carcinomas of the parotid gland correlated well with the clinical aggressiveness of the tumours (Cancer 1995;75:2037-44). Mutations in this gene have been shown to predict shorter survival in patients with cancers of the breast, lung, stomach, colon, and bladder. These observations are not just of academic interest—they might point the way for advances in treatment.
Measurement of the fetal nuchal translucency during the dating scan in the first trimester has been suggested as a screening test for Down's syndrome. Two papers in the “British Journal of Obstetrics and Gynaecology” (1995;102:381-5, 386-8) cast doubts on the value of the test. They estimate that as many as 6% of women could have positive test results and conclude that at present there are “insufficient data to warrant introduction of the test for screening the general population.”
Laparoscopy may be a useful technique for examining the abdominal and thoracic cavities of corpses (Archives of Surgery 1995;130:407-9). A laparoscopic necropsy gives reliable information on the state of the internal organs, allows specimens to be taken, and yet has the advantages of minimising invasion of the body. It could be a bedside procedure, the authors claim.
Minerva was sad to hear of the winding up of the Graves Medical Audiovisual Library, which pioneered the use of tapes and slides in the early years of postgraduate education for general practitioners. The library's fine collection of teaching material and its assets have been transferred to the medical audiovisual department at the University of Wales in Cardiff. In its new home the library will be administered by Professor Richard Morton, who looked after it for many years in its birthplace, Chelmsford.
Why do doctors go on looking for organic disorders in patients with somatic symptoms but no signs? A thought provoking review in “Annals of the Rheumatic Diseases” (1995;54:331-2) warns that some newer tests such as wrist arthography and magnetic resonance imaging will detect anatomical aberrations in many people without symptoms; use of these tests may legitimise a patient's pain and so delay recognition by both patient and doctor that the diagnosis is a somatisation disorder.
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