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This month sees the first in an occasional series entitled “Recent advances” (page 438). Professor Judith Chessells from the Institute of Child Health in London looks at the continuing success story that is childhood acute leukaemia. She lists some of the more common cytogenic changes recently identified and describes new methods of measuring minimal residual disease.
Professor Chessells reminds us how measles vaccination of children has been literally life saving for those with leukaemia and emphasises the importance of shared care. The most salutary lesson is less optimistic: the spectacular improvements in treatment leading to high survival rates are available for only a small minority of the world's children.
The fragile Welsh
No, I hadn't heard of the Tipping the Balance Toward Primary Care European Network (page 452). But there it is, in Wales and Scandinavia amongst other places. Some of its members have been looking at fractures identified in accident departments. The most careless by far are the Welsh who break things twice as commonly as their cautious counterparts in Norway, Sweden, and Finland. The authors claim that oval balls have only a small part to play. Welsh children should take greater care in spring; they are safer in winter because—say the authors—the climate is damp, wet, and unenticing.
Spacers—the last word (I hope)
When aerosol spacers were first marketed, shortages led to many of us improvising with polystyrene coffee cups and suchlike. The experts looked on with disdain and ADC receives a regular supply of research papers comparing the effect on asthma of various shapes and sizes of—well, let's face it—sophisticated coffee cups. So hurrah for Zar and colleagues from Cape Town (page 495). They have found a way of measuring aerosol deposition in lungs using technetium-99mDTPA. Babyhalers (GlaxoWellcome) did pretty well. So did Aerochambers (Trudell Medical). A 500 ml cold drink bottle was best of all.
Is your health visitor really necessary?
Our editorial, this month, describes Sure Start, a support programme for parents delivered by outreach workers (page 435). An accompanying paper, from Nottingham, presents a systematic review of the effects of home visiting on parenting. Thirty four of 102 eligible studies reported appropriate outcomes with an overall favourable effect. The authors recognise the complexity of measuring “parenting”, especially if parents present their best behaviour when confronted by researchers. As usual with meta analyses data were conspicuous by their absence and the authors rap knuckles.
Our UK readers should note that only four studies used health visitors and most concentrated on at risk families. The authors point out that there is a lot more to making life better than can be provided by health visitors.
Are you sitting comfortably?
One of the pleasures of reading a Victorian medical journal is that case reports are presented as whodunits and observational studies as novellas. The dry prose of modern day conventional scientific writing is nowhere near so inviting.
So, what a pleasure it was to read the first sentence of Irwin's paper on psychogenic seizures (page 474). It made me feel like drawing my easy chair closer to the fire as I settled a flute of madeira on the hearth. The paper remains a good read. Non-epileptic seizures are easily confused with their dysrhythmic cousins. Victorians would not have been surprised to learn that a careful history can be diagnostic but Irwin points out that we have the advantage of videotelemetry. Returning to the Dickensian metaphor, nine had “swoons”, while eight stared fixedly and five deployed tonic-clonic movements with pelvic thrusting, imagery more redolent of our own times. The authors identified an environmental, relationship, or abusive cause in 19 of their 24 patients.
Del Monte's revenge
Many disappointed authors will attest toADC's reluctance to publish case reports. The entertaining lunchtime CME fascinoma is prone to lose its novelty value when translated to the page. Case reports which define the aetiology, physiology, or genetics of a hitherto puzzling entity stand a better chance; as do reports whose conclusions can be generalised to other situations. The question at editorial meetings is always “What's the message?”.
I hope we will be forgiven the exception made this month for the pineapple papilla, if only for the illustration which we toyed with for the front cover but didn't want to upset the postman (page 488). But what probably swung the selection panel was the first known sighting inADC of “unchomped”. We'd like to know how this sounds in the original Italian.