BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.434 (Published 17 August 1996) Cite this as: BMJ 1996;313:434

Most neonatal deaths occur in infants born before 30 weeks' gestation, and in such cases careful examination will often show evidence of chorioamnionitis (American Journal of Public Health 1996;86:701-3). The organisms responsible are usually bacteria of low virulence that may cause vaginosis or no symptoms at all. Women who have had one pregnancy that ended in premature delivery might, says the journal, benefit from prophylactic antibiotic treatment.

Religious fundamentalists in the United States are continuing and intensifying their campaign to have schools teach that evolution is a controversial theory that should not be considered to be fact. According to “Science” (1996;273:420-2), publishers are now offering customised textbooks from which any contentious passages have been removed, and education authorities dominated by members of the religious right are commissioning the books they want.

Patients in North America with unexplained fatigue and muscle pains often conclude that they have chronic Lyme disease despite the lack of serological evidence for that diagnosis (Archives of Internal Medicine 1996;156:1493-500). Lyme disease is a real disease, is potentially curable, and provides an acceptable explanation for the patient's ills. In reality many of these patients have fibromyalgia, but many doctors have not even heard of this condition.

A survey of 319 Swedish men aged 50-80 found that 83% thought that sex was either very important or important and 85% had a steady partner. The article in “Age and Ageing” (1996;25:285-91) adds that the oldest men—aged 70-80—reported orgasm at least once a month, but 53% of the men of all ages said that they would have intercourse more often if they had a willing sexual partner.

The reason that the axons of injured spinal neurones do not regenerate within the spinal cord seems to be the presence of proteins that inhibit axonal growth. Research in Sweden (Science 1996;273:510-3) has now shown that complete gaps in the spinal cord in rats can be bridged with intercostal nerve grafts to redirect the pathways from white to grey matter. Apparently only 10% of the original spinal axons are needed for useful locomotor recovery.

A survey of the eating habits of 9003 British adults reported in the “British Journal of Nutrition” (1996;76:17-30) found that several patterns were regional: little fat and lots of fruit and vegetables in middle aged, middle class folk living in small households in the south of England and neither smoking nor drinking much alcohol; lots of sweets, biscuits, and cakes in old people living alone in Scotland. Everywhere, young people who smoked also ate lots of fat and drank large amounts of alcohol.

Mortality from coronary heart disease has been falling in many countries, but the reasons are unclear. Research workers at the Mayo Clinic looked at 601 patients who had had coronary angiography in the years 1980-9 as part of the investigation of non-ischaemic valve disease (New England Journal of Medicine 1996;335:316-22). The proportion with clinically important coronary artery disease showed no change. Other research has shown a 23% decline in the age adjusted death rate from coronary heart disease in the same period; the data from the Mayo Clinic suggest that the credit may go—at least in part— to improvements in medical care.

The fibrinogen story shows the extent to which medical research is the art of the possible. An editorial in “Heart” (1996;76:101-2) sets out the facts: for 20 years high fibrinogen concentrations in the plasma have been known to be an independent risk factor for coronary atherosclerosis—a stronger predictor than the low density lipoprotein cholesterol concentration—yet there has been little interest in measuring the fibrinogen concentration or in finding ways to lower it, because both have proved difficult. The editorial warns that the same process of indifference may apply to homocysteine, another powerful predictor of the risk of coronary heart disease.

Treatment with intranasal lignocaine relieved the headache in 29 of 53 patients with migraine in a study in California (JAMA 1996;276:319-21). The theoretical site of action of the drug is the sphenopalatine ganglion, so the results of this study have implications for the understanding of the aetiology of migraine as well as its management.


An elderly woman with arthritis overbalanced on to her rigth knee and suffered sudden severe pain behind the joint. She was unable to extend the knee from the flexed position. A lateral radiograph showed the sharp superior osteophytic rim of her patella to be partially embedded in her osteopenic femoral condyle. The patella was reduced—with difficulty—by closed manipulation under general anaesthesia. The quadriceps mechanism seemed to be intact. The patient regained her normal knee movement quickly but has resolved to avoid any future inadvertent genuflection.—TIMOTHY W DOUGALL, senior registrat, ADEL SABBOUBEH, staff grade, DOUGLAS WARDLAW, consultant, department of orthopaedic surgery, Aberdeen Royal Infirmary NHS Trust, Aberdeen AB9 2ZB

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The Delta trial of the treatment of HIV infection with zidovudine and either didanosine or zalcitabine or neither was published earlier this month (Lancet 1996;348: 283-91). Combination drug treatment is now clearly established as an effective method of slowing the progression of the disease. Yet the drugs are so expensive that they are unaffordable in the countries where HIV infection is most common. Ask the politicians what they propose to do about that.

Several correspondents have questioned whether Minerva had received signed consent to publication from Parennefer, the Egyptian mummy who was the subject of the picture report on 27 July. Our usual practice with patients who have died before consent could be obtained is to ask permission from the relatives. This is the only occasion on which no living relatives could be traced—though to be honest, we didn't try very hard.

Elite endurance athletes commonly have enlarged hearts, but whether or not this puts them at risk of sudden death is still said to be uncertain. A reassuring report from the Netherlands (European Heart Journal 1996;17:1271-8) compared competitive cyclists and controls and found that the athletes had increased left ventricular masses and diastolic volumes. All the tests of left ventricular function gave normal results. The athlete's enlarged heart is a physiological adaptation and not a pathophysiological response.

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