Minerva

British Medical Journal, Nov 17, 2001 by S Alexander Holme, Caroline M Mills

A single dose of steroids given to children undergoing tonsillectomy reduces the risk of postoperative vomiting and makes it more likely that a child will progress to a soft diet on the day after surgery. Given the safety and low cost of dexamethasone, the authors of a meta-analysis in the Laryngoscope (2001;111:1712-8) say it should be routinely used during tonsillectomy or adenotonsillectomy.

People with spina bifida are commonly allergic to latex because of their atopic disposition and frequent exposure to surgery in early life. But what about allergy to latex in other children undergoing surgery? A review of surgical intervention and skin prick testing in 86 patients identified a strong correlation between clinically important latex sensitisation and having had more than eight operations during the first year of life. The authors say that from birth, latex should not be used to handle any child having surgery (Journal of Pediatric Surgery 2001;36:1535-9).

An unsolicited letter sent to a clinic in Tokyo undermines the belief that the sale of organs is just an urban myth. It reads: "We are selling people of good health for 10,000 US Dollar. Organs including heart, lung, kidney and spleen among others. We bring these people from Europe to Fiji, Papua New Guinea, Macao, Virgin Is, French Polynesia, Kiribati, Nauru, Vanuatu, New Caledonia, Samoa, Tonga, Micronesia and Solomon Is." The letter originated in Germany.

Attention to workstation ergonomics is beginning to have an impact in many offices. Wheelchair users too have ergonomic needs. Without good design and adjustment, a wheelchair becomes a device for poor sitting and inactivity (Disability and Rehabilitation 2001;23:677-82). An audit of one service showed that taking the time to make individual adjustments to users' chairs resulted in a rapid improvement to 90% of users' problems (mostly seating and back pain).

Turning blue around the gills could take on a new meaning. Twenty patients newly diagnosed with septic shock were randomised to receive continuous methylene blue infusions or isotonic saline. The hypothesis was that methylene blue, an inhibitor of the nitric oxide pathway, would maintain better circulation and organ function. Those in the blue group had better myocardial function, maintained their oxygen transport, and reduced the need for adrenergic support, without incurring any important adverse effects (Critical Care Medicine 2001;29:1860-7).

What turns an acute episode of back pain into a chronic debilitating problem? An individual's fear of pain and the degree to which they will avoid painful experiences seem to be crucial. Such "fear-avoidance beliefs" are established before the actual episode of back pain; screening for such beliefs could help to identify people at risk of prolonged disability (Pain 2001;94:7-15).

Abdominal pain combined with a high serum amylase activity usually indicates acute pancreatitis. But amylase's short half life means that levels vary depending on how much time has elapsed since the onset of pancreatitis. With reliable lipase measurements now available, a study suggests that lipase activity may become the new gold standard. On day 1, lipase measurements gave the greatest diagnostic accuracy, and on day 3 no other enzyme measurements were superior to lipase (ANZ Journal of Surgery 2001;71:577-82).

The number of GP vacancies doubled last year; the jobs took longer to fill, and the number of applicants per post fell. Almost a quarter of vacancies took over six months to fill. Against this depressing backdrop, says the Health Service Journal (8 November 2001:17, 20), there are growing numbers of refugee and asylum seeking doctors "living in poverty in the UK" who have not been able to find work within the NHS. What's going wrong?

Spinal cord injuries can interfere with bladder function, allowing bacteria to multiply and cause symptomatic infections. Histological examination of bladder wall biopsy specimens taken from 94 patients with spinal cord injuries show that abnormal changes occurred in the vast majority of cases. Two thirds showed chronic inflammation, and one quarter showed subacute inflammation. But these changes were not correlated with time since injury, the annual number of infections, nor the neurological level of spinal cord lesion (Spinal Cord 2001;39:568-70).

A qualitative analysis of frequent attenders at one emergency department shows that these patients perceive their pain or other symptoms to be life threatening. Many of them have ongoing psychological struggles or problems with substance misuse, but referring frequent attenders to a psychiatrist did not produce a change in their health seeking behaviour (Emergency Medicine Journal 2001; 18:430-4).

Doctors are supposed to be committed to lifelong learning. One cross sectional survey of 80 consultants working in district general hospitals found that most claimed to be spending sufficient time undertaking continuing medical education activity. But most of it was limited to an individual's own subspecialty and did not deal with the wider clinical or non-clinical aspects of medical life. The question of educational needs is largely ignored, and the royal colleges exert little influence on how choices are made (Medical Education 2001;35:967-72).