Minerva is a believer in centres of excellence publishing their
results to encourage others. Surgeons at Johns Hopkins have recently
reviewed 650 patients who had pancreaticoduodenal resections, of
whom 443 had periampullary carcinomas and 71 had chronic pancreatitis,
while the remainder had neuroendocrine tumours or adenomas
(Annals of Surgery 1997;226:248-60). Only nine patients
(1.4%) died in hospital or within 30 days of surgery. The median
survival of the whole cohort was 47 months.
Only one case of "wild" poliomyelitis has been confirmed so
far this year in the European region of the World Health Organisation.
In 1996 there were 193 cases. In the eastern Mediterranean region cases
have fallen from 532 to 424. The WHO believes that it is now in the
last chapter of the history of poliomyelitis, which should be
eradicated from both these regions by 2000.
The US Task Force on Genetic Testing is concerned that the
number of genetic tests being developed could overwhelm institutional
review boards (Science 1997;278:602-5). It is
calling for some system to be developed to prioritise tests waiting for
review, looking at their ability to predict future disease in healthy
or apparently healthy people, their likely use for predictive purposes,
and the absence of independent confirmatory tests.
A study in Sweden of children born to women who had misused
alcohol during pregnancy (Developmental Medicine and Child
Neurology 1997;39:583-7) found that at the age of 11-14 years
10 of the 24 children had attention deficit hyperactivity disorder with
or without problems in coordination. Only seven of the 24 were
attending normal schools without any type of support.
An total of 41 279 people rescued from the sea near Rio de
Janeiro over 20 years looks less dramatic when a report in
Chest (1997;112:660-5) goes on to say that 2304 had then
been referred to the near drowning recuperation centre. Death could be
predicted from the state of consciousness at first assessment: 73% of
those in coma died, whereas among the conscious (including the confused
and the stuporous) the mortality was only 0.5%.
Severe exophthalmos associated with thyrotoxicosis may lead to a
substantial loss in visual acuity. If treatment with steroids is
unsuccessful the answer may be surgery: four wall orbital
decompression. In a series of 22 patients described in the
British Journal of Plastic Surgery (1997;50:507-16) all
were followed up for five years after their operations. Before surgery
only six eyes had normal visual acuity, but 34 were normal afterwards.
This operation seems to produce functional and cosmetic improvement in
most cases.
Patients fitted with pacemakers should be wary of close contact
with cellular phones, warns the European Heart Journal
(1997;18:1538-9). Apparently the electrode can act as an
antenna and pick up the signal, which it transfers to the pacemaker,
causing potentially dangerous interference. Long term the answer lies
in bipolar pacing, but for the time being patients with pacemakers
should be warned to keep any cellular phone at least 20 cm away from
the pacemaker and its leads.
Coffee drinking is discouraged for people with heart disease and
stomach disorders, but people who like their regular doses of caffeine
can point to one positive medical benefit. Research in Italy has
confirmed earlier reports that coffee protects against cancer of the
colon (International Journal of Cancer 1997;73:193-7).
The evidence came from a case-control study based on 2166 patients with
cancers of the colon: the odds ratio was 0.73 in people who drank four
or more cups of (Italian) coffee a day.
An investigation of motor vehicle fatalities in Finland
(British Journal of Psychiatry 1997;71:468-72) found
that 99 of 1419 deaths were possible suicides. Two forensic
pathologists made a diagnosis of suicide in 84 of the 99. Suicide was
most frequent among deaths in drivers aged 15-24, and the most common
method was a head on collision with a heavy goods vehicle.
Migrants from northern Europe to Asia and Africa take with them
their increased risk of multiple sclerosis if they make the move after
the age of 15. The converse also applies: adult migrants from India and
Pakistan to Britain rarely develop multiple sclerosis. Those who
arrived in childhood, however, have higher rates of the disease
(Journal of Neurology, Neurosurgery, and Psychiatry
1997;63:565-8). The data that do not fit are those on
immigrants from the Caribbean, in whom the age at migration seems not
to affect their risk of developing the disease, but that risk is higher
(at all ages) than in Asian immigrants.
The justifiable zeal of campaigners against tobacco seems
sometimes to distort their perceptions so that nicotine is seen as an
evil, dangerous drug. In reality, research has shown that nicotine
replacement treatment is usually safe (New England Journal of
Medicine 1997;337:1230-1). Nicotine patches and nicotine gum
are not dangerous for people with heart disease. Indeed, what is really
needed to combat smoking is a safe way of providing nicotine that
replicates the buzz derived from inhalation of smoke
As tuberculosis becomes more common in many parts of the world,
clinicians will need to relearn the lessons of the past. Abdominal
tuberculosis may go unrecognised for many months (Singapore
Medical Journal 1997;38:364-8). Patients may present with
diarrhoea or ascites, but a definitive diagnosis may not be possible
and a therapeutic trial of chemotherapy may sometimes be justified.
New Zealand is currently coming to the end of what it hopes will
be its last epidemic of measles (New Zealand Medical Journal
1997;110:387-8). The Ministry of Health is hoping to eliminate
the disease by 2000,but the problem is that measles is still perceived
as a mild illness. In reality, in the 1991 epidemic there were 10 cases
of encephalitis and seven deaths.
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