Minerva

Excess underarm sweating is distressing and may lead to social stigmatisation and problems from macerated skin—so sufferers will welcome the results of a large double blind trial on 145 patients in Germany (New England Journal of Medicine 2001;344:488-93) confirming earlier reports that intradermal injection of botulinum toxin dramatically reduces sweat production. The full benefit lasted for up to 24 weeks, but even as long as six months after the injection sweat production was only half that at baseline.

Most doctors believe that malignant disease and gallstones are the most common causes of jaundice, but a study on 121 patients in Wales (Gut 2001;48:409-13) found that although malignancy was the leading diagnosis, the next most frequent was septic shock, followed by cirrhosis. Doctors who were questioned put viral hepatitis high among the common causes, but in this study it accounted for only two cases. Patients with jaundice are still most often referred to surgeons, though in practice few require surgery.

Much of the increased mortality from heart disease in patients with diabetes seems to be due to a diabetic cardiomyopathy first described in 1972 but still unfamiliar to clinicians. A review in Heart (2001;85:247-8) says there are now “ample experimental, pathological, epidemiological and clinical …