BMJ, doi: 10.1136/bmjusa.03040011, (Published 6 May 2003)

Minerva

From BMJ USA 2003;April:232

Every surgeon's nightmare is to leave a swab or instrument inside a patient. So what are the risk factors? A case-control study of medical malpractice claims found that it's nine times more likely to happen during emergency surgery and four times more likely after an unplanned change in the procedure ( New England Journal of Medicine 2003;348:229-235). Overweight patients (and their surgeons) are also at increased risk.

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The risk of a surgical wound becoming infected is inversely correlated with the oxygen tension in the subcutaneous tissues. Providing supplementary oxygen during surgery reduces that risk. A study of 500 patients undergoing colon surgery found that only 5% of the patients given 80% oxygen developed wound infection compared with 11% of those given 30% oxygen. Supplementary oxygen also cut the rate of postoperative nausea and vomiting ( Clinical Infectious Diseases 2002;35:1397-1404[CrossRef][ISI][Medline]).

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An incidentaloma is the name given to a totally asymptomatic non-functional tumor that is clinically and biochemically silent and has been discovered by chance. These tumors are found most often in the adrenal glands of patients being investigated with modern imaging techniques. The name seems to have enraged some commentators. According to The American Surgeon (2002;68:1026-1028[ISI][Medline]) it is "a benign terminological mistake: useless, unfortunate and due to be abolished."

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Does smoking have an effect on pain? A postal survey of 21 201 adults brought answers from 12 907, including 6513 who had ever smoked and 3184 current smokers. Current and former smokers reported more pain in the low back, the neck, and the limbs than non-smokers did ( Annals of the Rheumatic Diseases 2003;62:33-36). The pain was often severe enough to prevent day to day activities. The authors suggest several possible explanations including a pharmacological effect of tobacco smoke and a tendency for people with a low pain threshold to take up and continue smoking.

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Humans seem to be genetically programmed to react to anxiety by sitting down and eating something. A review in the Mayo Clinic Proceedings (2003;78:92-94) claims that this behavior underlies the worldwide epidemic of obesity. The solution offered is to create a social and physical environment that rewards physical activity and nutritional restraint. Easier said than done.

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If you like the idea of bicycling to work, but don't want to work up a sweat, try sharing the journey with a friend. Tandem cycling is faster and, if you sit on the back, easier than solo cycling. A study in the British Journal of Sports Medicine (2003;37:50-53) shows that captains (the front half) have to pedal just as hard as they do going solo. Stokers (the back half) can relax because they don't have to pedal against the wind.

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When police in Vancouver seized 100 kg of heroin in September 2002, they must have celebrated a major upset in Canada's heroin trade. Unfortunately the seizure had little impact on the streets, according to a study of injecting drug users that was in progress at the time ( Canadian Medical Association Journal 2003;168:165-169). None of the users reported any interruption in or changes to their supply. The street price of heroin actually went down, suggesting that other shipments quickly compensate for drug seizures, even record breaking ones.

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When Minerva eats out, she usually takes most of the meal home with her in a "doggy bag." Portion sizes in fast food restaurants are getting bigger and bigger, along with customers' waistlines. A study in Journal of the American Dietetic Association (2003;103:41-47) finds that soft drinks are a particular problem. An extra 2 fluid ounces (60 mL) a day of any soft drink will increase your weight by around 3 lb (1.4 kg) each year.

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Things have moved on since patients were labeled by their physical signs, but some hospital staff still struggle with names. A woman named Joan reported that during her short stay in the Edinburgh Royal Infirmary, Scotland, she was called darling, dear, honey, Jane, Jean, Jeanette, hen, ma'am, my love, my pet, and sweetheart.

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Scientists examining autopsy specimens from female recipients of bone marrow transplants were mildly surprised to find some of the transplanted cells had become neurons (Proceedings of the National Academy of Sciences 2003, pnas.org/cgi/doi/10.1073/pnas.0337659100). About 0.1% of the Purkinje cells in the cerebellar samples had clearly come from donated bone marrow: they contained a Y chromosome. All the donors were male.

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Parents in Ohio think their children are too smart to play with guns. In a telephone survey ( Pediatrics 2003;111:109-114), nearly 90% of over 600 respondents said their children wouldn't touch guns if they found them, mostly because they "knew better." Each year, 15.4 per 100 000 children aged 10-14 are injured because they didn't.

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Patients having a colonoscopy might be interested in the latest data on perforation rates. A trawl through nearly 40 000 records in an American database found 77 perforations, a rate of 1.96 per 1000 procedures (Journal of the National Cancer Institute 2003;95:230-236). The patients were all over 65, and none had cancer. Just over 5% of perforations were lethal within 14 days.

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View larger version (107K): [in this window] [in a new window]   A 19 month old boy had a slowly enlarging lesion below his right eye. Examination showed a 1 cm nodular lesion, with a surrounding tender, boggy swelling. Additional satellite lesions confirmed the diagnosis of giant molluscum contagiosum with secondary infection. He was treated with intravenous antibiotics, which cleared the secondary cellulitis. Molluscum contagiosum is caused by a poxvirus and is most common in children and immunocompromised adults. The typical lesion is a small, firm, umbilicated pearly papule. Giant molluscum contagiosum can be confused with epidermoid cyst, keratoacanthoma, basal cell carcinoma, furuncle, or pyogenic granuloma. S Taibjee, senior house officer, A Abdullah, consultant dermatologist, Birmingham Skin Centre, City Hospital, Birmingham B18 7QH, UK

 

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