Minerva

Patients with systemic sclerosis are at risk of severe abdominal distension if they adopt a high fibre diet to relieve constipation (Annals of the Rheumatic Diseases 1998;57:641-2). Sluggish bowel movements are common in these patients, and the problem is often caused by a relative atony of the colon, which responds badly to loading with dietary fibre. Doctors should think carefully before giving the standard advice to eat more fruit and vegetables. Osmotic drugs such as lactulose may be a safer option

Children with mothers who smoke are more likely to take up smoking themselves later in life, possibly because they are introduced to the flavours of smoking in breast milk (New England Journal of Medicine 1998;339:1559-60). A panel of seven odour detectors sniffed a series of milk samples from breastfeeding smokers. They were more likely to detect cigarette flavours in breast milk expressed soon after smoking than in control samples taken after a 12 hour abstinence.

Vascular surgeons will be relieved to see hard evidence on the relative merits of surgery and watchful waiting for patients with small aortic aneurysms (Lancet1998; 352:1649-55). A randomised controlled trial of more than 1000 patients finds …