BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7007.760 (Published 16 September 1995) Cite this as: BMJ 1995;311:760

Surgeons in Bristol reviewed the operations they had done on the gall bladder in the three years up to April 1994 (Annals of the Royal College of Surgeons of England 1995;77:256-8). They had carried out 578 laparoscopic cholecystectomies and 35 open operations. Fourteen trainee surgeons had performed only 16 open cholecystectomies and assisted at 19. Open cholecystectomy may be needed if a laparoscopic operation encounters problems and may be the treatment of choice for empyema, perforation of the gall bladder, or severe acute cholecystitis. Yet current trainee surgeons may be adept at “lap choles” while rarely seeing an open operation, let alone becoming familiar with the different techniques required.

Fewer than one fifth of 90 year olds are men, says a thought provoking review in the “British Journal of Obstetrics and Gynaecology” (1995; 102:677-9), which then concentrates on early sex differences. The Y chromosome accelerates the growth of XY embryos so that by the time the indifferent gonad becomes a testis or an ovary the male embryo is larger. One lifelong effect of this early growth spurt may be the higher metabolic rate in males—and another may be the shorter male lifespan.

Minerva likes contradicting medical folk lore. One example is the belief that breast …

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