BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7410.350 (Published 07 August 2003) Cite this as: BMJ 2003;327:350

Concern about the one million unplanned pregnancies a year in the United States has led to efforts being made to make emergency contraception more easily available—which means without a prescription. Some articles in Obstetrics and Gynecology (2003; 102: 8-16) argue forcefully that women are more likely to use emergency contraception if they have a supply in the house. One useful initiative is to give a supply of the pills and some “appropriate education” to women shortly after they have given birth.

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A 51 year old man presented to the accident and emergency department with a 12 hour history of diarrhoea and vomiting after eating a take away meal. Examination was unremarkable but he was admitted for observation. That evening he collapsed. His blood pressure was 80/40 and responded to fluid resuscitation. Discharge was planned for the following day, but his haemoglobin concentration was found to be 6.6 g/dl. Results of upper gastrointestinal endoscopy and colonoscopy were normal. Computed tomography showed a large haematoma lateral to the gastric wall, and a mesenteric angiogram identified an inferior pancreaticoduodenal artery aneurysm that we assumed had ruptured and resealed. After transcatheter embolisation to treat the aneurysm no further blood loss occurred. We found no cause for the aneurysm.James A Gossage, senior house officer, Mathew Forshaw, specialist registrar in general surgery, St Thomas's Hospital, London SE1 7EH

Depressive symptoms may often be the main cause of morbidity in patients attending a neurological clinic, says a review in the Journal of Neurology, Neurosurgery, and Psychiatry (2003;74: 842-3). It bases its comments on a report in the same issue (893-6) of 300 new outpatients in Edinburgh, 40% of whom were depressed when first seen. Three months later 69 of the 88 with depression were still depressed, and 20 more had become depressed. Treatment of the depression led to improvement on a self rating scale.

Travellers to Turkey should be aware that brucellosis is still all too common, with more than 10 000 cases being notified in 2000 (Tropical Doctor 2003;33: 151-3). Most people become infected by consuming unpasteurised milk and milk products. These may be seen for sale in open markets with no controls. The picture could be transformed by a more aggressive policy of vaccinating sheep and goats.

The “wait and watch” approach to one 5 year old boy with scoliosis wasn't appropriate because during the three weeks it took to see an orthopaedic surgeon, he continued to visibly deteriorate. The surgeon recalled a form of traction therapy that had been commonly used in the 1940s and encouraged the lad to play on a “jungle gym.” He took to playing happily on the bars several times a day, swinging like a monkey. His postural improvement was rapid and noticeable within 10 weeks (Experimental and Molecular Pathology 2003;74: 326-35).

Racial categories may be correlated with disease for social or economic rather than biological reasons, but ancestral genetic data are far more useful for medical purposes. An example is sickle cell disease, which is often thought to be an African trait but is characteristic of ancient ancestry in a geographical region where malaria was endemic. The correct diagnostic approach is not just to determine race but to ask whether a person has African, Mediterranean, or South Indian ancestry (Nature 2003;424: 374).

The war on tooth decay caused by erosion continues almost unabated. A discussion about how to prevent tooth wear in the British Dental Journal (2003;195: 75-81) says that research which showed that adding calcium lactate to cola drinks reduces their erosive potential has not been taken up by the manufacturers. Changing fizzy drink recipes is probably the best way forward, but it's not likely to happen without public demand or legislation.

People claiming compensation for what they thought were deep vein clots caused by flying economy class recently failed to win their case. A prospective study comparing business class with economy class air travel provides evidence (South African Medical Journal 2003;93: 522-8). It found that none of the 898 passengers recruited to the study had ultrasonic evidence of deep vein thrombosis. More than 10% of all passengers developed raised levels of D-dimers, but this was unrelated to the class flown.

The citation rates of papers prepared by medical writing agencies differ from those that are not linked to agencies. A study of published papers about the antidepressant sertraline found that the citation rate for articles written by agencies was 20.2 (95% confidence interval 13.4 to 27.0) compared with 3.7 (3.3 to 8.1) for papers without links to agencies. Papers written by agencies included a greater number of authors and were significantly longer (British Journal of Psychiatry 2003;183: 22-7).

Minerva isn't sure whether the stresses and strains of work really do account for fluctuating blood pressures, but an Italian population study in Psychosomatic Medicine (2003;65: 558-63) indicates that, for men at least, they probably do. Among men, moving from “low” to “high” strain jobs pushed up systolic pressures by 3 mm Hg. This finding was independent of age, education, body mass index, smoking, and physical activity. The jury is still out about women.

It's all very well taking sibutramine to lose weight, but does that weight stay off? A complex analysis of the factors that determine weight maintenance over 18 months in people who had completed a six month weight loss programme with sibutramine came up with two clear pointers. A greater initial weight loss and a high level of physical activity during leisure time were the keys to success (American Journal of Clinical Nutrition 2003;78: 209-14).

A small trial of low dose radioactive iodine and β blockers to relieve symptoms in people with thyrotoxicosis found that 85% of these patients were in remission at one year. Re-treatment within this time for those who still had overactive glands brought the rate up to 95%. The study didn't compare this regimen with any other forms of treatment, but because of the potential for halving radiation exposure to the patient and the environment, these findings are food for thought (Clinical Medicine 2003;3: 265-7.

A guest on the BMJ's Christmas party list was delighted when he opened his mail last week to find an invitation. He was impressed that the BMJ was so well ahead of the game, until on closer inspection he realised it was for last year's party. To ensure that the Christmas issue of the BMJ doesn't suffer a similar fate, Minerva wishes to remind readers that anything they wish to be considered for publication for Christmas 2003 must reach us by the end of this month.

Guidance at bmj.com/advice

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