MinervaBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7159.690 (Published 05 September 1998) Cite this as: BMJ 1998;317:690
Disfiguring keloid scars may be associated with mutations of the p53 gene, according to a preliminary study of seven volunteers (Archives of Dermatology 1998;134:963-7). Investigators found p53 mutations in keloid tissue from all seven subjects. Mutations were absent from samples of normal tissue taken from the same subjects. The gene is known to be important in regulating apoptosis and cell proliferation.
A pilot study in the Journal of Neurology Neurosurgery and Psychiatry finds a link between poor cognitive performance and atrial fibrillation in elderly people (1998;65:386-9). The authors speculate that people with atrial fibrillation are at risk of silent cerebral infarction and suggest that antithrombotic treatments should be investigated for their potential to slow cognitive decline in these patients.
Drug treatments for inflammatory bowel disease have a good track record in pregnancy, and mesalazine is no exception. A case-control study from Toronto, Canada, confirms that exposure to mesalazine in pregnancy does not harm the fetus (Gut 1998;43:316). A comment on the study concludes that doctors and patients should trust the safety record of these drugs. The greatest risk to pregnancy is active disease, not active treatment.
The seasonal element to rates of sudden infant death has persisted despite the drop in deaths since the “back to sleep” campaign. Data in Archives of Diseases in Childhood (1998;79:269-70) confirm this view and add some fine tuning to the seasonality curves. Seasonal variation seems to be more pronounced in babies over 5 months old, and since 1992 the lessening of variation has been greater in babies under 4 months old. The researchers speculate that different aetiologies may explain the varying impact of the seasons in different age groups.
Technophobes will sympathise with a commentator in the British Journal of Ophthalmology (1998;82:984-6), who tries to be enthusiastic about new information technology but finds that the reality stops a long way short of the promised land—relevant information where you need it when you need it. His frustrations include the constantly evolving software, hardware that is almost always out of date, information overload, high costs, and wasted time. One thing is for sure, he concludes gloomily: it will all lead to more reading matter, not less.
Humans are unusual in their susceptibility to high blood pressure. The only other vertebrates to suffer from it are a few strains of inbred rodents and some genetically engineered animals. An article in Science (1998;281:933-4) blames our unique ability to poison ourselves with nutritionally valueless junk food. It argues that dietary salt has been a scapegoat for too long, and it suggests that hypertension is more likely to be the result of a general shift in eating habits from fruit, vegetables, and milk to salty snacks and sweet drinks that are free from vital vitamins and minerals. The salt debate has been diverting but may turn out to be a red herring.
The chemical composition of water may be linked to childhood eczema (Lancet 1998;352:527-31). In an ecological study of schoolchildren in Nottinghamshire, England, primary school children living in areas with hard water were more likely to suffer from eczema than their peers living in areas with soft water. The difference in the prevalence of eczema was attributable to the water's calcium content and not its magnesium content. No such associations were found in secondary school children.
Italian authorities have been screening athletes for hypertrophic cardiomyopathy for more than 20 years. A study in the New England Journal of Medicine (1998;339:364-9) finds that screening might have worked. Between 1979 and 1996, 49 young athletes died suddenly in the Veneto region of Italy, only one of whom had hypertrophic cardiomyopathy. In the United States, where there is no screening, hypertrophic cardiomyopathy is the main cause of sudden death in these athletes. The largest causes of death in the Italian study were arrythmogenic right ventricular cardiomyopathy and early coronary artery disease.
Men in families with an inherited predisposition to breast cancer tend to avoid genetic counselling, although a qualitative study suggests that they know that their daughters are at risk (Journal of Medical Genetics 1998;35:739-44). Researchers interviewed 22 Irish men with a family history of breast cancer, who reported that they did not like to think about breast cancer and, anyway, were often excluded from family discussions about it. The study found that communication within these families was often complex, making the choice of counselling strategies more difficult.
Exercise is good for you in many ways, but does it protect against breast cancer? Analysis of data from the nurses' health study suggests that it doesn't (Journal of the National Cancer Institute 1998;90:1155-60), although there are good biological reasons why it might. Research on this issue is plentiful but inconclusive, and an accompanying editorial calls for even more. Meanwhile Minerva will keep cycling to protect her coronary arteries, and her self esteem.
The link, or lack of one, between vasectomy and prostate cancer is another issue hamstrung by a large volume of poor research that is ultimately inconclusive. A systematic review and meta-analysis finds no association and shows clearly that poor research methods are more likely to lead to positive findings than methodologically sound study designs (Fertility and Sterility 1998;70:191-200). Men should not be deterred by an association generated by numerous sources of bias, including publication bias.
A 67 year old Jehovah's Witness survived emergency surgery for a leaking abdominal aneurysm despite having a postoperative haemoglobin concentration of only 30 g/l (British Journal of Anaesthesia 1998;81:256-9). During his 14 weeks in hospital he was given total parenteral nutrition, intravenous iron, folinic acid, and subcutaneous epoetin alfa to aid haemoglobin synthesis, but no blood.
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