BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1298 (Published 08 May 1999) Cite this as: BMJ 1999;318:1298

If, like Minerva, you are baffled by the explosion of acronyms in clinical trials, head for an article in the American Heart Journal (1999;137:726-65) which translates over 2000 acronyms in cardiology trials. You can then spend hours making up sentences with them to test your friends. Try MONICA WINS FANTASTIC DIAMOND, or RUTH SIPS ICED SPICED TEAS. Daftest and most baffling acronym of all, however, is TITS, which stands for Tetrofosmin International Trial Study group. Things must have been desperate at trial headquarters that day.

Activated charcoal is a common treatment for many forms of poisoning despite a dearth of evidence that it actually saves lives. Worse, evidence is accumulating that it may be toxic, particularly if aspirated into the lungs (Clinical Toxicology 1999;37:9-16). A laboratory experiment in rats showed that aspirated charcoal causes direct damage to lungs, independent of any damage caused by acidic gastric contents. Aspiration is the biggest potential problem with activated charcoal, which was previously thought to be inert.

An epidemiological study of severe ankle fractures finds that middle aged women are most likely to be injured while walking but young men tend to be injured playing rugby (Australia and New Zealand Journal of Surgery 1999;69:220-3). The authors aren't sure what their results mean for the prevention of ankle fractures since walking isn't optional for most middle aged women—and neither is sport for many young men. More detailed study of how the fractures actually happen could inform prevention strategies.

Spinal anaesthesia can worsen absorption of irrigation fluid during transurethral resection of the prostate, a randomised controlled trial has found (Acta Anaesthsiologica Scandinavica 1999;43:458-63). Over a third of the 40 patients randomised absorbed some irrigating fluid during surgery. Those who had a spinal anaesthetic absorbed more fluid, faster, than did controls who were asleep and ventilated. The authors blame lower hydrostatic pressure in the prostatic veins for the effect and suggest that anaesthetists monitor absorption by spiking irrigation fluid with ethanol and tracking it in expired air or blood.

The United Kingdom's cervical cancer screening programme regularly hits the headlines, usually when cancers or suspicious smear results are missed. Why do some abnormal smears fall through the net? A study of “missed” or false negative smears finds that they contain fewer abnormal cells than true positive smears do, and that the abnormal cells are more unevenly distributed on the slide, making them harder to spot (Journal of Clinical Pathology 1999;52:358-62). The authors say that we should be developing quality control systems that look specifically for these difficult smears.

Nearly 11 000 people called for help from the London ambulance service during a week long census in 1996 (Journal of Accident and Emergency Medicine 1999;16:174-8). Saturday was the busiest day, and Wednesday the quietest. Only 1.5% of calls were a complete waste of time, according to the ambulance crews, though they thought that 40% of incidents did not warrant a 999 call. Surprisingly, accidents accounted for only a quarter of calls. The rest were medical—mostly respiratory and cardiac—and obstetric emergencies.

Meta-analysis can be a frustrating business. Investigators looking for reliable answers to simple clinical questions can come up against a body of literature so poor that it is uninterpretable. A team from Dundee, Scotland, wanted to know when, and if, antibiotics against Staphyloccocus aureus were clinically useful in patients with cystic fibrosis (Thorax 1999;54:380-3). They found 13 trials of 19 different antibiotics with 17 different outcome measures. Only two of the trials considered the effect of antibiotics on lung function. Someone needs to do a decent randomised trial, they conclude.

Anecdotal evidence is accumulating that airbags prevent injury only if the driver or passenger is wearing a seat belt (Lancet 1999;353:1409-10). Doctors from Denmark report two cases of fatal injury probably caused by the impact of an airbag on an unrestrained driver. Both victims had avulsion injuries of the occipital bone, and one had complete separation of the skull from the first cervical vertebra. The most plausible mechanism of injury, they say, is violent neck extension caused by the airbag hitting the driver's chin. Wearing a seatbelt presumably prevents the driver pitching forward and meeting the inflating airbag coming the other way.

Two years ago a Taiwanese newspaper carried an advertisement promoting a poultice of betel leaves to lighten skin colour. Shortly afterwards dermatologists throughout the country noticed a small epidemic of disfiguring facial lesions including scattered hypopigmentation that looked like confetti (Journal of the American Academy of Dermatology 1999;40:583-9). Fifteen patients who reported using the facial dressing described a stinging sensation followed by up to two days of local erythema. Skin bleaching and irregular hyperpigmentation followed some weeks later. Derivatives of phenol in the plant's essential oils may have been to blame. The Asian vine Piper betle is closely related to black pepper and to Kava pepper, which is known to cause ichthyosis.

Embedded Image

An 86 year old man presented with a 3 month history of worsening dysphagia, regurgitation, and weight loss. He also had a productive cough. Endoscopy of the pharynx showed two pouches arising from the posterior pharyngeal wall in the region of the dehiscence of Killian. The entrance of one pouch lay above the other, with a horizontal bar of tissue dividing the two. The barium swallow shows duplication of the characteristic appearance of a pharyngeal pouch with aspiration of barium into the trachea and little in the oesophagus. Sadly, the patient died before endoscopic stapling diverticulotomy could be done.

Paul Spraggs, fellow in head and neck surgery, Royal Marsden Hospital, London SW3 6JJ

Submissions for this page should include signed consent to publication from the patient.

Canoeists share with cane cutters, rowers, and squash players a tendency to develop tenosynovitis in the extensor tendons of the forearm. In one survey, a quarter of the competitors in four long distance canoe events developed the condition (British Journal of Sports Medicine 1999;33:105-9). The rate might have been higher had the researchers interviewed everyone who started the race, not just those who managed to finish. Canoeing more than 100 km a week in training protects against injury, possibly because fitness enables a canoeist to maintain good paddling style whatever the conditions.

View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial