MinervaBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7155.422 (Published 08 August 1998) Cite this as: BMJ 1998;317:422
Anaesthetists are under increasing pressure to move patients quickly through intensive care units after major surgery, which means extubating them as soon as possible. A randomised controlled trial of “fast track” anaesthesia and early extubation after coronary artery surgery showed that it is possible to halve the time to extubation without increasing postoperative complications (Chest 1998;113:481-8). Median time to extubation in the fast track group was only four hours.
Genetic testing for Alzheimer's disease is now possible, but not necessarily ethical. A working group from the Stanford programme in genomics, ethics, and society warns that there are few people who would benefit from predictive testing (Nature Medicine 1998;4:757-9). In an admirably brief report the working group counsels against any form of testing in children, embryos, or fetuses and urges governments to control the marketing of tests in the same way as they control the marketing of drugs.
Postmenopausal women who have had a non-traumatic vertebral fracture plainly need treatment for their osteoporosis, but as yet there is no consensus on what should be done. A report in Annals of the Rheumatic Diseases (1998;57:346-9) of a controlled trial in 58 women says that combined treatment with cyclical etidronate and calcitriol gave better results than treatment with the bisphosphonate alone, but a lot more research will be needed to establish the optimum treatment.
Deinococcus radiodurans takes its name from its ability to survive enormous doses of radiationin—in excess of 104 Gy. Its genetic material is damaged by radiation, which fragments its chromosomes into 100 or more pieces, but within 24 hours the bacterial cell manages to repair its DNA completely (The Sciences 1998;38(4):16-9). Study of this bacterium has raised many interesting issues, but Minerva was most attracted by the suggestion that it has probably undergone no mutations in the past billion years, since any change would have been repaired.
Most women seen in hospital clinics who complain of hirsutism have the polycystic ovary syndrome and are overweight, says a review in the British Journal of Obstetrics and Gynaecology (1998;105:687-9). Often the underlying abnormality is insulin resistance, and weight loss may provide a simple, effective treatment. Unfortunately, many of the women also have an eating disorder, which makes losing weight very difficult.
A stroke can lead to undernutrition from perceptual impairment, anorexia, swallowing disorders, or weakness in an arm or leg. A report in the British Journal of Nutrition (1998;79:481-7) provides further evidence that malnutrition is common in patients admitted to hospital after a stroke—but it acknowledges that there is no clear evidence of clinical benefits from nutritional supplementation.
A carcinoma of the small bowel may be the first evidence of the genetic disorder hereditary non-polyposis colorectal cancer. A report of 42 cases in Cancer (1998;83:240-4) concludes that these cancers occur at an earlier age and have a better prognosis than do sporadic small bowel cancers in the general population.
Bulimia nervosa (recurrent bingeing and vomiting) seems to have as strong a genetic element as schizophrenia, according to a paper in the British Journal of Psychiatry (1998;173:75-9). A twin study in the United States found that a history of induced vomiting had a heritability of 70% (95% confidence interval 50% to 84%).
Alexander Borodin, the composer of Prince Igor, graduated in medicine at St Petersburg in 1856. An account of his life in Surgery (1998;123:606-15) concluded that he was “the greatest musician of all surgeons.” Rimsky-Korsakov lamented that Borodin spent too much time in his laboratory when he could have been composing.
Cold air often induces attacks of asthma, but its effect on patients with chronic obstructive pulmonary disease is less clear—though many complain that cold makes them more breathless. A study in Finland has confirmed this belief (Chest 1998;113:1560-5). Tests in a lung function laboratory on 18 patients produced clear evidence that severe cold lowered the maximum workload they could achieve and shortened the time for which they could continue vigorous exercise.
Radiotherapy reduces survival in patients with non-small cell lung cancer (Lancet 1998;352:257-63). A meta-analysis of nine randomised trials of this controversial treatment shows a reduction in survival from 55% to 48% over two years in patients given radiotherapy after surgery. The damage was most marked in patients with early, resectable tumours. The investigators warn of “substantial hazard” to these patients and urge doctors to stop giving radiotherapy routinely in early cases.
The Scientific Review of Alternative Medicine is a new peer reviewed journal claiming to be the first dedicated to scientific evaluation of alternative medicine. The current issue takes a critical look at oxygen therapy (used in cancer and AIDS), magnetic therapy, naturotherapy, and therapeutic touch (Scientific Review of Alternative Medicine 1998;2:2-66). Most of the journal is comment and analysis rather than original research, but it's a start.
Primary research into human anatomy isn't as popular as it used to be, so an account of the distribution of pacinian corpuscles in the hand caught Minerva's eye ( Journal of Hand Surgery 1998;3:370-2). Investigators studied hands from 10 fresh cadavers and found about 300 of these large mechanoreceptors in each, mostly in the fingers and metacarpophalangeal area.