Minerva
http://www.100md.com
《英国医生杂志》
Despite international leanings towards the later weaning of babies, a review of data from over 1600 infants from five prospective randomized trials of weaning before and after 12 weeks of age found little evidence of any influences on health either way up to the age of 18 months. The outcomes in question included diarrhea and vomiting, chest infections, atopy, and sleep patterns. Early weaned babies were larger at 12 weeks, but any differences in growth disappeared by 18 months ( Archives of Disease in Childhood 2004;89: 728-33).
Massage after sport is thought to enhance recovery after training and to protect against overuse injuries. But a study of massage after bilateral eccentric exercising of the quadriceps muscles suggests that it serves no useful purpose other than pleasure. With one leg acting as a control for the other, massage treatment affected neither the level of pain nor its duration. Nor did it influence the loss of strength or function after exercise ( American Journal of Sports Medicine 2004;32: 1499-503).
Internet shopping for drugs turns patients into consumers and removes doctors from the equation. When complications occur, however, consumers revert to being patients and return to the traditional health system. Internet shopping removes any role for professional responsibility and leaves no documentation. Doctors are getting better at remembering to ask about over the counter drugs, herbal products, and dietary supplements. In people with suspected overdose, intoxication, or treatment resistant depression, especially when there's a history of addiction or financial problems, also ask about internet purchasing ( Mayo Clinic Proceedings 2004;79: 1031-4).
People with irritable bowel syndrome often notice that their symptoms occur after they consume dairy products. But a case-control study from Norway found that lactose malabsorption and irritable bowel syndrome are unrelated disorders, and that milk and lactose related symptoms are unreliable predictors of lactose malabsorption. Vigorous bowel sounds starting within five hours after ingestion of lactose, and lasting for more than two hours, are an important indication of lactose malabsorption ( Scandinavian Journal of Gastroenterology 2004;39: 645-9).
Forget the labors of nit removal and the application of neurotoxins. Now there's a new approach to head lice: it's non-toxic, dry-on pediculicides (DSPs) that suffocate and kill the little critters. Even without removal of the nits, trial results of DSPs indicate a 96% cure rate, and no adverse effects, and the results are better than those achieved by malathion, permethrin, and pyrethrin, the conventional medical treatment for lice ( Pediatrics 2004;114: e275-9).
The days of human surgeons may be numbered if a report of a super sophisticated robotic system is anything to go by. Ten patients undergoing complex laparoscopic anti-reflux surgery were selected for "solo surgery," where surgeons worked alone with just a robot. Setting up the robots took almost half an hour per patient, and some of the procedures took almost three hours, but no adverse events were noted and all patients were able to leave hospital the following day ( Journal of the American College of Surgeons 2004;199: 368-73).
An American professor of pharmacy and his colleagues split 45 tablets with a kitchen knife and 45 with a pill splitter and discovered that neither method worked very well. The variance in estimated drug content due to uneven tablet splitting ranged from 50% to 150% of the ideal targets, confirming there's no guarantee that patients consistently receive the intended amount of drug when they split tablets ( Wall Street Journal, September 14, 2004).
If you already have diabetes and have a heart attack, your chances are much worse than for your neighbor without diabetes. But what about people who have just developed diabetes? A study in Circulation ( 2004;110: 1572-8) compared people with previously known diabetes who had a myocardial infarction with people with a new diagnosis and those with no diabetes. It found that people with newly diagnosed diabetes had just as poor a prognosis as those with long-standing disease. The authors say that metabolic abnormalities must contribute to the adverse outcome after myocardial infarct.
The best way to insert a cannula into the internal jugular vein, avoiding the common carotid artery, is to use external landmarks. We're taught to rotate the patient's head, but how far? With the aid of an ultrasound probe, and trying a variety of head positions, anesthetists discovered that rotating heads 45° or 60° left from the midline gave them a better chance of hitting the internal jugular vein while reducing the risk of getting into the common carotid artery. In fatter people, however, they suggest aiming for a rotation of no more than 30° ( Anesth Anal 2004;99: 982-8).
A 37 year old woman sustained 60% flame burns to her body. Towards the end of her three month inpatient stay she complained of undue stiffness in her left knee. A plain radiograph revealed extensive heterotopic ossification. Solitary areas of heterotopic ossification in patients with major burns are an uncommon but important complication. The precise etiology is unknown, although predisposing factors include the degree of burn and the length of physical immobility, as in the case of prolonged mechanical ventilation. Most patients respond to conservative treatment, with spontaneous resolution in many. Surgery is reserved mainly for patients with appreciable loss of range of motion or nerve compression symptoms, as recurrence is common.
P K Y Goon senior house officer
Pat28g@yahoo.co.uk
Y Wilson consultant
Department of burns and plastic surgery, University Hospitals Birmingham NHS Trust, Selly Oak Hospital, Birmingham B29 6JD, UK
Minerva has learned somewhat late in life that although expressing anger feels good, it doesn't necessarily get her what she wants. A study of anger related personality traits in men with untreated high blood pressure has shown that having an "antagonistic disposition," particularly a tendency to experience anger on the least provocation and a propensity to lash out, are linked to heightened carotid atherosclerosis. The authors can't comment on whether their findings apply to all cultures ( Psychosomatic Medicine 2004;66: 633-9).
