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BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:104
  1. Harvey Marcovitch (h.marcovitch{at}, BMJ syndication editor

    Silence soothes the savage breast

    Different types of music (and silence) have a detectable effect on blood flow, blood pressure, and breathing characteristics. Twelve musicians and 12 controls listened in random order to six types of music: slow and fast classical, dodecaphonic, techno, rap, and raga. They were monitored throughout for heart rate, blood pressure, cerebral artery blood velocity, respiratory movements, and end tidal CO. In all subjects, breathing rate, heart rate and blood pressure increased proportionally to the tempo and, perhaps, complexity of the rhythm. Music style or personal preference had little effect. Musicians had slower baseline breathing rates but breathed faster than controls at faster tempos, presumably because they are trained to breathe in synchrony with music.

    Pauses for silence reduced all the variables so that the subjects were more relaxed than when music was playing. The authors speculate that pleasure may arise from controlled alternation between arousal and relaxation. They suggest this phenomenon could be used to reduce sympathetic activity and induce relaxation in cardiac patients.

    What clinical features precede lung cancer diagnosis?

    Seven symptoms, one sign, and two abnormal test results seem to be precursors of lung cancer, according to a population study of 247 patients and 1235 matched controls in Devon, England. The symptoms are haemoptysis, anorexia, weight loss, dyspnoea, chest pain, fatigue, and frequent consultations for cough. The sign was finger clubbing, and many patients had thrombocytosis or abnormal spirometry. However, positive predictive values for single variables were all under 2% except for haemoptysis (2.4% for one attendance and 17% for two). Certain combinations increased predictive values markedly, especially haemoptysis combined with loss of appetite or weight, thrombocytosis, or abnormal spirometry. The authors claim to have provided an evidence base with which to develop guidelines on whom to investigate.

    Standing does produce varicose veins

    Standing at work has been confirmed in a prospective study as a risk factor for developing varicose veins requiring inpatient care. Of nearly 9000 Danish adults recruited in 1991, 111 needed such treatment by 2002. After adjustment for all confounders (including pregnancy), the relative risk was 1.78 (95% CI 1.19 to 2.68). Smoking possibly offered some protection, albeit weak. The authors speculate on whether this is because smoking is a socially acceptable way to get a break at many workplaces, with the opportunity to sit down, several times during the working day.

    Influenza vaccine is effective in patients with rheumatoid arthritis

    Patients with rheumatoid arthritis generated a good humeral response to influenza vaccine, apparently unaffected by long term treatment with prednisone, methotrexate, infliximab, or etanercept. Although antibody titres were a little higher in controls and one vaccine variant provoked response from more controls than patients, in practical terms the vaccine was effective. Immunisation did not produce any increase in arthritis symptoms, so the authors recommend that it should be offered to this group of patients.

    The food of love, perhaps

    Dark chocolate induces a rapid improvement in endothelial and platelet function in healthy smokers. White chocolate has no effect. Twenty male smokers volunteered for measurement of flow mediated dilatation (FMD) by ultrasonography of the brachial artery and of shear stress dependent platelet function. After abstaining from polyphenol-rich foods for 24 hours, they ate 40 g of either dark or white chocolate and measurements were repeated. FMD increased by 7% after dark chocolate (v 4.4% at baseline), and the effect lasted about eight hours. White chocolate had no effect on FMD. Within two hours, platelet function decreased by a third, but only after dark chocolate, and total antioxidant status increased, again only after dark chocolate. The authors comment that a small daily treat of dark chocolate may be good for vascular health.

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    Osler-Weber-Rendu syndrome

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    A 54 year old woman presented with 10 years of progressive dyspnoea and exertional hypoxia. Her conjunctivas contained telangiectasia (left). Pulmonary artery catheterisation confirmed a right to left shunt and angiography (right) showed multiple arteriovenous malformations. Symptoms improved after pulmonary coil embolisation.

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