eMJA: In Other Journals, 16 January 2006

Sleeping with a dummy (pacifier) is linked with a reduced risk for sudden infant death syndrome (SIDS), according to US researchers. In a case-control study, they examined the use of a dummy the night before death in 185 SIDS cases and 312 non-SIDS infant deaths. Not only was there a 90% reduction in risk for SIDS in infants who had used a dummy during their last sleep — use of a dummy also seemed to reduce the influence of other known risk factors in the sleep environment, such as sleep position and co-sleeping with a mother who smoked. The researchers say that promoting the use of a dummy when an infant is sleeping may be an effective public health measure in further reducing the incidence of SIDS.

World first finds favour

A Lancet editorial says that the French team that recently performed the world’s first partial facial transplant had taken a cautious and justifiable first step in exploring the potential of facial transplantation.1
A team of nearly 50 people and 8 surgeons used the nose, lips and chin from a brain-dead living donor to repair the face of a 38-year old woman who had been mauled by a dog.2 The woman had been unable to eat, talk or breathe without difficulty. According to press reports, the patient was unlikely to benefit substantially from standard restorative surgery and had been prepared psychologically for the operation and its aftermath.
Recognising key concerns, among them, the use of a potentially life-threatening procedure to treat a disfigurement, the Lancet said “. . . the time comes when enough is known to do an experiment and when an experiment may be the only way to answer the questions that remain”.

1. Lancet 2005; 366: 1984
2. BMJ 2005; 331: 1349-1350, 1359

Botox for tennis elbow?

Botulinum toxin injection has shown some promise as a short-term treatment option for some patients with tennis elbow, according to Hong Kong researchers. They conducted a small randomised trial in 60 patients with lateral epicondylitis, comparing the effects of giving a single injection of 60 units of botulinum toxin type A (Dysport) with a normal saline placebo injection. Over a 3-month period, botulinum toxin led to greater pain relief than placebo; however, adverse effects of digit paresis and weakness of finger extension were noted. Although botulinum toxin has now been used in various pain syndromes, its exact mechanism for relieving pain remains unknown.

Ann Intern Med 2005; 143: 793-797

Holiday fare

In the movie Heartbreak Ridge, Clint Eastwood exhorted marines under his command to “adapt, improvise and overcome” when faced with a challenging situation. Clint would be proud of Canadian doctors Keegan and Bannister.
Faced with a case of bilaterally impacted “cement-like” ear wax while holidaying on a rural island, they found no syringe readily available. A resident engineer referred them to his grandson, who kindly provided a super-duper water pistol. With the patient dressed in swimming shorts and holding a Tupperware container in lieu of a kidney basin (see Figure), the water cannon (operated by an emergency physician) cleared both ears of the offending wax in seemingly record time and without damage to the ear.
Keegan and Bannister are calling for a trial. However, “despite what bush-mad physicians may get up to on their private islands”, CMAJ (and the MJA) do not endorse this use of a water pistol. Do not try this at home (or in Australia). However, by all means, enjoy your vacation!

CMAJ 2005; 173: 1496-1497

Death by cannabis?

Driving under the influence of cannabis increases the risk of having a fatal car crash, say French researchers. In a case-control study, they examined the use of cannabis in 6766 at-fault drivers in fatal crashes and 3006 not-at-fault drivers involved in fatal crashes. Cannabis users were about three times as likely to be responsible for a fatal car crash as drivers who didn’t use cannabis. Further, a dose effect was evident, suggesting that cannabis use may actually cause crashes.

BMJ Online First, 1 Dec 2005

Antipsychotic agents and the elderly: more bad news

Recently, the US Food and Drug Administration and Health Canada advised that atypical antipsychotic agents, such as risperidone and olanzapine, may lead to increased mortality among elderly patients with severe dementia.1 Now, US researchers have suggested that older, conventional antipsychotic agents may be just as dangerous, if not more so, in any elderly patient.2 They conducted a retrospective cohort study of 22 890 patients, 65 years of age or older, who had begun receiving either type of agent for any indication. Conventional agents were linked to a higher short-term risk of death than atypical agents — the greatest risk was within the first 40 days of use and with higher doses.

1. Med J Aust 2005; 183: 216
2. N Engl J Med 2005; 353: 2335-2341

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA