BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7298.1374 (Published 02 June 2001) Cite this as: BMJ 2001;322:1374

The media are often accused of whipping up medical scare stories, so Minerva was interested to read that sometimes they can be praised. According to the leading article on changing physician behaviour in the Archives of Disease in Childhood (2001;84:459-62), the widespread dissemination of accurate information in parenting magazines about resistant bacteria and the inappropriate use of oral antibiotics has led to fewer parents requesting a prescription for antibiotics for respiratory illnesses.

To avoid the problem of contaminated water supplies, researchers in Bangladesh taught mothers to use biodegradable two-compartment water purification sachets to make up safe therapeutic feeds for malnourished children (Lancet 2001;357:1587-8). The device contains a semipermeable cellophane membrane, and is hydrated by osmosis when placed in water. Sucrose takes about five hours to hydrate and can then be mixed with the dry components held in the waterproof upper section of the sachet.

After an acute myocardial infarct, balloon angioplasty is cheaper than stenting. But since stents result in better event-free survival and fewer readmissions, it may be a false economy to choose the cheaper option. A randomised controlled trial comparing the outcome of balloons with stents in acute myocardial infarction confirmed that, after two years, stenting produced better clinical outcomes without increased cost (Heart 2001;85:667-71).

The tribal wisdom of the Dakota Indians says that when you discover you are riding a dead horse the best strategy is to dismount. Information about managing change in the NHS presently circulating around the London Regional Office suggests that when heavy investment factors are taken into consideration other strategies are often tried with dead horses. These include buying a stronger whip, changing riders, threatening the horse with termination, appointing a committee to study the horse, and hiring a consultant to tell you the horse is dead.

Rather than trying to prevent clumps of amyloid β peptides forming in the brain, dementia researchers are taking another tack and looking at ways to destroy them instead. Apparently even a small reduction in the activity of an amyloid β destroying enzyme leads to the build up of amyloid clumps in mice (Science 2001;292:550-2). The researchers suggest that amplifying the activity of one particular enzyme called neprilysin might be a useful therapeutic alternative to compounds that inhibit the enzymes that build up amyloid β but which have unwanted side effects.

The Sheffield Supertram was introduced in 1994 as the city's solution to its public transport requirements. The city's cyclists, however, seem to have come off worst. Cyclists sustained almost half of the 90 tram related injuries seen at the local casualty department, with most of them suffering upper limb fractures and head injuries (Injury 2001;32:275-7).

Doctors are beginning to realise that COX 2 inhibitors such as rofecoxib (Vioxx) and celecoxib (Celebrex), which their developers claim cause fewer ulcers than other analgesics, are not all they're cracked up to be. Data presented to the US Food and Drug Administration suggest that patients taking these drugs have a higher risk of heart attacks than patients taking older pain relievers (about four heart attacks per 1000 patients). According to the New York Times (22 May), the Food and Drug Administration is considering adding cardiovascular warnings to the drug labels.

Enthusiasts of keyhole surgery often claim that it causes fewer postoperative problems and allows patients to leave hospital and to return to work earlier. But no one has ever produced a statistically sound, randomised comparison of laparoscopic and open appendicectomy. A study from the Mayo Clinic has now found that, while the need for pain relief is lower and the length of admission is shorter in laparoscopic appendicectomy, operative morbidity and the time taken to return to work is the same (Surgery 2001;129:390-9).

Scientists looking for new uses of statins have shown their anti-inflammatory potential. Leucocyte surface molecules (LFA-1) interact with cell adhesion molecules (ICAM-1) to attract leucocytes to sites of inflammation. The researchers identified several statins that bind to LFA-1 and, by doing so, block the inflammatory response (Nature Medicine 2001;7:687-92). They then created a new molecule with superior LFA-1 binding affinity and reduced cholesterol lowering ability and showed that it completely blocks peritonitis in a mouse model.

A voluntary palliative care service in India has been hailed by the World Health Organization as a model for palliative care delivery suitable for developing countries. The Pain and Palliative Care Society started life as a single, one room clinic seven years ago and now boasts over 20 others, all providing free care to poor patients. As described in the National Medical Journal of India (2001;14:65-7), their experience shows that “there are numerous kind-hearted individuals who are willing to help others.”


A 54 year old man presented with a reduced level of consciousness after three weeks of watery nasal discharge without sepsis. He attributed the onset of his symptoms to an episode of violent nose blowing. His medical history included a depressed occipital fracture without intracranial injuries in childhood. Computed tomography revealed osteomalacia at the site of the previous skull trauma (A) as well as extensive intraventricular air (B). The thin plate of bone separating the mastoid air cells from the already breached dura at the old trauma site had fractured by severe nose blowing, leading to cerebrospinal fluid rhinorrhoea and the reciprocal pneumocephalus.

E Hadjihannas, senior house officer, K Ashkan, specialist registrar, J Norris, consultant, department of neurosurgery, Hurstwood Park Neurological Centre, Haywards Heath RH16 4EX


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