Minerva likes eponyms and so was pleased to read a commentary in Medicine (1998;77:1-2) justifying their use. They can’t mislead about aetiology, they avoid long winded terms such as angiokeratoma diffusum hereditaria (Fabry disease) and terms upsetting to parents such as happy puppet syndrome (Angelman syndrome). What divides the two sides of the Atlantic is the British fondness for the apostrophe, even when it leads to error prone use such as Graves’s disease.
The irritant atmosphere of indoor swimming pools is due to nitrogen trichloride, which is derived from the reaction between the chlorine used as a disinfectant and nitrogenated substances of human origin such as sweat and urine. Research in France (Occupational and Environmental Medicine 1998;55:258-63) has shown (not surprisingly) that lifeguards who spend their working days exposed to this atmosphere often complain of irritation of the eyes, nose, and throat but that they do not seem to develop permanent bronchial hyperresponsiveness.
More than 300 different mutant alleles have been described at the phenylalanine hydroxylase locus. These cause different degrees of reduction in the catalytic activity of the enzyme and thus different clinical severities of phenylketonuria (Journal of Medical Genetics 1998;35:301-4). Research in Portugal has established that the population there shows much the same genetic heterogeneity as do other European populations, but it also shows that the pattern of mutations in Portugal is very different from that in Spain. Findings like this are the foundation of the new science of molecular anthropology.
Repeated findings of an apparent total absence of hepatitis C virus from the blood should not be taken to mean that the virus is absent from the liver. Hepatitis C RNA has been found in 10 out of 12 liver biopsy specimens from patients with no virus DNA in serum samples (Gut 1998;42:570-5). These results cast doubt on the belief that some patients who have an attack of hepatitis C make a full recovery: careful follow up studies will be needed to establish the natural course of this infection, which has a prevalence of 0.5-2.0% in developed countries.
When Minerva was a student she clerked patients in huge Nightingale wards, in which drawing the curtains around the bed gave only psychological privacy: every word could be heard by the patients in neighbouring beds. This lack of privacy persists even in modern hospitals, says an editorial in the Canadian Medical Association Journal (1998;158:613-4). Hospital outpatient departments have cubicles with dividers that do not reach the ceiling. Medical receptionists have telephone conversations with patients that are clearly audible to everyone in the waiting room. It is up to doctors to insist on proper privacy for their patients.
Surveillance of patients treated for seminoma by orchidectomy and radiotherapy can be expensive and upsetting. Follow up of 56 patients over five years required 815 chest films, 839 measurements of serum markers, 250 computed tomograms, and 112 abdominal x ray films (Cancer 1998;82:1126-33). Only two patients developed evidence of recurrence—and in neither was the detection due to the post-treatment screening programme. By any reasonable measure this style of follow up is a waste of money and effort and an unnecessary burden to the patients, who are expected to attend 20 times over the first five years.
The incidence of classic Kaposi’s sarcoma varies widely in developed countries. According to a report in the British Journal of Cancer (1998;77:1190-3), the highest rates recorded in Northern Europe are in Iceland and the Faeroe Islands—around 0.5/100 000 person years. Both classic Kaposi’s and the type associated with HIV infection are thought to result from herpes virus 8, so studies of this virus may explain the variations.
The anaemia that occurs in patients with chronic inflammatory disorders is usually linked to low concentrations of erythropoietin. Research in the Sudan suggests that visceral leishmaniasis (kala-azar) may be an exception (British Journal of Haematology 1998;100:720-4). A study of 27 patients found that they were profoundly anaemic but had raised concentrations of erythropoietin. Treatment with antimony raised the patients’ haemoglobin and brought their erythropoietin concentrations back towards normal.
Dermatologists who prescribe isotretinoin for their women patients with acne are supposed to ask whether they are sexually active and, if they are, to make sure that they are using a reliable contraceptive. A survey of consultants in Scotland found that mostly they followed these guidelines (British Journal of Dermatology 1998;138:450-5), but they were less likely to ask questions about a risk of pregnancy in women under the age of 16.
Transmission of infections via penetrating injuries could be reduced in two ways, says an article in the Journal of the Royal College of Surgeons of Edinburgh (1998;43:6-8). Firstly, trainee surgeons should be taught to handle sharp instruments with needle holders, forceps, and instrument trays; and, secondly, more use should be made of diathermy, blunt ended needles, and stapling devices.
The longitudinal study on socioeconomic differences in utilisation of health services is a Dutch project that started in 1991. A report in the Journal of Clinical Epidemiology (1998;51:171-9) shows that the course of almost all health measures was less favourable for the participants with the lowest educational achievements. Health is poor among the disadvantaged not just because they get sick more often but also because once sick they become sicker faster.
Whether or not children who watch a lot of television are likely to become violent criminals is still debated: what seems less controversial is a study showing that they become overweight (JAMA 1998;279:938-42). Boys and girls who watched for more than four hours a day had more body fat and a higher body mass index than those who watched for less than two hours.
Figure.
These teeth were removed from a man aged 30 who had been taking tetracycline for his acne. They show severe staining of both the crowns and the roots: the picture should act as a reminder of the potential disfigurement that can result from the administration of tetracycline during the time of development of the teeth.
A Siddiqui, senior house officer, P D Cannon, consultant, department of oral surgery and orthodontics, Huddersfielde Royal Infirmary HD3 3EA
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