BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7413.510 (Published 28 August 2003) Cite this as: BMJ 2003;327:510

People with genital warts may do better if they treat themselves rather than attending a genitourinary clinic. For 358 immunocompetent adults participating in a randomised controlled trial of self applied podophyllotoxin 0.5% solution or 0.15% cream, compared with clinic treatment with 25% podophyllin, self treatment worked best. The 0.5% solution was most cost effective, but warts reoccurred in more than 40% of participants, equally across the three groups (Sexually Transmitted Infections 2003; 79: 270-5

A 75 year old woman with no history of trauma recently underwent a thyroidectomy for thyroid cancer. She had no evidence of metastatic disease. She visited the toilet on the high dependency unit and after a period of sustained straining she reappeared with a swelling around the left eye. Through a valsalva manoeuvre she had forced air into her left orbit, and periorbital surgical emphysema progressed rapidly.

Narman Puvanachandra, senior house officer, Andrew Ramsay,consultant, department of ophthalmology, West Suffolk Hospital, Bury St Edmunds IP33 2QZ

Clinics, on the other hand, may be better for anticoagulation than are family doctors. The authors of a study inCMAJ (2003;169: 293-8) say it shows that both models of care …

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