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Treating sleep apnoea may save lives. More than 200 adults with sleep apnoea were treated with nasal continuous positive airways pressure for at least three years. Their motor vehicle collision records three years before and after treatment were compared with those of a similar number of control drivers. Untreated patients had had more recorded collisions than the controls, but after the treatment the rate in both groups became equal (Thorax 2001;56:508 12). One commentator estimates that treating 500 patients for three years could prevent 180 serious crashes.
Dyspepsia guidelines commonly used in clinical practice say that referrals for endoscopy should be limited to patients over the age of 45 and those who present with "alarm" symptoms such as weight loss, recurrent vomiting, or dysphagia. But an American multivariate analysis of over 20 000 patients reports that such rules are not effective predictors of endoscopic findings: major disease was found at endoscopy in only 21% of cases (sensitivity 87%, specificity 26%). The authors recommend that more effective strategies are needed if detection of significant upper gastrointestinal pathology is to improve (Gut 2001;49:2934).
Litigation over breast implants abounds, and despite the range of settlements achieved, women continue to report unexplained symptoms (Annals of Rheumatic Disease 2001; 60:6537). Similar symptoms in fibromyalgia and chronic fatigue syndrome have proved amenable to behavioural interventions. One hypothesis is that the adoption of a mass somatisation model for breast implant patients may help to discern the potential effects of litigation and other social influences (including media attention, hype, and suggestible fears about presumed toxic exposure in the absence of objective evidence).
The General Assembly of the United Nations met this week to discuss the need for an expanded global response to HIV. Commentators estimate that by 2005 the costs of prevention and care under such a plan will require £9bn annually. Half of this resource is needed for subSaharan Africa. The two main challenges ahead are allocating the necessary resources and making sure they are used efficiently (www.sciencexpress. org/sciencexpress/recent.shtml; accessed 21 June).
The internet seems to be a useful source of self help for people who self harm (Psychiat ric Bulletin 2001;25:2225). Most of the information available is about suicide, self injury, and psychological issues. Some unregulated sites offer email support and online discussions. A search for "How to commit suicide" using a "meta" search engine (one that combines several other search engines) yielded 75 results, but none actually gave information on how to do it.
"Do not resuscitate" decisions are notoriously difficult to make, and medical staff may simply end up evoking the response, "Do you expect me to die then?" if the question is asked injudiciously. But one commentator in Heart (2001;86:12) says that if public confidence in the integrity of the medical profession does not improve, such questions may well become mandatory, and that every patient who enters hospital may eventually be required to sign a consent form for or against resuscitation.
Using a condom is a real turn off for anyone with an allergy to latex. Reactions range from genital urticaria to anaphylaxis, although no cases of fatality have yet been recorded. An open study of a deproteinised latex condom produced by a French company found that among the 19 adults who took part, 17 had a positive skin reaction through a conventional condom, while none reacted to the deproteinised version (Sex Transmitted Infections 2001;77:2023).
Ancient skeletons dug up in the north east of England have confirmed that height and longevity were associated as long ago as the 9th century. The causes of early death may be different in the 21st century, say the investigators, but the association was as robust then as it is today. Short bones are a marker for a short life (Journal of Epidemiology and Community Health 2001;55:5057).
A 7-year-old boy was admitted with a sore mouth, bleeding gums, and painful knees. Further examination showed gum hyperplasia, flaky skin, perifollicular bleeding, and telangiectasia around the nose and ears. His diet consisted of mostly cereal, with no fruit or vegetables. His vitamin C concentration was less than 1.0 Ïmol/l (normal is >32 Ïmol/l). Subsequent investigations showed other nutritional deficiencies, including vitamin A and trace elements (copper, zinc, and selenium). His oral lesions completely resolved with dietary changes and vitamin C supplementation. Poor dietary intake of vitamin C is a rare cause of childhood scurvy in developed countries, and as nutritional deficiency diseases rarely occur in isolation, other deficiencies should be sought.
A J Thompson, senior registrar, H J Steen, consultant, A J M Reid, locum consultant, department of child health, Queen's University of Belfast, Institute of Clinical Science, Belfast BT12 6BJ
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studentBMJ 2001;09:261-304 August ISSN 0966-6494
