Minerva

Despite all the efforts made to get people who've had a heart attack to stick to the drug regimens they've started in hospital, many don't. One large Scottish study found that only 7.7% of patients continued to take statins after their myocardial infarction. There's a definite penalty to pay for stopping: those who took statins had a significant reduction in their risk of a further infarct compared to those who stopped (Heart 2002;88:229-33)[Abstract/Free Full Text].

When laparoscopic technology started, nitrous oxide (N₂O) was the gas of choice for creating a therapeutic pneumoperitoneum. But two reports of intraoperative explosions put a virtual stop to its use, and carbon dioxide (CO₂) replaced it. A prospective randomised clinical trial comparing the two gases now concludes that N₂O has sufficient advantages and should be reinstated as the gas of choice. Everything else being equal (and no explosions), patients in the N₂O group had less postoperative pain (Journal of the American College of Surgeons 2002;195:173-80)[Medline].

In field experiments female lions tend to choose male partners with the darkest manes. Darker manes indicate better nutrition and higher testosterone, and are associated with longer reproductive lives and higher offspring survival (Science 2002;297:1339-43)[Abstract/Free Full Text]. As in some other parts of the animal kingdom, however, male lions tend to go for females with lighter hair.

Estimates of the future burden of diabetes make frightening reading. Although the total UK population is not likely to increase by more than 3% during the next 60 years, the effect of an ageing population means that by 2036 there will be about 20% more cases of type 2 diabetes. Even worse, the number of complications related to diabetes is projected to rise by 30% by 2045 (Diabetic Medicine 2002;19(suppl 4): 1-5).

Another statistic that's set to rise is the number of children conceived by in vitro fertilisation (IVF). A large Dutch study investigating the number of congenital malformations in children conceived naturally and by IVF is rather reassuring. It found a small increase in malformations among the IVF children, which disappeared after maternal age and other maternal characteristics were controlled for. The authors conclude that the increase is probably not attributable to the IVF procedure itself (Human Reproduction 2002;17:2089-95)[Abstract/Free Full Text].

When change is badly needed, it's frustrating to hear the very people who have been resisting change saying that "we're doing it already." According to one of the editors of the Journal of Epidemiology and Community Health (2002:56:642), what's required is a willingness and maturity to let the resistors take the credit for change and creativity. This, he says, is one of the greatest challenges of public health.

The number of organs available for those who need liver transplants could rise dramatically if the technique of liver "splitting" is used more. When the records of 407 consecutive donors in Switzerland were scrutinised, 15% fulfilled all the criteria for a split liver procedure. This figure rose to 43% if donors with just one missing criterion were included. The authors say it's time to think of the liver as a paired organ and realise that whole liver transplantations can waste resources (Transplantation 2002;74:222-6)[Medline].

A writer in Spinal Cord (2002;40:371-3)[Medline] likens the effect of ageing on a person already living with a disability to a house of cards. Life is precariously balanced, but easily brought down, sometimes by the smallest disturbance. Ideally, those working in primary care should anticipate the possibility of a wobbly card and be alert to the first signs that the structure is becoming unstable. The balance of a single card should be restored without disturbing those around it, ultimately aiming to keep the whole house intact.

Many peopleincluding some doctorsmistakenly believe that women who carry mutations in breast cancer genes BRCA1 and BRCA2 have a high risk of developing breast cancer. The misconception is not helped by the exaggerated risks estimated from most genetic studies, concludes a study in the Journal of the National Cancer Institute (2002;94:1221-6)[Abstract/Free Full Text]. Inflated estimates arise because women who are mutation carriers are more likely to have other breast cancer risk factors as well, and until the complexity of disease risk is unravelled, say commentators, disease prevention is likely to remain flawed.

Half of people who have a primary haemorragic stroke die within one monthbut for those who survive and regain independence, the long term prognosis remains a bit of a mystery. One large study that attempts to shed light on the issue calculates an annual rate of recurrence, a vascular event, or vascular death of up to 5.9%. The risk doubled for those over the age of 65, and men were twice as likely to have vascular events as women (Neurology 2002;59:205-9)[Abstract/Free Full Text].

View larger version (105K): [in this window] [in a new window]   Elaborate nail painting is currently fashionable in the United Kingdom and this woman's nails were the envy of her friends. The 36 year old woman in question was diagnosed as having a high grade non-Hodgkin's lymphoma and had received five cycles of combined chemotherapy at the time the photo was taken. The Beau's lines shown here, which are particularly distinct, are thought to result from the temporary cessation of growth of the nail plate induced by repeated cycles of antimitotic drugs. S P Moule, senior house officer, J Heron, patient, A H Goldstone, professor, K M Ardeshna, specialist registrar, department of haematology, University College London Hospitals, London WC1E 6AU

Lying between the two populated shores of ethics and neuroscience is the unexplored continent of neuroethics, an emergent field that will overlap substantially with traditional issues in biomedical ethics. This new land, says Neuron (2002;35:21-3)[CrossRef][ISI][Medline], will bring together neuroscientists, ethicists, journalists, philosophers, and policy makersbecause our ever increasing understanding of the brain mechanisms underlying diverse behaviours has unique and potentially dramatic implications for our perspective on ethics and for social justice.

Footnotes

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