MinervaBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7337.622 (Published 09 March 2002) Cite this as: BMJ 2002;324:622
Lawyers in Australia have decided that exposure to tobacco smoke may cause cancer of the larynx (Medical Journal of Australia 2002;176:113-6). The Australian court decided that exposure to smoke “materially contributed to the cancer.” The decision was based on a scientific finding that the contribution of smoke to the cancer was “more than trivial.” Australian lawyers expect that more passive smokers will soon be filing claims against employers in bars and clubs.
Standard teaching is that the prognosis of polyarteritis nodosa is worse in patients aged over 50 at diagnosis. However, a case notes study in Paris (Medicine 2002;81:27-40) of patients aged over 65 found a survival of 70% at five years, a figure not significantly different from that in age matched controls. The authors conclude that the poor results reported in elderly patients simply reflect decreased life expectancy after the age of 65.
Ductal lavage is a “safe and minimally invasive procedure” that can provide additional useful information about women at high risk of breast cancer. A review in Cancer (2002;94:291-8) concluded that ductal lavage should not be seen as replacing mammography, but that it does add to the overall diagnostic picture. More long term studies are needed to provide data from which the positive and negative predictive values can be calculated.
Air pollution by small particles is associated with increased mortality and morbidity not only from respiratory disease but also from cardiovascular causes. A study on volunteers (Circulation 2002;105:411-4) who inhaled technetium-90 labelled carbon particles <100 nm in diameter found that these particles were detectable in the systemic circulation within one minute. These findings, says the report, help explain the extrapulmonary effects of air pollution.
About a third of deaths in patients with systemic lupus erythematosus are due to infections—not surprising in a population taking immunosuppressive drugs and corticosteroids. Both mortality and morbidity could be reduced, says a leader in Annals of the Rheumatic Diseases (2002;61:191-2) by some simple measures. These would be more attention to personal hygiene, antibiotics to protect against tuberculosis (in countries in which the disease is common) and Pneumocyctis carinii, and immunisation against the main causes of pneumonia.
Patients with coeliac disease are advised not to eat wheat or rye but that corn and rice will not provoke an immunological reaction in the lining of the small intestine. Advice on oats has been less clear, with some doctors believing that they are also harmful. Those who believe that oats are not a threat will be encouraged by a study from Finland (Gut 2002;50:332-5), which has shown no ill effects from oats over a five year period of observation. Adding oats to the cereals recommended for a gluten-free diet should increase its palatability.
Epidemiological data show that the prevalence of cervical infection with human papillomavirus increases with the number of sexual partners, and this finding has led to a belief that papillomavirus infection is linked with high risk sexual behaviour. This may be a mistaken impression (British Journal of Obstetrics and Gynaecology 2002;109:96-8). A study from a family planning clinic in Birmingham found that 46% of 242 women who had had only one sexual partner had papillomavirus in the cervix three years after first intercourse. The median time from first sexual experience to detection of papillomavirus was three months..
The challenge for coronary imaging is to develop techniques that will identify which plaques are stable and which unstable. A review in Heart (2002;87:195-7) claims that big advances have been made in the past decade but adds that the non-invasive techniques—magnetic resonance coronary angiography, electron beam computed tomography, and multisliced computed tomography—lack sufficient and consistent image quality to replace conventional coronary angiography. Several years' more research seem to be needed.
A comparison in Sweden of laparoscopic and open surgery for the treatment of oesophageal reflux found that treatment failure and patient dissatisfaction were twice as common in the patients who had had the laparoscopic procedure (British Journal of Surgery 2002;89:225-30). The study was based on questionnaires sent to patients four years after operation. The authors strongly recommend that someone should carry out a randomised clinical trial.
Echinacea is an increasingly popular complementary medicine and is widely available over the counter. In Australia there is growing evidence for allergic type reactions to echinacea in atopic individuals. Some sources now suggest that there may be a cross reactivity between echinacea and other environmental allergens in people who have not previously taken it (Annals of Allergy, Asthma, and Immunology 2002;88:42-51).
Many studies have shown that cigarette smoking is not a cause of persistent hypertension. Now a study in France has added to the data, showing that former smokers are at risk of hypertension—presumably because of the higher prevalence of overweight and obesity in this group (Journal of Hypertension 2002;20:187-93). The authors stress that their findings should not be interpreted as an incentive for smokers not to give up the habit. What is needed is for physicians to be alert to the risk of hypertension in their patients who have quit.
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