Minerva

Minerva

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7014.1238 (Published 04 November 1995) Cite this as: BMJ 1995;311:1238

The treatment of choice for rectal cancer is total mesorectal excision, a difficult operation that takes three to five hours (British Journal of Surgery 1995;82:1297-9). Surgeons in Scandinavia have agreed that the operation should be attempted only by surgeons who have been specially trained and who do the operation at least 10 times a year. The first British training workshop for the procedure took place last April. If this operation comes into general use the improvement in outcome could be substantial--on one estimate four times that achievable by adjuvant chemotherapy and at a fraction of the cost.

Women patients who have sexual relationships with men doctors are typically portrayed in the popular tabloid press as “busty blondes,” says an analysis of press coverage reported in “Sociology of Health and Illness” (1995;17:458-76). The men, by contrast, are presented as light hearted sex rompers who were tempted into sexual indiscretion.

The human genome project is forging ahead, identifying long sequences of thousands of the 100000 genes that determine the growth and development of Homo sapiens. Unique sequences have been determined that identify around half the genes (Science 1995;270:368-9)-- but, says one of theresearchers, “We don't have a clue about the function of three quarters of the genes identified.”

Multiple sclerosis is said to be a disease of the countries in the high latitudes, but that may be changing. Some research reported in the “Journal of Neurology, Neurosurgery, and Psychiatry” (1995;59:528-30) says that in the National Institute of Neurology and Neurosurgery of Mexico the diagnosis is being made much more often than 20 years ago, while the rate of other neurological disorders such as amyotrophic lateral sclerosis and myasthenia gravis has shown no change.

Cancers of the mouth and tongue became less frequent in Britain in the first half of this century, but their incidence and mortality have both risen in recent years (Annals of the Royal College of Surgeons of England 1995;77:321-2). Around 2000 new cases are reported each year in England and Wales--about the same number as the number of cases of cancer of the cervix--but the mouth cancers receive less publicity. Doctors and dentists should carry out opportunistic screening in all patients over the age of 40 who smoke and drink heavily.

The Oxford survey of childhood cancers has for many years been looking at the safety of ultrasound examination during pregnancy. A report in the “British Journal of Obstetrics and Gynaecology” (1995;102:831-2) is based on 1373 children who died of cancer and three controls for each case. The relative risk for all cancers was 0.94 (95% confidence interval 0.65 to 1.36). The verdict is reassuring: ultrasound does not increase the rate of childhood cancers.

Minerva is fascinated by centenarians, probably because they were so rare when she was young. Research workers in Naples managed to recruit 15 healthy people aged over 100 into a study of body composition (American Journal of Clinical Nutrition 1995;62:746-50). When compared with controls aged around 75 the centenarians had a lower fat free mass and a higher body fat--differences that were thought to be due to their reduced physical activity.

Drivers over the age of 65 have a higher accident rate per vehicle mile travelled than those aged 25-64. Some but not all states in the United States require tests of vision on drivers over 70 when they renew their licences. According to a report in “JAMA” (1995;274:1026-30), drivers in the states with vision tests had lower rates of crashes causing death. Tests of knowledge had a smaller effect.

When smokers switch to cigarettes with low tar yields some may inhale more to compensate for the reduction in the strength of the smoke. A study in civil servants (Thorax 1995;50:1038-43) found that people who switched to a brand of cigarette yielding around half as much tar, carbon monoxide, and nicotine as their usual brand did smoke “harder” but that their intake of all three constituents of the smoke was nevertheless reduced. If smokers cannot give up, the report concludes, then switching to cigarettes with a lower tar yield would be better than making no change at all.

Figure1

A woman aged 50 presented with a history of abdominal pain for three days and vomiting and constipation for 24hours. Two years earlier she had had a laparoscopic appendicectomy. A plain radiograph of the abdomen showed metal appendicectomy clips in the upper left quadrant and dilated loops of bowel. This was taken as evidence of bowel obstruction secondary to caecal volvulus, and the diagnosis was confirmed at laparotomy, when a right hemicolectomy was performed.--I M LOFTUS, S S UBHI, D F L WATKIN, department of surgery, Leicester Royal Infirmary, Leicester LE1 5WW

Ten years have passed since calls were first made for worldwide, non-selective immunisation against hepatitis B. Calculations in the United States have shown that universal vaccination of infants is cost effective, and at least 75 countries have included the vaccine in their childhood immunisation programme (JAMA 1995;274:1242-3). Some countries are giving the vaccine to adolescents. Why do other countries including Britain lag behind? Governments respond to public demand, and the publicdoes not perceive hepatitis B as a threat to the population at large.

Might we have reached a stage in the development of treatment for Paget's disease when the objective should be cure rather than simple control of the symptoms? A review in “Annals of the Rheumatic Diseases” (1995;54:783-4) argues that the primary lesion in the disease is a mass of abnormal hypernucleated osteoclasts, analogous to the mass of tumour cells in cancer. Chemotherapy with biphosphonate drugs may soon be able to eradicate the abnormal cells in at least some patients and so lead to a cure.

Ovarian hormones are known to reduce the risk of coronary heart disease, but the mechanism is still not entirely clear. Some recent research (American Journal of Medicine 1995;99:1-5) showed that when oestrogen was given to postmenopausal women the blood flow in the forearm was increased. No change was seen in the blood pressure. The vasodilator action of oestrogen may be an important contribution to its beneficial effects on cardiovascular health.

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