Tarnished gold

Colonoscopy, as the gold standard for detecting colorectal neoplasia, has lost some of its glitter, according to a US expert.1 Lieberman was commenting on a multicentre trial in the US, which found that, compared with same-day, state-of-the-art 3-D virtual colonoscopy, optical colonoscopy missed 55 of 511 polyps detected in a series of 1233 asymptomatic patients; 21 of the polyps measured at least 6mm, one being an adenocarcinoma.2 The adenomas missed were usually on the proximal side of a colonic fold or near the anal verge. Virtual colonoscopy also missed adenomas detected by optical colonoscopy, underscoring the complementary nature of the two techniques. Nevertheless, Lieberman says optical colonoscopy remains the pre-eminent method for diagnosing and treating colonic neoplasia.

1 Ann Intern Med 2004; 141: 401-403
2 Ann Intern Med 2004; 141: 352-359

Human versus H. pylori

Most people infected with Helicobacter pylori stay symptom-free because of the natural antibiotic activity of a glycoprotein in human mucin, according to a team of Japanese and American researchers. In-vitro studies by Kawakubo and colleagues showed that mucin-type glycoproteins, with unique α1,4-N-acetylglucosamine residues, suppressed the growth and mobility of H. pylori by interfering with the organism’s ability to form a key cell-wall component.

The researchers hope their work will lead to the development of novel and potentially safe therapeutic agents to prevent and treat H. pylori infection.

Science 2004; 305: 1003-1006

Double trouble

When managing women with chronic pelvic pain, doctors may be able to diagnose and treat concurrent irritable-bowel syndrome (IBS), say US researchers. They studied 987 women, newly referred to a pelvic pain clinic, who had all had self-reported pelvic pain for more than 6 months. About one in three of these women also had IBS, as defined by Rome I criteria. Women who were older than 40 years of age, and with muscular back pain, depression and/or a history of adult physical abuse, were more likely to have IBS as well as chronic pelvic pain, indicating that these two conditions may not be manifestations of the same disorder.

Obstet Gynecol 2004; 104: 452-458

Stop yoghurt for thrush?

Australian researchers have found that Lactobacillus preparations may not be effective in preventing post-antibiotic vulvovaginitis. In a placebo-controlled trial, Pirotta and colleagues randomised 278 women aged 18 to 50 years who were to commence short-term antibiotic treatment for non-gynaecological infections to also receive lactobacillus orally or vaginally, or both, or neither. Overall, 23% of the women developed post-antibiotic vulvovaginitis and lactobacillus was ineffective in prevention.

BMJ 2004; 329: 548-551

Suffer the little children . . .

When a child is dying, is it OK for a parent to talk to that child about death? Yes, say Swedish researchers. They surveyed almost all parents who had lost a child to a malignant disease in Sweden from 1992 to 1997, with over 400 responding.1 None of the 147 parents who had talked about death with his or her child regretted it; however, nearly a third of the 258 parents who hadn’t talked about death with their child regretted that they hadn’t had such a conversation. Parents were more likely to talk about death with their child if they were religious, if the child was older, and if they sensed the child was aware of his or her imminent death — in an accompanying editorial, a US paediatric oncologist said he believed most dying children are aware of their impending death.2

1 N Engl J Med 2004; 351: 1175-1186
2 N Engl J Med 2004; 351: 1251-1253

INTERHEART

Increased consumption of fruit and vegetables, moderate activity, and smoking avoidance (together with lipid lowering) should make up the cornerstones of coronary heart disease prevention in all populations worldwide, according to the INTERHEART Study Investigators.1 This large case-control study, involving about 30 000 subjects in 52 countries from all over the world (including Australia), has determined that these three measures could lead to about an 80% lower relative risk for myocardial infarction. Among other potentially modifiable risk factors for myocardial infarction, the INTERHEART group also found that psychosocial factors, in particular stress at home and at work and financial stress, may play a more important role than commonly recognised.2

1 Lancet 2004; 264: 937-952
2 Lancet 2004; 264: 953-962