Massage after sport is thought to enhance recovery after training and to protect against overuse injuries. But a study of massage after bilateral eccentric exercising of the quadriceps muscles suggests that it serves no useful purpose other than pleasure. With one leg acting as a control for the other, massage treatment affected neither the level of pain nor its duration. Nor did it influence the loss of strength or function after exercise ( American Journal of Sports Medicine 2004;32: 1499-503).
Internet shopping for drugs turns patients into consumers and removes doctors from the equation. When complications occur, however, consumers revert to being patients and return to the traditional health system. Internet shopping removes any role for professional responsibility and leaves no documentation. Doctors are getting better at remembering to ask about over the counter drugs, herbal products, and dietary supplements. In people with suspected overdose, intoxication, or treatment resistant depression, especially when there's a history of addiction or financial problems, also ask about internet purchasing ( Mayo Clinic Proceedings 2004;79: 1031-4).
People with irritable bowel syndrome often notice that their symptoms occur after they consume dairy products. But a case-control study from Norway found that lactose malabsorption and irritable bowel syndrome are unrelated disorders, and that milk and lactose related symptoms are unreliable predictors of lactose malabsorption. Vigorous bowel sounds starting within five hours after ingestion of lactose, and lasting for more than two hours, are an important indication of lactose malabsorption ( Scandinavian Journal of Gastroenterology 2004;39: 645-9).
Forget the labors of nit removal and the application of neurotoxins. Now there's a new approach to head lice: it's non-toxic, dry-on pediculicides (DSPs) that suffocate and kill the little critters. Even without removal of the nits, trial results of DSPs indicate a 96% cure rate, and no adverse effects, and the results are better than those achieved by malathion, permethrin, and pyrethrin, the conventional medical treatment for lice ( Pediatrics 2004;114: e275-9).
The days of human surgeons may be numbered if a report of a super sophisticated robotic system is anything to go by. Ten patients undergoing complex laparoscopic anti-reflux surgery were selected for "solo surgery," where surgeons worked alone with just a robot. Setting up the robots took almost half an hour per patient, and some of the procedures took almost three hours, but no adverse events were noted and all patients were able to leave hospital the following day ( Journal of the American College of Surgeons 2004;199: 368-73).
An American professor of pharmacy and his colleagues split 45 tablets with a kitchen knife and 45 with a pill splitter and discovered that neither method worked very well. The variance in estimated drug content due to uneven tablet splitting ranged from 50% to 150% of the ideal targets, confirming there's no guarantee that patients consistently receive the intended amount of drug when they split tablets ( Wall Street Journal, September 14, 2004).
If you already have diabetes and have a heart attack, your chances are much worse than for your neighbor without diabetes. But what about people who have just developed diabetes? A study in Circulation ( 2004;110: 1572-8) compared people with previously known diabetes who had a myocardial infarction with people with a new diagnosis and those with no diabetes. It found that people with newly diagnosed diabetes had just as poor a prognosis as those with long-standing disease. The authors say that metabolic abnormalities must contribute to the adverse outcome after myocardial infarct.
The best way to insert a cannula into the internal jugular vein, avoiding the common carotid artery, is to use external landmarks. We're taught to rotate the patient's head, but how far? With the aid of an ultrasound probe, and trying a variety of head positions, anesthetists discovered that rotating heads 45° or 60° left from the midline gave them a better chance of hitting the internal jugular vein while reducing the risk of getting into the common carotid artery. In fatter people, however, they suggest aiming for a rotation of no more than 30° ( Anesth Anal 2004;99: 982-8).
A 37 year old woman sustained 60% flame burns to her body. Towards the end of her three month inpatient stay she complained of undue stiffness in her left knee. A plain radiograph revealed extensive heterotopic ossification. Solitary areas of heterotopic ossification in patients with major burns are an uncommon but important complication. The precise etiology is unknown, although predisposing factors include the degree of burn and the length of physical immobility, as in the case of prolonged mechanical ventilation. Most patients respond to conservative treatment, with spontaneous resolution in many. Surgery is reserved mainly for patients with appreciable loss of range of motion or nerve compression symptoms, as recurrence is common.
P K Y Goon senior house officer
Pat28g@yahoo.co.uk
Y Wilson consultant
Department of burns and plastic surgery, University Hospitals Birmingham NHS Trust, Selly Oak Hospital, Birmingham B29 6JD, UK
Minerva has learned somewhat late in life that although expressing anger feels good, it doesn't necessarily get her what she wants. A study of anger related personality traits in men with untreated high blood pressure has shown that having an "antagonistic disposition," particularly a tendency to experience anger on the least provocation and a propensity to lash out, are linked to heightened carotid atherosclerosis. The authors can't comment on whether their findings apply to all cultures ( Psychosomatic Medicine 2004;66: 633-9).