Minerva: July 2000
A historical medical textbook, written by an English monk over 800 years ago, went on display last week at the US National Library of Medicine in Bethesda after an absence of over half a century (
Washington Post 22 May). The book, which contains many of Hippocrates' famous aphorisms, disappeared under suspicious circumstances sometime in the 1940s. It turned up last year at a rare book market in Southern California. The dealer donated the book to the library after some "decorous wrangling."
Lipid lowering drugs are expensive but they work, reducing the risk of coronary heart disease even in smokers (
Heart 2000;83:619-20). People who cannot stop smoking even though they have a risky serum lipid profile should therefore be offered statins just like everyone else, argue two doctors from Glasgow. There are plenty of effective interventions to help smokers give up, but once these options have been tried and have failed, statins are considerably better than nothing.
The cost effectiveness of statins in people with high serum cholesterol concentrations depends on a wide range of factors including age, sex, and other risk factors for coronary heart disease. One analysis concludes that statins are cost effective when used for secondary prevention, but not (with a few exceptions) when used for primary prevention (
Annals of Internal Medicine 2000;132:769-79). In most cases primary prevention with a statin costs more than $50 000 per quality adjusted life year saved.
The recreational drug ecstasy is neurotoxic if taken in high enough doses. The clinical effects of taking moderate doses mainly at weekends is still unclear, although a study from Germany suggests that regular use impairs memory, attention, and the ability to learn (
Journal of Neurology, Neurosurgery and Psychiatry 2000;68:719-25). Twenty eight users recruited from dance clubs did worse than matched controls in some psychological tests, but not in others. A comparison group of people who used cannabis did no worse than controls in the same tests.
Doctors have been waiting a long time for a suitable oxygen carrying alternative to transfused blood. The latest product on test, a heat treated salt solution of stabilised human haemoglobin, looked promising in the laboratory but worked poorly in patients after cardiac surgery (
Anesthesiology 2000;92:646-56). A few patients avoided transfusion but most needed blood before they left hospital. Worse, the solution caused more serious adverse events than standard packed red blood cells.
New research in the
American Heart Journal supports the theory that men do better than women after myocardial infarction because they have larger coronary arteries (2000;139:649-53). A retrospective look at stored ultrasound images of the main coronary arteries showed a clear difference between the sexes that was independent of body size. Future studies will have to investigate why.
Volunteer life savers patrolling the beaches of Queensland rescued nearly 3000 people during the 1997-8 season. Their small inflatable powerboats are flexible and fast, but more than 1% of volunteers using them are injured each season (
Medical Journal of Australia 2000;172:485-8). The crew member at the front is the most vulnerable, and fractures or dislocations of the right leg predominate. Dangerous design features could be to blame, say accident investigators.
Scientists from Israel have reprogrammed liver cells in laboratory mice to produce insulin, bringing them one step closer to their ultimate goal: responsive, insulin producing cells that are immunologically protected from rejection (
Nature Medicine 2000;6:568-72). Transfer of the gene PDX1 into liver cells turned on the production of insulin, which reduced hyperglycaemia in diabetic mice.
Escherichia coli O157:H7, a foodborne pathogen with a fatality rate of nearly 4%, has been found in undercooked beefburgers, unpasteurised milk, unpasteurised apple juice, yoghurt, cheese, salad, and now salami (
Canadian Medical Association Journal 2000;162:1409-13). Thirty nine Canadians from Ontario became ill after eating Genoese salami from a single source. Remarkably the bacterium survives the dry, salty, and acidic conditions during processing.
Doctors at a hospital in the Netherlands were baffled when a previously fit woman aged 34 came in and died of a rapidly progressive lung disease. Her five children developed lung disease soon afterwards and were eventually diagnosed with bird fancier's lung after health inspectors spotted a flock of wild pigeons nesting against the back of their house (
Paediatrics 2000;105:e62). The children improved after treatment with systemic steroids, but efforts to get rid of the pigeons have been unsuccessful.
Editors at the
Canadian Medical Association Journal (2000;162:1393) urge researchers to stop using meaningless descriptors such as "black" and "white" when describing the participants in their research. Unsophisticated references to race are biologically unsound and unlikely to be relevant to the research question, they say. Use of all ethnic descriptors must be scientifically justified and clearly explained.
This photograph was taken one month after the patient developed pressure sores on the great and little toes of both feet as a result of wearing thromboembolic deterrant (TED) stockings. The constricting elastic band with the toe hole was situated over the toes instead of under them. The patient, a fit 30 year old woman who had had a breast reconstruction operation, made a smooth recovery after surgery, but the sores persisted for eight weeks.
I U Khan, clinical fellow,
M S Coady, consultant, department of plastic surgery, Middlesbrough General Hospital, Cleveland TS5 5AZ
As scientists race to complete the map of the human genome, staff at one laboratory in Long Island, USA, have opened betting on the total number of genes in the genome (
New York Times 23 May). Over 200 bets have been placed so far and estimates range from 27 462 to 200 000 genes. Even the best informed commentators cannot agree on the likely total. The more there are, of course, the harder it will be to find out what they all do.
studentBMJ 2000;08:217-258 July ISSN 0966-6494
