Cefotan

Women doctors practising in America are a contented lot, according to an analysis of questionnaire data from the women physicians' health study (Archives of Internal Medicine 1999;159:1417-26). Despite challenges like juggling work and home, long hours, and poor control over their work, more than four fifths of a national sample reported satisfaction with their careers. Less than a third said they would not choose to do it all again.

African-Caribbean people living in the United Kingdom have a high rate of schizophrenia, twice as high African-Caribbean people living in Barbados (British Journal of Psychiatry 1999;175:28-33). We still don't know why this group is vulnerable to schizophrenia, but the authors of the first incidence study from Barbados reiterate the view that it may be something to do with the unexpected poverty and racism faced by the first immigrants 40 years ago. Unfortunately, rates of psychotic illness are getting worse with each generation.

What should happen to frozen embryos when the couples who created them divorce? An American lawyer argues that when couples disagree, the partner with the strongest case is the one who wants the embryos to be disposed of or used for research (Fertility and Sterility 1999;71:996-7). The harms of unwanted genetic reproduction, he says, outweigh the harms of losing the opportunity to reproduce with the disputed embryos. The balance only tips the other way when the embryos are a last chance at reproduction for one of the partners.

It's not often that Minerva finds a paper showing that a new treatment is actually worse than a conventional one (perhaps because they don't get published). Adding nightly lubricating ointment to a standard treatment for corneal abrasion does, however, make recurrent symptoms more likely, not less (Eye 1999;13:345-7). The authors concede that they have no randomised evidence to support their standard treatment either, but they have plans to get some.

It's not immediately clear why smoking and drinking should make gut anastamoses leaky, but retrospective analysis of data from over 300 consecutive patients in one department suggests that they do (British Journal of Surgery 1999;86:927-31). Smokers who had colonic or rectal anastamoses were three times more likely to spring a leak than non-smokers. The risks were even higher for heavy drinkers (more than 35 units a week). A controlled trial of quitting before surgery is planned. Sometimes it's difficult to be good, but nothing could be easier (for UK readers) than telephoning 0800 55 66 96 and adding your name to a petition supporting the millennium gesture to cancel all debts owed by poor countries to rich countries. Comic Relief has organised the petition in response to a challenge from Tony Blair and Gordon Brown, who insist the British government will act if enough people want it to happen.

Wound infections are relatively rare after laparoscopic cholecystectomy, and prophylactic antibiotics don't seem to reduce the rate any further (Archives of Surgery 1999; 134:6114). A randomised trial in 450 patients found no difference in infection rates between groups given a single dose of cefotan, cefazolin, or placebo before surgery. Surgeons still using prophylaxis in straightforward elective cases should probably think again.

Amiodarone is known to cause thyroid dysfunction, and patients with congenital heart disease may be particularly vulnerable (Circulation 1999;100:149-54). In one series of 92 patients, over a third developed thyroid side effects, which were commonest in women and patients with cyanotic disease. The authors point out the irony that patients who most need the benefits of amiodarone are least able to stand the thyrotoxicosis that might follow.

Botulinum toxin is a lethal poison, but its paralysing properties make it useful for treating the anal sphincter spasm associated with anal fissure. In one trial, bilateral injections of the toxin into the internal anal sphincter worked better than twice daily applications of glyceryl trinitrate for six weeks; 96% of fissures healed in the toxin group, 60% in the glyceryl trinitrate group (New England Journal of Medicine 1999;241: 65-9) There were no relapses in either group during 15 months of follow up.

Cystoscopists in the United Kingdom don't usually decontaminate or throw away the irrigating system between patients, but a study in BJU International shows that they should (1999;83:948-53). A sensor placed in the system detected backflow of fluid from the bladder in 17% of men undergoing cystoscopy. The possibility of urine, or even blood, contaminating the connecting tubing means that endoscopy units should switch to disposable irrigating systems. The authors add a vague reassurance that it would not cost much, relative to a department's overall budget.

The role of stored iron in ischaemic heart disease is still controversial, but data from a population cohort in Rotterdam suggests that it is most important in people already at risk because of smoking, diabetes, or hypercholesterolaemia (American Journal of Clinical Nutrition 1999;69:1231-6). High serum concentrations of ferritin, the best available measure of body iron stores, were clearly linked to the risk of myocardial infarction in people with other risk factors.

The chest pain associated with achalasia of the cardia is common, unresponsive to conventional treatment, unrelated to tests of oesophageal motility and manometry, and independent of swallowing symptoms, say two German researchers who have been following up their patients since 1981 (Gastroenterology 1999;116:1300-4). Nearly two thirds of their new patients had episodic chest pain, which tended to occur early in the course of the disease and to improve with age.

Deaths from cardiovascular disease in the Netherlands have fallen by about 2% a year since 1975. The cloud to this silver lining is that the survivors have contributed to a relentless and expensive rise in hospital admissions for heart failure, chronic coronary syndromes, and diseased arteries (Heart 1999;82:52-6). Worse, the lifetime chance of dying a cardiovascular death is still 40%.

COPYRIGHT 1999 British Medical Association
COPYRIGHT 2000 Gale Group