MinervaBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7106.496 (Published 23 August 1997) Cite this as: BMJ 1997;315:496
Heavy use of cannabis can affect motivation, but there is no need to evoke an amotivational syndrome to explain the narrowed interests, loss of motivation, and reduced achievement seen in some heavy cannabis users, says an editorial in the British Journal of Psychiatry (1997;171:107-8). These are simply the symptoms of chronic cannabis intoxication. Heavy use is unlikely to cause structural damage to the brain, because the drug acts on a specific receptor.
Old people who survive an attempt at suicide are likely to try again. A study of 100 patients over 65 referred to a liaison psychiatric service (British Journal of Psychiatry 1997;171:42-6) and followed up an average of 3.5 years later found that 42 had died, 12 from repeat suicides and five from delayed effects of their first attempt. Thirty seven of the 58 survivors were still receiving active psychiatric treatment.
The Chingford study has been investigating the health of 1003 middle aged London women since the late 1980s. Its data show that those women currently using hormone replacement treatment are less likely than the others to have osteoarthritis affecting their hands or knees (Annals of the Rheumatic Diseases 1997;56:432-4). No benefit could be found in women who had taken hormones in the past but had stopped them three or more years before their joints were assessed.
Children and teenagers with one leg longer than the other benefit both physically and psychologically from surgery to lengthen the shorter limb. The standard technique requires an osteotomy and traction to extend the callus. A report from Hong Kong (Annals of the Royal College of Surgeons of England 1997;79:280-6) says that dual energy x ray absorptiometry gives the best data on changes in the bone mineral content of the callus and hence on the speed at which the bone can be stretched.
In both world wars military hospitals were set up for Canadian servicemen at Lord Astor's estate at Cliveden, and in 1946 the second hospital was presented to the people of Britain as the Canadian Red Cross Memorial Hospital, Taplow. The first patient was admitted in 1947, and the 50th anniversary of the hospital has been marked by publication of its history by Dr Barbara Ansell (9 Beaumont Road, Windsor SL4 1HY) and her colleagues. Despite its enormous achievements in research into childhood rheumatism the hospital now stands “empty, derelict, waiting to be pulled down,” but those who worked there remember it with great affection.
Twelve months after a call for an end to the use of pulmonary artery catheters in monitoring critically ill patients a consensus statement has appeared in Critical Care Medicine (1997;25:910-25). The experts acknowledge that a lot of research is needed to provide high quality evidence but offer reassurance, saying that there “is no basis for a moratorium on use of the catheters” while the evidence is collected.
A boy aged 10 presented with one year's worsening nasal obstruction and mouth breathing associated with snoring. His general practitioner had noticed what seemed to be a third tonsil in his oropharynx. A computed tomogram showed a right antrochoanal polyp originating from his maxillary antrum, entering the nose through the enlarged natural ostium, and extending through the posterior choana into the pharynx. Such polyps can mimic the symptoms of adenoidal hypertrophy. Radiological evaluation is imperative to exclude conditions such as an angiofibroma or a meningocele.
Henry Sharp, acting registrar, Helen Myatt, acting senior registrar, department of otorhinolaryngology, Charing Cross Hospital, London W6 8RF.
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A number crunching analysis of 38 931 patients with colorectal cancers has identified several associations that may make screening more effective (Cancer 1997;80:193-7). At present, sigmoidoscopy and barium enema are the most cost effective screening strategies for adults at average risk. The paper suggests that the first choice for white men (who tend to have distal cancers) should be sigmoidoscopy, while black women, who tend to have proximal tumours, should have a barium enema as the first choice.
Lung cancer should possibly be included among the cancers that are more common in people infected with HIV. Data from a hospital in New York (British Journal of Surgery 1997;84:1068-71) indicate that in patients with HIV infection the lung cancer develops at an earlier age than usual and seems to behave more aggressively. Lung cancer may be underdiagnosed in these patients, in whom serious lung infections are so common.
Fraud is being recognised ever more frequently among research workers, and attention is now being directed to parafraud—illogical or improper behaviour towards other people's views or publications (Science and Engineering Ethics 1997;3:121-36) Scientists often blame “pressure to publish” for dubious behaviour, but what that really means is that their desire to advance their careers may make them act in an intellectually dishonest fashion.
Patients whose seizure disorder seems to be exacerbated by stress may benefit from psychological techniques, says a review in the Journal of Neurology, Neurosurgery and Psychiatry (1997;63:137-42). Further research is needed to compare cognitive behavioural methods with those that have a more direct neurophysiological rationale, such as electroencephalogical feedback. Whatever methods are used, however, the patients' perceptions of their ability to affect the number of seizures they have may be an important factor.
Dengue may seem an obscure tropical disease of which readers of the BMJ know little, but one third of the world's population live in areas in which dengue is endemic, and tens of millions are infected each year. The disease affects many islands in the Caribbean (West Indian Medical Journal 1997;46:38-41), including Cuba, Jamaica, and Trinidad, where increasing efforts are being made to control vectors.