Archive for the ‘Science’ Category

Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

  • A favourable outcome depends on early, aggressive, treatment
  • Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
  • Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
  • Subtle signs of organ hypoperfusion should be sought in physically robust patients
  • The role of activated protein C and low dose steroids remains to be clarified

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A database analysis reported by James N Armitage and colleagues shows that mortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity – as many as one in four men admitted to hospital with acute urinary retention will die within a year.

Katia M C Verhamme and Miriam C J M Sturkenboom, in an accompanying editorial, say that since the increased mortality seen in men admitted to the hospital for acute urinary retention is probably the result of comorbid conditions and frailty, multidisciplinary care is warranted in these men.

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Plans to introduce a law in Germany that would force doctors to notify a patient’s health insurance company if medical treatment is for a complication of a beauty operation or piercing have been heavily criticised by doctors and welfare organisations. BMJ 2 November 2007.

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Mike Fitzpatrick, The meaning of cancer.

British Journal of General Practice, October 2007, p 847.

In the 19th-century the concept was, that disease can be challenged by will. This notion is always closely linked to the idea that disease is itself an expression of character.

The cultural critic Susan Sontag, who died from cancer in December 2004, observed that the view of disease as an expression of inner self appears less moralistic than that of disease as a punishment for sin. ‘But this view turns out to be just as, if not even more, moralistic and punitive’, she argued.

Contrasting the old myths about tuberculosis (TB) and modern myths about cancer, she noted that both proposed notions of individual responsibility. But, for her, the cancer imagery was ‘far more punishing’.

Whereas TB was regarded as a disease of passion or excess, cancer is a disease of repressed emotion, associated with depression (‘melancholy minus its charms’) and stress.

Whereas the tubercular character was once envied as an outlaw, a misfit, a bohemian, today’s cancer patient is a loser, with a shameful affliction, someone deserving of pity.

Sontag shrewdly observed that ‘theories that diseases are caused by mental states and can be cured by willpower are always an index of how much is not understood about the physical terrain of a disease’.

When the identification of the tubercle bacillus in the 1880s deprived TB of much of its mystery.

Cancer — a group of diseases that is still ill-understood and for which current treatments are often ineffectual— became the focus of modern fears and of notions that both its onset and its course could be influenced by emotional factors and psychological therapies.

Sontag S. Illness as metaphor: Aids and its metaphors. London: Penguin, 1991.

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EU postponed threathened restriction of using MRI scanners

Rory Watson, BMJ 2007;335:844-845

Medical specialists, patients’ groups, and European parliamentarians launched a campaign last week to ensure that new EU health and safety legislation will not restrict the use of magnetic resonance imaging (MRI).

The Alliance for MRI fears that new Europe-wide measures, which are
designed to protect employees , from short term exposure to electromagnetic fields, will inadvertently make it harder to use equipment to diagnose and treat illnesses from cancer and heart attacks to strokes and brain tumours.

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Management of endometriosis in general practice: the pathway to diagnosis By: Pugsley, Zoë

BJGP, Volume 57, Number 539, June 2007 , pp. 470-476(7).

Background: The prevalence of endometriosis is estimated to be around 10%. Diagnosis is through visualisation of the lesions, mostly via laparoscopy.

Ultrasound was frequently requested by GPs, but was helpful in diagnosing endometriosis in only 10.6% of women who underwent a scan.

Thirty-nine per cent of women were referred to gynaecologists two or more times BEFORE a positive diagnosis was made.

The median time from first presentation with symptoms to diagnosis was 9.0 years. NINE years

Read more about the MANAGEMENT of ENDOMETRIOSIS here.

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BMJ 2007;335:618 (22 September).

Doping in sport—a warning from history.

East German athletes who were doped to win gold medals in 1976 Olympics now struggle with chronic health problems.

Sport is tough, mean, and uncompromising.

The German Democratic Republic looked coldly at what was required and did it. Potential medal winners were selected at an early age for sports school, trained, and prepared systematically.

Athletes were given oral anabolic steroids until the time of competition but were injected with testosterone during competition as it was then undetectable.

It is the involuntary and systematic abuse of underage athletes that hits hardest. These athletes, recruited from as young as 10 years old, did not know what medication they were taking and were discouraged from asking.

The sports doctors had signed a confidentiality agreement, monitored by the East German secret police, the Stasi. They made no protest, and 70 of them were later convicted of illegal doping.

We were left wondering where those doctors are now and how they feel about their role.

Perhaps it is a little unfair to judge history by current standards. But doping remains a part of sport.

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