559 For several years now, there has been a stream of trials comparing aromatase inhibitors with tamoxifen at various stages of breast cancer, and the aromatase inhibitors always win. A couple of years ago, a review in the NEJM suggested that exemestane was perhaps the most effective, and in this trial, women who had been taking tamoxifen for 2-3 years after breast cancer treatment and without recurrence were randomised to receive exemestane or carry on with tamoxifen. Once again, the aromatase inhibitor proved better at preventing recurrence and improving survival.
571 The freeways of Southern California are hellish places and give out hellish quantities of sulphur, particulate carbon and all the rest. Is this good for the developing lung? Why no, it isn’t. This study compared the lung function of Californian children living close to or distant from freeway motor traffic: there are substantial and probably permanent effects on FEV1 and maximum midexpiratory flow rate.
578 The idea that fish is good for the brain was frequently expounded by Bertie Wooster in his exchanges with Jeeves, and is absolutely correct. This American study looked at neurodevelopmental outcomes in children according to whether their pregnant mothers adhered to a 340g per week limit on fish intake or not. The presumption was that more fish meant more methylmercury contamination and hence more brain damage; but in fact it means more omega-3 fatty acids, and therefore better brain development.
587 I have a patient who has a patch of face which looks as it has been bitten off by a wolf and is vaguely red: this is the origin of the term lupus erythematosus, and it is rare, unlike lupus vulgaris, which used to be common in the days of rampant tuberculosis. The systemic form of lupus erythematosus on the other hand is fairly common, nine times more so in women than men, and especially so in people of African origin. Nothing about SLE is straightforward, and there are competing ideas about pathogenesis, diagnosis and treatment – comprehensively summarised in this review, which you need to read, as you are bound to have a patient with this condition. It includes a short and useful section on antiphospholipid syndrome.