Minerva

The earthquake that struck Los Angeles in 1994 seems to have led to a dramatic increase in sudden deaths from heart disease: 24 people died on the day of the earthquake as against the usual daily average of five (New England Journal of Medicine 1996;334:413-9). In the days after the earthquake fewer than the average number of sudden deaths occurred, suggesting that the stress of the tremors may have precipitated cardiac events in people who were already on the brink. Possibly, say the authors, prophylactic treatment with β blocking drugs or aspirin might have prevented some deaths in the hours immediately after the earthquake.

Appendicectomy with a laparoscopic technique may sometimes leave the stump of the appendix behind. The patient is then at risk of developing a second attack of “residual appendicitis,” warns an article in the “British Journal of Surgery” (1996;83:217). In a patient with abdominal pain a reliable history of apparently successful laparoscopic appendicectomy should not, therefore, be taken as ruling out the possibility of appendicitis.

The most distressing symptom for patients waiting for surgical treatment for coronary heart disease is uncertainty about the future, according to some recent research in Sweden (Heart 1996;75:257-60). A total of 904 …