BMJ  2003;327:E29 (4 October), doi:10.1136/bmjusa.01040007 (published 5 September 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

A retrospective look at a cohort of American women with breast cancer suggests that survival can be reasonable even when the disease has spread to bone ( Cancer 2001;91:17-24[CrossRef][Medline]. Women with a solitary bony metastasis survived more than four years, on average, from the time of recurrence. Survival gets steadily worse, however, as the number of metastases goes up. In this cohort, recruited between 1974 and 1985, women with two bony lesions lived for three years, and those with more than three metastases lived only two years after recurrence.

Another study on breast cancer, this time comparing survival rates in different types of hospitals, confirms again that patients do better in teaching hospitals ( Canadian Medical Association Journal 2001;164:183-188[Abstract/Free Full Text]. The Canadian researchers, who included only women with node negative disease, conclude that for women with tumours less than 20 mm in diameter, initial treatment in a teaching hospital reduces the risk of death by 53%. The difference was smaller, and not significant, for women with larger tumours.

Every now and then people in a deep coma are wrongly declared dead, and survive the experience. That this happened to a woman from Massachusetts who later woke up in a body bag at the funeral parlour is worthy of comment only because of a headline written by subeditors at (USA Today (January 26), which read "Woman Declared Dead in Good Condition."

People infected with hepatitis C are substantially more likely than healthy controls to end up with cirrhosis of the liver. Factor in a history of heavy alcohol use, and the risk climbs to 31 times that of healthy controls ( Annals of Internal Medicine 2001 ;134:120-124[Abstract/Free Full Text]. Investigators who studied an American cohort think that even this figure may be an underestimate and urge doctors to offer alcohol counselling to all of their patients with hepatitis C.

About a quarter of non-fatal heart attacks in young Americans are caused by cocaine, according to research in Circulation (2001;103:502-506[Abstract/Free Full Text]. The data, which come from an established cohort, show that cocaine users have a substantially increased risk of heart attack that could be anywhere between 1.3 and 58 times the risk of non-users. The paper is consistent with other, more anecdotal evidence linking cocaine to heart attacks in young people. The first case report was published in 1982.

Thanks to functional brain imaging, it is now possible to visualise a person's craving for cocaine ( American Journal of Psychiatry 2001;158:86-95[Abstract/Free Full Text]. Video tapes designed to cue the desire for cocaine seem to switch on the anterior cingulate and switch off the frontal lobes in addicted users. In volunteers, activation of the cingulate preceded the craving, and this happened even in people who were addicted but said they had no craving. The cingulate remained deactivated in healthy controls.

Hormone replacement therapy has been implicated in the aetiology of stroke, mostly by observational studies. Results of the first clinical trial, however, are negative ( Circulation 2001 ;103:638[Abstract/Free Full Text]. Postmenopausal women randomised to take conjugated oestrogen and progestin were no more likely to have a stroke or a transient ischaemic attack than controls taking placebo. Note that the trial was set up to look at the impact of hormone treatment on secondary prevention of heart disease, not stroke. All the women had coronary heart disease, and 80% of both groups were taking aspirin.

Is the genome the secular equivalent of the soul? asked a Swiss bioethicist in ( Science (2001;291:831[Free Full Text] recently. Several thousand words on the philosophy of the soul later, he concludes that it isn't. To be human is to have far more than just a human genome, he says. Instead of trying to fit the human genome discoveries into traditional thinking about what it means to be human, we should start again from the beginning and accommodate the new knowledge into a new philosophy. So get started.

In theory, antioxidants such as vitamins C and E should help to prevent colorectal cancer. In practice, the effect—if it exists at all—is too small to show up in a cohort study of over 700 000 Americans ( Cancer Epidemiology 2001;10:17-23). Members of the cohort who took regular supplements of vitamins C or E were no less likely to die of colorectal cancer than the others. Subgroup analyses were more hopeful—the group taking supplements for 10 years or more had a lower risk—but Minerva is now conditioned to ignore subgroup analyses ( BMJ 2001;322:231[CrossRef].

View larger version (165K): [in this window] [in a new window]   A 26 year old woman presented with positive results on a pregnancy test and an abdominal mass consistent with a 20 week pregnancy. An ultrasound scan showed a fetus of no more than 8 weeks' gestation, and this later magnetic resonance image clearly shows the fetus and a large fundal fibroid. The mass continued to grow but did not interfere with fetal development; a healthy infant was delivered at term with blood loss of less than 400 ml. The fibroid regressed post partum, and the patient required no further treatment. D J D'Souza, specialist registrar, W E MacKenzie, consultant, department of obstetrics, Heartlands Hospital NHS Trust, Birmingham B9 5SS, UK

A rare look at the male side of teenage pregnancy finds that men and boys with a history of sexual or physical abuse are more likely than others to have sexual contact with a teenage girl that results in pregnancy (www.pediatrics.org/cgi/content/full/107/2/19). More surprising perhaps is the finding that 43% of more than 4000 men attending an American primary care clinic reported physical or sexual abuse or said their mother had been battered. Nearly a fifth of the respondents said they had made a teenage girl pregnant. The patients sampled were predominantly well educated and wealthy enough to have health insurance.

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