Reviews

Anaesthetists and pregnant women have waited for more than a decade for randomised evidence on a suggested association between epidural analgesia in labour and back pain. The results are reassuringly negative (British Journal of Obstetrics and Gynaecology 2001;108:27-33). Against all the odds, researchers recruited 369 primigravid women who were happy for their pain relief to be decided by a computer acting at random. Those who were allocated an epidural had no more back pain in the year after delivery than controls who received intramuscular pethidine. The epidural group had more instrumental deliveries, however.

As rates of coronary angiography and revascularisation continue to climb steeply, Australian researchers ask: what is the "best" rate for Australians in the subacute phase after a heart attack? After a systematic review (Medical Journal of Australia 2001;174:130-6) they conclude that rates above 30% for coronary angiography, and 20% for revascularisation probably don't save any more lives or prevent any more heart attacks. To make sense of their review however, policymakers will need to update their data on the use of these procedures in Australiathe latest were obtained more than four years ago.

If you are running a link between a health facility in Britain and a corresponding service in the developing world, make sure your efforts are recorded in a fledgling database hosted by the International Health Exchange. Send details to Patrick Brooke at info{at}ihe.org.uk and help to build a valuable resource for others wanting to set up arrangements for exchange visits, equipment donations, teaching trips, or any other mutually beneficial enterprise. The information on the database is for anyone who needs it, and it's free.

Minerva was just finishing off her Valentine's day chocolates (no expense spared, 85% cocoa solids) when she noticed a study reporting that calcium can be added to chocolate to make it less fattening (American Journal of Clinical Nutrition 2001;73:246-52). It works by reducing the absorption of cocoa butter by about 13%, so more of it passes harmlessly through the gut, instead of going via the bloodstream directly to the thighs. The volunteers, who agreed to collect all their faeces for 16 days in return for 100 g of chocolate, could not taste the added calcium.

New revelations about the human genome left egg on many faces, not least companies such as Incyte Genomics and Human Genome Sciences, which have been busy selling access to over 100 000 human genes (New York Times 13 February). Since there are no more than 40 000 genes in the entire genome, marketing managers now have some awkward explaining to do. Minerva, meanwhile, feels strangely reassured that our "book of life" has only a third more chapters than that of the roundworma rare example of things being fundamentally simpler than we thought.

About 40 people every year present to the poisons centre near Phoenix, Arizona, after an encounter with a rattlesnake (Academic Emergency Medicine 2001;8:177-82). Three quarters of them are men, many of whom have been bitten on the arm or hand after deliberately approaching a snake. The best policy is to keep out of the way of rattlers, particularly during the months between April and September when they are active. A bite is rarely fatal but commonly causes pain, severe swelling, and a coagulopathy. The antivenom can be nasty too. In one series, a third of the patients had anaphylactic reactions.

StigmaBusters, a campaigning branch of the US based National Alliance for Mentally Ill, were outraged recently by the new Armani fragrance "Mania" and its accompanying logo "Driven by Desire. Live a little." Lobbyists at the alliance, which campaigns against the stigmatisation of mental illness in the media, contacted the Italian company for an explanation. Mania, they were told, is simply the Italian translation of the word obsession, and anyway it's pronounced with the accent on the second syllable. So that's all right then.

Abdominal aortic aneurysms, even small ones, are associated with high death rates from all causes and from cardiovascular disease. In a large cohort of Americans aged over 65 screened by ultrasound, 8.8% had an aneurysm, although 87.7% of the aneurysms had a diameter of 3.5 cm or less (Annals of Internal Medicine 2001;134:182-90). Cardiovascular events were commoner in people with aneurysms even when they had no other relevant historythey should probably be advised to adopt healthier lifestyles.

The unthinkable has happened. A respected cohort study of American nurses turned up a link between eating saturated fat from animal protein and a lower rate of stroke (Circulation 2001;103:856-63). So should we resurrect the beefburger as a healthy diet option? Emphatically no, says a cautionary editorial (784-6). The isolated finding is confined to intraparenchymal haemorrhage, which is very rare; the finding was based on only 74 strokes out of a cohort of 86 000 women. Further, it is probably the result of confounding, chance, and ethnic differences in risk of stroke. Pulses, nuts, and spinach win again.

Surgery to reduce the size of uncomfortably, or even dangerously, large breasts has an important fringe benefitit lowers a woman's risk of breast cancer. It's still unclear why, although a recent study shows a direct relation between the amount of tissue removed and subsequent cancer risk (Cancer 2001;91:478-83). It's possible that surgery removes potentially malignant glandular breast tissue and so reduces the chances of cancer within the reduced breast.

View larger version (152K): [in this window] [in a new window]   A two year old boy developed acute airway obstruction immediately after adenoidectomy and was intubated. A computerised tomography scan showed an extensive bilateral retropharyngeal abscess, although no distortion of the posterior pharyngeal wall was seen during surgery or later examination. The abscess was incised and drained, and his airway symptoms immediately improved. P Chatrath, senior house officer, M Black, senior house officer, S Blaney, specialist registrar, department of otolaryngology, Great Ormond Street Hospital for Children, London WC1N 1EH

Readers who fondly remember the kind of humour usually confined to medical student's drunken reviews will enjoy the website www.qfever.com, an offering from two American doctors. If you don't find it funny, however, do not adjust your browser, or ring your therapist. Just check that you are not George Bushwho wouldn't understand itthen congratulate yourself for having a sense of humour more sophisticated than a mollusc.

Footnotes

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