How did I get it, doctor?

The exact mode of spread of Helicobacter pylori is still unknown. Now, French researchers provide another piece to help complete the puzzle of this organism’s transmission. Over a one-year period, they monitored H. pylori infection status in 112 young people living in an institution for the neurologically handicapped. Using a non-invasive stool antigen test, the researchers detected that seven of the 65 residents who were initially H. pylori-negative had converted during follow-up. All seven either lived in the section of the institution, or associated with residents living in that section. This section had experienced peaks of potentially infective diarrhoea during outbreaks of gastroenteritis; in all cases, conversion occurred 3 to 11 weeks after a peak of diarrhoea.

BMJ 2004; 329: 204-205

Looking for breast cancer

In women at high risk of breast cancer, screening with magnetic resonance imaging (MRI) may help to pick up some cancers earlier, according to the Dutch MRI Screening Study Group. The Group conducted six-monthly clinical breast examination and yearly mammography and MRI in 1909 women with a familial or genetic predisposition to breast cancer. In an average follow up period of 2.9 years, 44 invasive cancers were detected. Compared with mammography, screening MRI was more sensitive (79.5% v 33.3%) but less specific (89.8% v 95%) in detecting invasive breast cancer. The role of ultrasound was not addressed.

N Engl J Med 2004; 351: 427-437

A rash of ecstasy . . .

A young man at a rave party scored more than a "high" when he took a tablet of ecstasy for the first time, according to the Australian authors of a case report. Four days later he got an itchy rash, which developed into typical guttate psoriasis. The rash cleared after 14 sessions of narrowband UVB treatment. Although the main ingredient of ecstasy is a phenylethylamine (3,4-methylenedioxymethamphetamine, [MDMA]), various other drugs are also mixed into the tablet and impurities are common, making rechallenge (to prove causation) impractical as well as illegal.

Australas J Dermatol 2004; 45: 167-169

Death by 1000 arrows

Although NZ doctors have benefited from a largely "no fault" medical misadventure compensation system, they may have suffered unduly as a result of their current complaints process. The process is jokingly referred to as "death by a thousand arrows", as complaints can be made and handled via multiple pathways and disciplinary processes. According to a series of surveys of doctors' opinions, this process is flawed and may have had a largely negative impact on doctors and doctor-patient relationships, without necessarily improving patient care.1 In an accompanying editorial, the NZ Health and Disability Commissioner (HDC) says that from 18 September 2004, the HDC will become the single point of entry for all complaints about patient care (except those regarding confidentiality).2

1. www.nzma.org.nz/journal/117-1198/968/
2. www.nzma.org.nz/journal/117-1198/970/

Smoke gets in our hearts

Exposure to passive smoking increases the risk of coronary artery disease (CAD), according to new results from 1978-1980 British regional heart study. In 2001-2002, stored serum samples from more than 2000 men who were non-smokers at the time of the original study were thawed, allowing their serum cotinine concentration to be assayed. Cotinine, a nicotine metabolite, is a biomarker of passive exposure to smoking. The men in the quarter with the highest concentrations of cotinine were 50%-60% more likely to have developed CAD during 20 years of follow-up than those in the lowest quarter. Study researchers said their results added to the weight of evidence suggesting that exposure to passive smoking is a public health hazard and should be minimised.

BMJ 2004; 329: 200-204

Dr Ann Gregory, MJA