What's new this month in BMJ JournalsBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7467.646 (Published 16 September 2004) Cite this as: BMJ 2004;329:646
- Harvey Marcovitch, BMJ syndication editor ()
Cataract surgery results are satisfactory after two years
A two year follow up of 92 New Zealand patients who underwent phacoemulsification for cataract has shown that 95% maintained “best spectacle corrected visual acuity” of 6/12 or better. This was despite 18 developing new systemic illness, as might be expected in this elderly cohort, and 10 experiencing new ocular disease such as glaucoma or the need for lid surgery. Overall, three quarters of patients were satisfied with their vision. As the long term result of cataract surgery is poorly documented, the investigators intend to keep these patients under review.
Documented symptoms of brain tumours may be misleading
Investigators in Scotland were prompted by reading the diaries of the late Alan Clark to rethink the early symptomatology of brain tumours. (Clark described gradually increasing fatigue, problems with concentrating, and feelings of anxiety as well as intermittent headache.) They visited at home 92 patients with previously diagnosed glioma. The symptoms the patients and their relatives described were not always those detailed in the hospital records. Particular disparity was noted in the prevalence of cognitive loss, personality change, and fatigue—all underestimated in the documented history, especially fatigue. Many of the patients and their families criticised their doctors for delay. The authors call for prospective studies to determine the criteria needed for urgent referral to a neurological clinic.
Rock and heavy metal music can damage your lungs
Researchers in Brussels report three young men who experienced sudden chest pain and dyspnoea while attending rock concerts or standing near an amplifier in a dance hall. All had developed pneumothorax. A fourth patient sustained the condition while listening to a 1000 watt base box situated in his car boot. Two had had a pneumothorax previously. The authors speculate that repetitive pressure changes in the high energy, low frequency sound range may tear alveoli or subpleural blebs, analagous to what happens in blast injury. They recommend asking specifically about exposure to loud music when treating patients with pneumothorax.
Bacillary dysentery may provoke irritable bowel syndrome
One to two years after recovering from bacillary dysentery, 8% of 295 Chinese patients were diagnosed with irritable bowel syndrome and 22% with functional bowel disorders—10 times and three times, respectively, the proportions in their sibling and spouse controls who had not had dysentery. In a separate cohort of patients with post-infectious irritable bowel syndrome, the investigators found raised intestinal mucosal interleukin 1β mRNA, which they postulate may be a marker of an enhanced inflammatory response.
Should we disinfect the umbilical stump at birth?
A baby girl developed a purulent umbilical discharge at 10 days of age. This progressed, despite topical fucidin, to generalised staphylococcal sepsis and septic arthritis. The organism was fucidin resistant. In the 19th century, recognition of Staphylococcus as a cause of pemphigus neonatorum led to the application of antiseptics to the umbilical stump at birth. Over the past 25 years, this practice has virtually disappeared from UK hospitals. A Cochrane review has concluded that, in the developed world, simple hygiene is just as effective, but the increasing prevalence of antibiotic resistant bacteria and the rapid bacterial exchange between hospitals and the community provoked by early discharge may be increasing the risk for serious sepsis. The doctors who treated this baby ask whether the cost effectiveness of umbilical disinfection and staff handwashing needs to be reassessed and guidelines devised.
Full articles can be accessed via bmj.com