Category: health

Adapted from BMJ 21 September 2025

Cholecystectomy is a commonly undertaken operation for the relief of gall stone pain. In the US 700,000 of these are done, now usually by laparoscopy.

A few years ago a trial was done that randomised patients with uncomplicated, symptomatic gall stone colic to either immediate operation or restricting the operation only to people who had severe recurrent attacks. After a year, symptoms were the same in each group.

After another five years, results have found that the restrictive strategy results in a small reduction in the operation rate, without any increase in complications.

However, whether operated on or not, two thirds of the patients get remission of the pain while one third do not.

My comment: Presumably it would be worthwhile finding out what is the actual cause of the recurrent pain.

Adapted from BMJ 23 August 2025

It is taken for granted that a parent will usually stay with a young child in hospital, but this was not always allowed. Mary Lindsay changed that.

She was born in 1926 and died in March 2025 of heart failure after a long career as a paediatrician.

In the early 50s visiting hours for parents of children were severely restricted. This was due to the idea that parents brought germs with them into the hospital and that their presence upset their children. At the time, the emotional development of children was ignored by the medical profession. Mary opposed this view. The first consultant that provided beds for mothers in children’s wards was Dr Dermod McCarthy in Amersham Hospital with whom she worked. He was the only doctor to change his practice after seeing a film about it.

John Bowlby, a child psychiatrist, had presented A two year old goes to hospital to paediatricians at the Royal Society of Medicine in 1952. It was not well received. A professor of surgery wrote in The Lancet, “There is a lot of sloppy sentiment talked about this. If children are left alone for a day or two they forget all about their parents. The hours in hospital after a parent visits is chaotic. The children all cry and shriek and will not go to sleep”.

Various films were made demonstrating the improvements experienced by children when they were allowed to have a parent (usually the mother) with them. Mary appeared in Going to hospital with mother in 1958.

Mary, Dr MacCarthy, and ward sister Ivy Morris, conducted a study of 1,000 children who had been admitted with their parents, and demonstrated how much better they did, but it took till well into the 1960s before the movement to have parents with their children in hospital took off.

Mary was born in Belfast but moved to Dorset where her father was a headmaster. During WW2 she was evacuated to Northern Ireland. She qualified at Belfast in 1951. After experience in paediatrics, general practice, adult and child psychiatry, she became a consultant in child psychiatry in Aylesbury. Throughout her career she emphasised the importance of emotional well being in the physical health of children. In 1989 she was elected president of the Royal Society of Medicine (Paediatric Branch).

Mary married at the age of 75 becoming a step-mother to three children, who survive her.

Adapted from BMJ 5th April 2025

A double blind randomised controlled trial of Vitamin D has shown significant reductions in progression of early multiple sclerosis.

An acute first episode such as optic neuritis or transverse myelitis is known as clinically isolated syndrome typical for multiple sclerosis (CIS).

316 people with CIS who had vitamin D levels below 100 nmol/L were randomised to 100,000 IU of colecalciferol or placebo every two weeks.

After two years the rates of disease activity, either clinically or on MRI were seen in 60.3% of those who had had the Vitamin D and 74.1% of the placebo group.

Adapted from BMJ 27 September 2025

Last year I had good news for the slightly chunkier older adult regarding total mortality rates, and today I can cheer some of us up with a further study, this time regarding surgical outcomes.

A post operative series of 400 older adults who were getting major elective surgery reports that the mortality rate was lowest in the people who had BMIs of 25-30.

In the post operative period, 25 people out of 133 died whose BMI was in the normal range (20-25), but only one of the 128 patients in the overweight group died in the 30 days post operation. This is despite higher BMIs being associated with cardiovascular disease and type two diabetes as well as other chronic diseases.

Perhaps advice to lose weight before operations needs to be reconsidered if you are overweight but not obese.

Adapted from BMJ 21 September 2024

Do you really need a gastroscopy? This is a very commonly performed and unpleasant procedure for the patient. Health Boards tend to have criteria to guide GPs as to referral. Despite this, pick up rates of serious pathology are low.

In the UK, 400,000 gastroscopy results were analysed. Only one in ten showed anything other than normal findings or minor pathology.

Only one in 100 gastroscopies showed malignancy.

In patients under 50, less than 1% had malignancy, regardless of symptoms.

Those most likely to have cancer were men, the over 50s, those who had problems swallowing, and those with weight loss.

Adapted from BMJ 13 September 2025

A longitudinal study of 100,000 Seventh Day Adventists in the USA and Canada indicated that they got 10-20% fewer cancers than non-vegetarians.

The largest reductions were for breast, colorectal, prostate, stomach and lymphoproliferative cancers.

There could be several reasons for this:

They have a higher intake of fruits, nuts and legumes which are rich in protective phytochemicals.

They don’t eat any meat, including red and processed meats which are linked to a higher risk of gastro-intestinal malignancy.

The vegetarians studied also had a lower rate of obesity, and were also less likely to smoke or drink alcohol.

Adapted from BMJ 13 September 2025

After having early invasive breast cancer, development of other cancers or a new breast cancer in the other side, over the next twenty years is only 2.1% more than in women who have not had breast cancers.

The risk of contralateral side cancer is comparatively raised in younger women. Radiotherapy tended to increase the risk of contralateral breast cancer and lung cancer. Endocrine therapy tended to increase the rate of uterine cancer but reduced contralateral breast cancers. Chemotherapy increased the rates of leukaemia.

Other cancers that occurred more often in the breast cancer survivors were soft tissue, head and neck, thyroid, oesophagus, kidney, bladder, skin melanoma, haematological, ovarian and stomach cancers. It is thought that part of the adjuvant treatments for breast cancer could contribute to this increased risk.

Researchers looked at the data of 475,000 women who had been diagnosed between 1993 and 2016. After 20 years, 14 out of 100 women will develop some other kind of cancer compared to 12 out of women without the previous breast cancer diagnosis. 6 out of 100 will develop contralateral breast cancer compared to 3 in 100 of the general population.

This study was done because cancer treatments have long been recognised as contributing to the development of second cancers.

Second primary cancer is known to be substantially higher if a woman has a family history of breast cancer or genetic variants such as BRCA1 and BRCA2. Genetic evaluation of each woman who develops breast cancer will hopefully lead to targeted follow up and treatment.

Adapted from BMJ 13 September 2025

Gepotidacin is the first new antibiotic to be approved in the UK in 30 years.

It has a mechanism that makes it more difficult than usual for bacteria to develop resistance to it.

It is approved for females over the age of 12 and over the weight of 40 kg.

Its use will only be for uncomplicated urinary tract infections.

My comment: Urinary infections are indeed a misery. I’m delighted that another antibiotic has been found. Remember that D:Mannose can also be very effective for the prevention and treatment of UTIs.