Minerva
BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.198 (Published 19 July 1997) Cite this as: BMJ 1997;315:198
American Airlines has supplied its “long distance over water” aircraft with automatic external defibrillators, and 2300 cabin staff are being trained in their use. An editorial in Aviation Space and Environmental Medicine (1997;68:365-7) explains that aircraft are already in radio contact with a “physician on call” system. The airline believes that taking this action may save lives and will expose it to a lower risk of litigation than doing nothing.
Fewer than one third of patients with sickle cell disease or with ß thalassaemia have a relative who can provide an HLA identical bone marrow donation. The alternative is to use unrelated cord blood as the source of donor stem cells (Journal of Pediatrics 1997;130:695-703). At least 200 patients have been treated with this technique, but it is still uncertain whether the use of cord blood cells overcomes all the problems of HLA incompatibility.
The treatment of epilepsy with drugs still leaves much to be desired, says a review in the Southern Medical Journal (1997;90:471-80). The review recalls that in the 1920s the observation was made that people who fasted often stopped having epileptic seizures, and treatment was tried with a ketogenic diet, high in fat and low in protein and carbohydrates. This worked, but patients disliked the diet and many preferred to go on having seizures.
A circular from Unesco landed on Minerva's desk addressed to Abstracts of World Medicine, a BMA journal that ceased publication in 1971. Before being too critical, other publishers might look at their own circulation lists.
One fifth of children attending two London hospitals for treatment of their congenital heart disease have never seen a dentist (Archives of Disease in Childhood 1997;76:539-40), as against 3% of controls. Yet cardiologists continue to give children “heart cards” to take to their dentists, giving advice about antibiotic prophylaxis. Clearly many parents and children have failed to understand the possible links between dental problems and endocarditis.
Now that multiple drug treatment has become established as the optimum regimen for people with established HIV infection, should it be given to patients who have been diagnosed as having an acute primary HIV infection? A grand rounds article in JAMA (1997;278:58-62) suggests that this may offer a possibility of cure: if HIV replication can be suppressed to undetectable numbers for 18-36 months the virus may be eradicated.
“Eighteen years of research have produced considerable paranoia, but little insight and no prevention,” says an editorial in the New England Journal of Medicine (1997;337:44-6) commenting on the latest research report to find no association between electromagnetic fields and childhood cancer, especially leukaemia. Unfortunately, too many of the studies have produced results which might best be described as weakly equivocal.
Maastricht is clearly a great place for treaties, meetings, and so on: the European Helicobacter Pylori Study Group has just published its Maastricht consensus report (Gut 1997;41:8-13) on diagnosis and treatment. The report recommends that the infection should be eradicated in patients with peptic ulcers, low grade gastric lymphomas, and gastritis with severe abnormalities and after resection for gastric cancer. Eradication treatment should be based on a proton pump inhibitor and two of clarithromycin, a nitroimidazole, and amoxycillin.
Both professional and amateur forensic scientists have been fascinated by the saga of the mummified “Iceman” discovered in the Alps in 1991. Investigations in Vienna have shown that the body spent several months submerged in water before the process of desiccation began (Chemistry European Journal 1997;3:1032-7). Floating face down in the water, the body would have been partially exposed to the elements, and some of the damage to the face may have been due to the corpse being dragged over rock as the water receded.
Raised concentrations of creatine kinase and its myocardial isoenzyme are pointers to recent myocardial infarction, but these enzymes are also present in raised concentrations in patients receiving haemodialysis for renal failure. A refinement of the enzymes test uses subforms of the myocardial isoenzyme. Unfortunately (Nephron 1997;76:296-99), all forms of the myocardial enzymes are raised in renal failure—a finding that might lead to an erroneous diagnosis of a heart attack in some circumstances.
More than 90% of Americans are concerned about the links between sunlight and skin cancer (and wrinkling), but 68% still thought they looked better and felt better when they had a suntan (Mayo Clinic Proceedings 1997;72:461-6). Public health campaigns have improved knowledge and increased anxiety but had little impact on behaviour—and the upward trend in the numbers of new cases of malignant melanoma shows no sign of slowing down.
A girl aged 7 came to our unit with burns to her face covering 3% of her total body surface area. She had been treated with malathion (Prioderm) for her hair lice. The fumes from the lotion made her panic, and as she ran past the lit gas cooker at a distance of 1 m a trail of fire followed her and caused severe burns. Prioderm contains isopropyl alcohol and it should be applied in a well ventilated room well away from any naked flames.
A el Habashy, senior house officer, plastic surgery and burns unit, Selly Oak Hospital Birmingham B29 6JD
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In 1884 the American surgeon William Halstead read of the local anaesthetic effect of cocaine and began experiments with the drug that led to his becoming addicted (Annals of Surgery 1997;225:445-58). He was treated by being switched to morphine, but he remained dependent on morphine for most if not all of the 30 years in which he was chief of surgery at Johns Hopkins and the leading academic surgeon in the United States.
Most studies of hormone replacement therapy provide data on only a few years' experience, so Minerva was interested in a report from Denmark (British Journal of Obstetrics and Gynaecology 1997;104:702-7) on 73 women who were enrolled in a trial in 1985 and have been followed up since. After eight years the bone mineral density in the lumbar spines of the women taking the hormones had increased by 12% over the baseline value and was 15% higher than that in untreated controls. Six of the women in the control group and one in the treated group had had fractures.