MinervaBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1702 (Published 07 June 1997) Cite this as: BMJ 1997;314:1702
In Britain women found to be infected with HIV either before or during pregnancy seem increasingly willing to accept advice on reducing the risk of transmission of the infection to their babies. Between 1994 and 1996 the use of zidovudine by pregnant women rose from 14% to 75% of those offered the treatment (AIDS 1997;11:F53-8). The authors of the report conclude that if all women infected with HIV attending for antenatal care in London consented to testing and accepted treatment the number of babies infected would fall from around 41 to 13 a year. The problem is getting consent to the HIV test.
Surgeons do far fewer radical operations for cancer nowadays: one example is carcinoma of the rectum. Small, low rectal cancers are now being treated by local excision (sometimes with adjuvant chemotherapy) instead of by abdominoperineal resection (Diseases of the Colon and Rectum 1997;40:388-92). Follow up for 40 months of 48 patients having local excisions found that only four had had local or distant recurrences. Clearly this type of surgery will be suitable for only selected patients, but it dramatically reduces postoperative morbidity and mortality.
How should a paediatrician try to decide whether a child has had a simple head injury from a fall or has been hurt by parental abuse? A review in Archives of Disease in Childhood (1997;76:393-7) concludes that the effects of falls are so variable that nothing can be deduced from the height that a child seems to have fallen but adds that “small infants rarely sustain serious injuries from accidents in the home and any brain injury with subdural and retinal haemorrhage should raise suspicions of abuse.”
Teenagers in Nova Scotia are using more drugs, alcohol, and tobacco now than they did in 1991, says a report in the Canadian Medical Association Journal (1997;156:1387-93). Only 32% of the schoolchildren questioned used none of the three categories; use of cannabis had risen from 17% to 32% between 1991 and 1996, and use of LSD had risen from 7% to 12%. Plainly, says the report, school programmes designed to persuade adolescents to abstain from using drugs have failed.
Some curious “non-language” is used in medical journals. A report from the study of osteoporotic fractures in the United States (Archives of Internal Medicine 1997;157:857-63) describes data from 6754 non-black women, calculating their risk of non-spine fractures as determined by whether they had lost weight during an observation period of six years. The relative risk of a fracture increased by one third in women who had lost 10% of their weight.
Data on deaths associated with alcohol in Scotland have shown some puzzling trends in recent years (Health Bulletin 1997;55:134-9). The amount of alcohol being drunk by the whole population has shown little change since 1980, but mortality from alcohol related liver disorders has risen substantially, more than doubling between 1983 and 1995. No clear explanation has emerged, but changes in society such as greater income disparity and greater social isolation may be playing some part.
Until recently patients whose liver failure was due to hepatitis B infection had a worse outlook after liver transplantation than those with other causes, such as cholestatic liver disease. A leading article in Gut (1997;40:568-71) describes several new approaches which are changing that picture. Hepatitis B immunoglobulin reduces the rate of recurrent infection of the new liver with the virus, but this treatment is expensive. Promising results have come from trials of treatment with the nucleoside analogues lamivudine and famciclovir. Sadly, the cost and complexity of the treatment of liver failure from hepatitis B put it out of the reach of the vast majority of people dying from the condition.
Implantable cardioverter/defibrillators have to pack a substantial electrical punch to do their job effectively, so it was not too surprising that a doctor removing one of these devices from a patient who had died got a nasty electric shock while washing it under running water (Heart 1997;77:484-5). He burned his fingers and the sink he was using was damaged: the report calls for clear guidelines for the health workers who may be asked to take out devices of this kind.
The use of tap water in a medical setting was examined in another paper, this time in the Journal of Accident and Emergency Medicine (1997;14:165-6). Dirty wounds are sometimes irrigated with mild antiseptics, but these may damage new fibroblasts and so slow the healing process. The usual alternative is saline, but the study in Leicester showed that ordinary tap water is just as safe–no pathogens were cultured from it–and its use would save £5000 a year currently spent on sachets of saline.
An architect has written to Minerva asking for advice on the choice of glass for a hospital ward whose windows will face south. Tinted glass would give better control of heat and glare, but some people have suggested that reducing patients' exposure to ultraviolet light might slow their recovery. In the first half of this century patients with tuberculosis were sent to sanatoriums in the Alps to benefit from the ultraviolet reflected from the snow. Is there any evidence that this did any good? Does bright sunlight make patients feel better or get better?
The European Union's Social Chapter is much concerned with working hours and in particular with the right of employees to refuse to work more than 48 hours a week. A review in Occupational and Environmental Medicine (1997;54:367-75) that examined research into this topic found few data on the effects of long working hours on health; what evidence there was related to people working over 50 hours a week. So the (predictable) conclusion was that more research is needed.
Almost every night the accident department sees men who have a neatly incised lacerations of their index finger tips. The cause is brushing away, in darkness, what they believe to be debris stuck to their soles of their training shoes. They then discover the debris is broken glass. We have named this lesion “night club finger,” and we believe that the answer lies in making darkened night clubs into glass free zones.
Mark Bailey, senior house officer, Chris Luke, consultant, accident and emergency medicine, Royal Liverpool University Hospital
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The nurses health study continues to generate interesting data. Follow up since 1976 of 116 759 women aged 30-55 found that 866 had had strokes (JAMA 1997;277:1539-45). A multivariate analysis showed an increase in the risk of stroke with increased body weight: women whose body mass index was over 32 had a relative risk of 2.37. The greatest risk was in women who had gained most of their weight after the age of 18. weight after the age of 18.