MinervaBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7211.718 (Published 11 September 1999) Cite this as: BMJ 1999;319:718
Cultured cells from human neonatal foreskin combine with bovine collagen to make a promising “off the shelf” alternative to skin grafts (Archives of Dermatology 1999;135:913-8). The tissue engineered product, known as living skin equivalent, had the same healing potential as traditional meshed autograft when tested on standardised wounds (donor sites for split skin grafting). In a comparative trial, wounds treated with living skin equivalent or autograft healed in about seven days; those dressed with a popular occlusive dressing took at least two days longer to heal and were more painful.
Advice from health educators that people should eat more fresh fruit and vegetables has a downside: uncooked fresh produce may be contaminated by bacteria. Research in the United States (Epidemiology and Infection 1999;122:385-93) has linked outbreaks of salmonellosis with the consumption of uncooked fresh tomatoes. Tomatoes placed in a water bath contaminated by bird droppings may absorb water and salmonella organisms into their core tissues through the stem scar In theory, chlorination of washing tanks should eliminate the problem; in practice, few growers monitor chlorine levels.
Consumers in Sicily seem to have their own exclusive species of salmonella Salmonella bongori, a rare species usually found in lizards and other reptiles, has surfaced repeatedly in various Sicilian towns, the latest outbreak affecting seven babies in the west of the island (Eurosurveillance 1999;4:97-8). Public health officials have yet to identify the source of the infections and are anxious to know why Sicily is the only area in Europe to harbour this exotic pathogen.
Electrotherapy and ultrasound treatments add little to standard exercises for non-specific shoulder pain, according to research from the Netherlands (Annals of the Rheumatic Diseases 1999;58:530-40). In a randomised trial, about 40% of patients got better within three months regardless of the treatment they were given. All of them had up to 12 exercise sessions during the study Meanwhile, debate about the relative merits of exercise, steroid injections, oral analgesics, or nothing to treat shoulder pain goes on.
Minerva has seen many cost of illness studies but few looking at the cost of death. One study in a Canadian journal finds that each suicide in New Brunswick costs nearly $C850 000 (£354 000) for treatment (presumably unsuccessful), necropsies, funerals, police investigations, and lost productivity (Chronic Diseases in Canada 1999;20:89-95). Suicides account for about 2% of deaths in the province and in 1996 cost nearly $C80m in total, excluding the cost of mental health services and lost productivity in bereaved family and friends.
In another study of suicide, researchers found that 16% of patients making a serious suicide attempt were cannabis users compared with only 2% of community controls (Addiction 1999;94:1155-64). The link between cannabis and suicide was largely accounted for by social disadvantage, childhood problems, and concurrent mental illness, such as alcoholism or depression, which are themselves associated with use of the drug. If use of cannabis does cause suicidal behaviour, the risk is likely to be small, the authors conclude.
It is a little publicised fact that smoking up to 10 cigarettes a day protects pregnant women against pre-eclampsia (Acta Obstetricia et Gynecologica Scandinavica 1999;78:693-7). The agent in cigarette smoke responsible for the effect is still obscure, although there are plenty of theories, including the notion that nicotine alters serotonin metabolism in favour of vasodilation. This small benefit, however, is no more than a snowflake in the avalanche of adverse effects of smoking on a fetus and the mother.
Pressing down on a patient's chest with the paddles of a defibrillator reduces transthoracic electrical impedance and improves the chances of a successful shock. Experiments with defibrillation in pigs suggest that the same is true for self adhesive defibrillator pads, which are used increasingly in automatic defibrillators outside hospitals (Annals of Emergency Medicine 1999;34:129-33). Applying 25 pounds of force to the pads cut thoracic impedance by about 15%, and although survival rates were statistically unaffected, there was a trend in the right direction.
Data from Sweden's exemplary cancer registry show that survival from gastric cancer is slowly improving (Annals of Surgery 1999;230:162-9) In 1970, about 13% of patients survived for five years; by 1989, that figure had risen to nearly 20%. Prospects for patients with cancer of the gastric cardia, however, remained dismal throughout the 1980s: by the close of the decade only 10% of patients lived five years after diagnosis. Interestingly, patients diagnosed in teaching hospitals did discernibly better than patients diagnosed in community or county hospitals.
A clown care unit (CCU) is not a ward where sick circus performers can set fire to each others' trousers in safety and comfort, but a new venture to entertain inpatients at Chicago Children's Hospital Legacy, the University of Chicago hospitals' newsletter, reports that clown care has been bought for the children's hospital by a technology services company for $105 000 and is proving popular with the kids. No doubt some enthusiastic intern is already conducting a randomised trial comparing the health benefits of red noses, buckets of water, and unfeasibly large shoes with more standard entertainment: reruns of Sesame Street.
Babies fed on formula milk can have problems with hard stools. Adding long chain polyunsaturated fatty acids to the feed softens the stool as well as reduces the number of stools each day, says a Scottish study funded by a leading baby milk manufacturer (Archives of Disease in Childhood 1999;81:253-6). The authors aren't sure why the supplement softens stools, but they say it's likely to be something to do with fat absorption. Breast milk naturally contains long chain polyunsaturated fatty acids, and constipation is rarely a problem in breast fed babies.
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