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Minerva: December 2000 It's part of a vascular surgeon's job to advise smokers to stop smoking, and 98% of members of the Vascular Surgical Society of Great Britain and Ireland do give advice (Annals of the Royal College of Surgeons of England 2000;82:424.7). Only a minority give out written information, however, and even fewer (11%) run an antismoking clinic or group. Over half of the surgeons in this survey also counsel their junior staff about smoking. Whether the juniors take any notice could be the subject of another investigation. Researchers from Oklahoma took advantage of an "animal damage control" exercise to test 21 of the state's wild coyotes for infectious diseases (Emerging Infectious Diseases 2000;6:477.9). Nearly three quarters carried Ehrlichia chaffeensis, the ricketsial pathogen responsible for human monocytotropic ehrlichiosis. White tailed deer are the best known carriers of E chaffeensis, which jumps to humans and domestic animals on board the lone star tick. Digestive surgery has become more evi. dence based over the past 10 years as researchers design, conduct, and analyse more randomised trials (British Journal of Surgery 2000;87:1585.6). The increase has been driven partly by the rise of new laparoscopic techniques: half the randomised trials conducted in Europe between 1990 and 1999 evaluated laparoscopic procedures. Researchers from Finland, Sweden, and Denmark do the most trials per million inhabitants. Dressing up on Hallowe'en night may be fun, but it's hard to see where you are going with a cardboard pumpkin on your head. Excitement and an overdose of sugar all add to the hazard, substantially increasing the risk of a road traffic accident, writes a reporter for the Canadian Medical Association Journal (2000;163:1046). Less serious reported hazards include eye injuries from flying missiles, particularly eggs, and flatus from gummy bears. Older people with end stage renal failure should not be excluded from dialysis programmes because of their age, conclude researchers from London (Lancet 2000;356: 1543.50). Their cohort study in people over 70 years found that mortality was similar to previously published rates in younger people, and that many comorbid conditions including diabetes and heart diseases had no impact on mortality. Women doctors behave just like everyone else when it comes to taking vitamin and mineral supplements, according to data from the Women Physicians' Health Study (American Journal of Clinical Nutrition 2000; 72:969.75). About half of them take some sort of supplement. Those with osteoporosis are more likely to take calcium; those at risk of heart disease take antioxidants; and use of supplements increases with age. Users eat less fat and more fruit and vegetables than non-users. During some surgical procedures - mastectomy, for example - only one of the patient's arms is available for monitoring and fluid replacement, forcing the anaesthetist to put a blood pressure cuff on the same arm as an intravenous cannula. To prevent the backflow of blood through the cannula every time the cuff blows up, a tip in Postgraduate Medicine ( www.postgradmed.com/pearls.htm) recommends securing the plastic tubing between the layers of the cuff. When it blows up, the tube is kinked. When it goes down, forward flow is restored. A link between Helicobacter pylori and sudden infant death was first postulated three years ago, and evidence has been accumulating slowly ever since. This month's Archives of Disease in Childhood reports that babies who died from sudden infant death syndrome are significantly more likely than controls to have evidence of H pylori infection in the stomach, trachea, and lung (2000;83:429.34). Experiments in rats suggest two possible causal mechanisms, but it will be extremely difficult to study either of them in humans. The association between smoking and depression is established, but it's still unclear whether depression leads to smoking or smoking leads to depression. In a cohort of initially happy teenagers, being a smoker strongly predicted becoming depressed in the next year (Pediatrics 2000;106:748.55). In another cohort - all non.smokers at Baseline - being depressed did not independently predict the onset of heavy smoking. It looks as though the smoking may come before the depression. When most members of a football team from North Carolina developed diarrhoea and vomiting during a game, communi. cable diseases investigators found that turkey sandwiches in their lunch boxes were contaminated with a Norwalk.like virus (New England Journal of Medicine 2000;343: 1223.7). The sick players continued to play in between bouts of retching on the sidelines and managed to infect 11 of the opposing team's players. The paper reporting the outbreak does not say who won the game. The World Health Organization last week declared its Western Pacific Region a polio.free zone, the second global region to have been cleared of the disease since the launch of an eradication initiative in 1988 ( www.eurosurv.org/update). The Western Pacific region includes the People's Republic of China as well as many smaller countries and tiny islands. There has not been a case of polio here for three years. Leaders of the eradication programme are aiming for a polio.free world by 2005. The latest in a long line of studies on the prevalence of tiredness in patients with cancer finds that more than three quarters of people on chemotherapy suffer from debilitating tiredness for at least a few days each month (Oncologist 2000;5:353.60). The profound effect this can have on their lives is well known, but management remains decidedly poor. An accompanying leader urges doctors to talk about and take seriously all reports of tiredness by cancer patients.
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