Minerva

Artemether is an antimalarial drug developed from the traditional Chinese remedy for malaria, qinghaosu. Controlled trials of artemether and quinine in severe falciparum malaria (New England Journal of Medicine 1996;335:69-83) have shown that the two drugs are equally effective in preventing deaths, and the new drug seems likely to be highly valuable should resistance to quinine continue to spread. Some questions still need to be answered about the possible neurological toxic side effects of artemether, but these reports are encouraging.

Penetrating injuries to the heart and great vessels are becoming more common, and a review in “Annals of the Royal College of Surgeons of England” (1996;78:327-30) has distilled experience from series around the world. Roadside thoracotomy should be abandoned in favour of “scoop and run.” Patients with agonal features such as no recordable blood pressure and gasping respiration may benefit from a thoracotomy in the accident and emergency department, but most patients needing urgent surgery do better if transferred to the operating theatre.

An increased liability to venous thrombosis due to inherited resistance to activated protein C is found in around 4% of northern Europeans but occurs in as many as 20% of women who develop pulmonary embolism in pregnancy or while taking oral contraceptives …