Minerva

Early orthopaedic surgery has much to offer women with metastatic bone disease from breast cancer, and a multidisciplinary working party on the topic has now underlined what a disaster it is for the disease to be allowed to progress to a pathological fracture (Journal of Bone and Joint Surgery 1999;81B:1-2). The main problem seems to be that orthopaedic surgeons are asked for their advice early on in only half of the cases in which effective treatment might be offered.

There is more to informed consent than telling patients once about the risks of surgery (Lancet 1999;353:645). In a survey of British patients needing carotid endarterectomy only one out of 56 responders remembered the percentage chance of a stroke during surgery even though they had been told only a month before. Many of them were wildly out in their estimates, and the authors urge surgeons to provide written information if they want patients to make informed decisions about potentially life threatening surgery.

There are good theoretical reasons why hyberbaric oxygen should improve outcome in carbon monoxide poisoning, but researchers disagree over whether it works in practice. Another randomised trial—the fifth—finds that it is no better than 100% oxygen given at …