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Minerva

Minerva

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7002.462 (Published 12 August 1995) Cite this as: BMJ 1995;311:462

The publication of the first complete genome of a bacterium, Haemophilus influenzae Rd, a benign laboratory strain of H influenzae (Science 1995;269:496-512) has galvanised geneticists. As the commentaries accompanying the genetic map point out, the techniques used are not only enabling other bacterial sequences to be defined but may well be adaptable to the human genome and so greatly speed up the race to sequence it.

A study on volunteers in Nottingham showed that fine particles of bran were better tolerated that coarse bran but that both types substantially delayed gastric emptying. The report in “Gut” (1995;37:216-9) comments that this effect may have clinical applications: a high fibre meal will delay the onset of hunger and so may be useful for people trying to lose weight, and the slowing effect of fibre may relieve symptoms due to precipitous gastric emptying in the dumping syndrome.

Surgery for second and third degree prolapse of the uterus accounted for one fifth of all gynaecological operations in two hospitals in Ethiopia (East African Medical Journal 1995;72:2-9). The mean age of the women being treated was 40, but many were under 30; the average parity was 4.4.

Each year in England and Wales over two million people have illnesses that they think are work related, and such illnesses account for around 7% of consultations in general practice. A review in “Occupational and Environmental Medicine” (1995;52:497-9) argues the case for the specialty of occupational medicine to be brought back into the mainstream of medical education and medical practice, with a cadre of NHS consultants providing services for their local areas. The alternative is for the discipline to continue to be practised predominantly outside the NHS.

Keratitis linked to the use of contact lenses is due most often to infection with Pseudomonas aeruginosa (Epidemiology and Infection 1995;114:395-402). A study of a small sample of patients seen at Moorfields Eye Hospital in London failed to show any association with poor hygiene. The conclusion is a depressing one: good hygiene cannot guarantee that contact lenses and their storage cases are free from contamination.

Reconstruction of the breast after total mastectomy is not associated with any increase in the rate of local recurrence, does not affect the surgeon's ability to detect recurrence, and yields substantial psychological benefits, says a review in the “British Journal of Surgery” (1995;82:865-6). No method is free from complications, but these are much less common than in the past. The search continues, however, for a satisfactory substitute for prostheses filled with silicone--which are widely perceived as having side effects, whether or not this is true.

Girls with cystic fibrosis survive on average three years less than boys. This sex gap is evident before puberty and persists after it. A partial explanation has come from research in the United States (Journal of Clinical Epidemiology 1995;48:1041-9) that showed that lung infection with Pseudomonas aeruginosa occurred at a younger age in girls and became chronic at 9.5 years, as against 11.2 years in boys.

The much voiced concern about Europe's fast growing elderly population does not seem to be shared by the research community. In the list of research proposals submitted for financial support under the European Commission's biomedicine and health programme, “Cordis focus” (1995;42: 3-4), only 109 of the 1709 proposals concern chronic disease, aging, or age related problems, and of these only four have been deemed to be of a standard to warrant support.

A double blind placebo controlled randomised crossover trial of a short course of high doses of methylprednisolone in 35 patients with chronic progressive multiple sclerosis is reported in European Neurology (1995;35:193-8). The active treatment was followed by improvement as assessed by Kurtzke's expanded disability status scale--but this improvement, when it occurred, lasted no more than 90 days. Side effects were minor.

Figure1

These two patients had a similar history of longstanding swelling of the nasal bridge; clinically the appearances were typical of a midline nasal cyst. Computed tomography in the woman showed extension of the lesion into the ethmoidal sinuses and cribriform plates, and it proved to be a chondromyxoid fibroma. A computed tomogram of the man's lesion was suggestive of a midline dermoid, but after excision it proved to be a trichofolliculoma. Before attempting excision of what seems to be a dermoid cyst clinicians would be wise to obtain a scan of the lesion, and all specimens should be sent for histological examination. (Photographs published with patients' consent.)--BOON KOAY, registrar, DERMOT COMMINS, registrar, ear, nose, and throat department, Radcliffe Infirmary, Oxford OX2 6HE

Probably all people with Down's syndrome who live longer than 35 years develop the characteristic neuropathological features of Alzheimer's disease (Journal of Neurology, Neurosurgery and Psychiatry 1995;59:111-4). Differences have been found in features such as the plaque density, and a lot of attention is being focused on the shortened lifespan of people with Down's syndrome, but the disease seems essentially the same, with multiple prospects for further research.

Debate continues about doctors assisting suicide. St Christopher's Hospice in London has treated close to 20000 patients with terminal illness; only three inpatients and two home care patients have taken their own lives. Giving these statistics in an article in the “Hastings Center Report” (1995;25(3):44-5), Dame Cicely Saunders says that she and her colleagues will continue to urge people “to realise their own importance to the end of life and our commitment… not in any way to help them to a hastened death.”

A study of 67 children aged 5-18 with insulin dependent diabetes found that 58 had biomechanical abnormalities of their feet (Archives of Disease in Childhood 1995;73:151-3). Skin abnormalities were also common, and the children had higher rates of infections such as tinea pedis than controls. Children with diabetes should be given education about foot problems and have regular podiatric assessments.

The paragraph on the eradication of postoperative pain in Minerva of 3 June (1995;310:1478) gave the wrong reference. The source was “Annals of the Royal College of Surgeons of England” (1995;77:202-9).

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