BMJ  2005;331:E398 (17 December), doi:10.1136/bmj.331.7530.E398

BMJ USA: Minerva

Minerva

Risperidone is used to help manage short term aggression, temper tantrums, and self injury in children with autism. But what if these behaviors become chronic? A six month trial in children aged 5 to 17 found that risperidone continued to be efficacious (in over 80% of the children) and was tolerated well. But when the drug was stopped after six months, the troubling behavior rapidly returned in most of them (American Journal of Psychiatry 2005;162: 1361-9[Abstract/Free Full Text]).

People who take an overdose and then present to the emergency department are often given activated charcoal to adsorb the poison. A randomized trial of charcoal versus no decontaminant in one Australian hospital over 16 months (excluding patients who were suspected of having taken lethal drugs) reports no difference in patient outcomes such as length of stay, vomiting, death, or intensive care admission between the two groups (QJM 2005;98: 655-60[Abstract/Free Full Text]).

Young people (under the age of 50) who have ischemic strokes but do not have any obvious risk factors may not need long term secondary prevention, according to a study in Neurology (2005;65: 609-11)[Abstract/Free Full Text]. After six years, the risk of a second vascular event rises from 2.1% with no risk factors, compared with 67% with five traditional risk factors. This may be fine in theory, but Minerva wants to know who's going to take the risk of stopping all preventive medication.

Writing on a patient's skin with a marker pen and attaching signed checklists to the patient's charts are one way to tackle the problem of wrong-site surgery. Another, described in the latest issue of UK Casebook (2005;13:17), is the "safety band." This looks like a standard hospital identity bracelet, but it also has the correct procedure written on it and room for three sets of initials—the patient's, the admitting doctor's, and the surgeon's—which are added when the patient is in the anesthetic room, still conscious.

For 56 toddlers taking part in a randomized double blind placebo controlled trial of the effects of oral probiotics on their moderately severe atopic dermatitis, taking supplements of Lactobacillus fermentum benefited them greatly. Both the extent and severity of their skin condition improved. They took a supplement or placebo for eight weeks, and had a final assessment at 16 weeks (Archives of Disease in Childhood 2005;90: 892-7[Abstract/Free Full Text]). The authors say their findings support the notion that L fermentum may accelerate the natural tendency for atopic dermatitis to improve over time.

View larger version (67K): [in this window] [in a new window]   A 16 year old girl was admitted to the otolaryngology ward with a three day history of sore throat, malaise, vomiting, and bilateral upper eyelid swelling. On examination she had a fluctuating temperature and a congested oropharynx. Funduscopy was normal. Investigation showed positive results for glandular fever screening and Epstein-Barr virus serology. Conservative treatment with intravenous steroids settled the patient's symptoms. Bilateral eyelid edema presenting in a patient with infectious mononucleosis is known as Hoagland's sign. It was first described by Hoagland, who saw it in young military recruits. Acute infectious mononucleosis should be considered in the differential diagnosis when bilateral eyelid edema is present. Ranjeeta Matharu senior house officer Kenneth Wu specialist registrar drkenwu{at}hotmail.com Andrew McRae consultant department of otolaryngology, head and neck surgery, Lincoln County Hospital, Lincoln LN2 5QY, UK

Apart from the desire to see babies gain weight, there's another lesser known reason to make sure breast feeding is successfully established before new mothers leave hospital. Hypernatremic dehydration is associated with poorly established breast feeding, and a US study found that almost 2% of term and near term breastfed neonates admitted to hospital had the condition. Most presented with jaundice, and 17% of these babies developed apnea and bradycardia (Pediatrics 2005;116: e343-7[Abstract/Free Full Text]).

Several studies have found that people who have total hip replacement live longer than control populations, suggesting that the operation somehow protects life. But does it really? An analysis of data from nearly 25 000 patients in the US shows that the improvement in mortality emerges rapidly after surgery but then falls by three months after the operation. The protection seems to be related to the selection of low risk patients for elective surgery rather than anything else (Journal of Bone and Joint Surgery [Am] 2005;87: 1965-71).

One year on, a third of 94 survivors of severe acute respiratory syndrome (SARS) still have impaired lung function. The main determinants of the cause of prolonged chest problems have not been identified, but all these survivors had poorer general health than the healthy population (Chest 2005;128: 1393-400[Abstract/Free Full Text]).

Colchicine is well known as an effective treatment for acute attacks of gout. The results of a randomized controlled trial from Italy indicate that it is useful in acute pericarditis as well. When added to conventional treatment with aspirin, colchicine shortened the duration of symptoms and reduced the recurrence rate. The researchers found no serious adverse effects (Circulation 2005;112: 2012-6[Abstract/Free Full Text]).

The optimal time to undergo carotid endarterectomy after a stroke is within two weeks of the first event. A study of delays in one UK center found that just 6% of suitable patients had surgery within two weeks and 43% within 12 weeks. The risk of recurrent stroke in those with more than 50% carotid blockage before surgery was estimated to be 21% at two weeks and 32% at 12 weeks. The delays are similar to those reported in several other countries, and are associated with very high risks of what otherwise are preventable events (Neurology 2005;65: 371-5[Abstract/Free Full Text]).

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