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“Though Conan Doyle’s celebrated failure as a medical practitioner appears to be exaggerated, it seems clear that he had little luck, and took as little pleasure, in his chosen career. (At least one writer has suggested that Conan Doyle might have managed to kill a patient, through Charles Bovary-like ineptitude for more sinister motives; he subsequently married the dead man’s sister and took control of the income that she inherited from her brother.) Like so many Scotsmen of his time, those engineers, overseers, managers, merchant princes, foot soldiers, and rationalizers of the Empire, Conan Doyle had a powerful taste for adventure. In seeking to elude the fate that Waller, his personal Moriarity, had determined for him, Conan Doyle made two inconclusive or ill fated attempts at becoming a ship’s doctor and a rash and doomed decision to abandon general practice for the study, in Germany, of ophthalmology, in spite of the fact he barely understood German.” (

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Acute central retinal artery occlusion, a painless monocular reduction of vision, usually results in a poor visual outcome. The efficacy of current treatments, including paracentesis of the anterior chamber, acetazolamide, massage of the eye, heparin, and aspirin, remains unproved. Investigators from Switzerland recently reported 37 patients with central retinal artery occlusion who were treated with intra-arterial thrombolysis using urokinase within 6 hours of the onset of symptoms. Their visual outcomes were compared to a control group of 19 patients also seen within 6 hours who did not undergo thrombolytic treatment. In this study intra-arterial thrombolysis enhanced the chances of visual improvement compared to conventional treatment alone. Younger patients had a better chance to achieve some visual recovery. Three patients had minor treatment related cerebral ischaemic events; two had transient ischaemic attacks, and one a minor stroke. There were no haemorrhagic complications. (

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Although Helicobacter pylori has long colonised human stomachs, improved sanitation and antibiotics have drastically cut the bacterium’s prevalence in developed countries over the past century. People carrying H pylori have a higher risk of developing peptic ulcers and stomach cancer but a significantly lower risk of acquiring diseases of the oesophagus including oesophageal cancer. Recent studies suggest that once scientists fully catalogue the different strains of H pylori and discover how each affects the host cells of the stomach, physicians might actually want to colonise different strains of H pylori according to the patient’s genetic susceptibility to different forms of cancer. (

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Silicone oil is widely used as a tamponade in the repair of complex retinal detachments, macular holes, and in trauma cases that would otherwise be inoperable. It has a reasonably good intraocular safety profile in animals, being tolerated in the vitreous cavity for many months with no significant retinal damage. Removal of silicone is recommended to reduce potential anterior segment complications such as cataract, glaucoma, and keratopathy. Investigators from Moorfield’s Eye Hospital, however, have recently reported seven patients with visual loss following removal of silicone oil. This sudden visual loss averaged 4.7 Snellen lines. The retina remained attached in all cases. No patients developed cystoid macular oedema or epiretinal membrane; however electrodiagnostic testing showed a range of abnormalities with the majority of patients showing severe macular dysfunction. The pathogenesis remains obscure. (

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Severe disruption of sleep patterns is a major complication of Huntington’s and Alzheimer’s diseases. Recent studies suggest that this is correlated with the progressive loss of brain neurons in the hypothalamus. The hypothalamic neurons that die produce orexin, the loss of which has been implicated in narcolepsy. These findings may provide better treatments for patients with neurological disease and sleep disorders and perhaps insomniacs without neurological disease. (

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Interest in the so called polypill continues. The polypill, containing a low dose of statin, aspirin, folic acid, and three antihypertensive medications, was the subject of a meeting before Christmas at the US Centers for Disease Control and Prevention in Atlanta. At this meeting it was concluded that a rigorous placebo controlled trial of the polypill in people at indeterminate risk of heart disease and stroke should be performed. Approximately 6000 participants would be required. (

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High income countries continue to suffer from an epidemic in obesity. The failure of most diets to produce sustained weight loss is well known. Only a small portion of the population adheres to a long term routine exercise programme. A recent report from the Mayo Clinic suggests, however, that a change in general activity may be useful in preventing weight gain. In this study the simple change of activity from sitting to standing at the workplace and even the degree to which individuals fidgeted or moved at their desk was significantly correlated with body weight. The authors suggest that the degree to which patients can be involved in non-exercise activity thermogenesis (NEAT) may have a significant role in preventing obesity. (

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Convergence insufficiency is a common binocular vision disorder with a reported prevalence from 2.25% to 8.30%. Symptoms include diplopia, asthenopia, headaches, and blurred vision. There is a lack of consensus regarding the most appropriate treatment for convergence insufficiency. A multicentred randomised clinical trial has now been completed comparing vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics as treatment for convergence insufficiency. In this study neither pencil pushups nor placebo vision therapy/orthoptics were effective in improving symptoms whereas vision therapy/orthoptics was effective. Regrettably this study did not investigate a more sophisticated home exercise programme beyond pencil pushups. (

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Taking a vacation is vital to one’s health. This has been once again re-emphasised by analysis of the Whitehall 2 Study. During a 3 year follow up period 17% of unhealthy male British civil servants took no time off work. The incidence of non-fatal and fatal myocardial infarction over 9 years was twice as high in this group as in unhealthy employees who took a moderate amount of time off work. (

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