Practice tip. Which cerumenolytic?

AIM: To test the in vitro dispersion of ear wax by four commonly used cerumenolytics. METHOD: Equal parts of the same piece of ear wax were covered with 10 mL of each preparation and observed for up to 30 days. RESULTS: Sodium bicarbonate and Waxsol dispersed wax within 2 hours, Cerumol was much slower and olive oil had no effect. CONCLUSIONS: The cheapest and most effective cerumenolytic is a solution of sodium bicarbonate.

A rational management of tennis elbow.

Tennis elbow is due to a torque injury or sudden overstretching of tendons which insert into the epicondyles of the humerus. The predominant lesion is an enthesopathy--a pathological lesion at the insertion of tendon into bone. The most common site is at the lateral epicondyle and this is 3 times as frequent as at the medial epicondyle. Approximately 50% of tennis players can expect to get a tennis elbow at some time during their playing lifetime. In one-third of the players this will be severe enough to interfere with their tasks of daily living. The major unresolved question about the aetiology of tennis elbow is why it has its peak incidence between the ages of 40 and 50 years and why 90% of players then have no further recurrence. Making sense of the literature on the treatment of tennis elbow is difficult because there are few studies that have used the acceptable epidemiological techniques of the prospective randomised controlled trial or case-controlled study. Most papers are based on a collection of highly selected cases which represent the more intractable end of the tennis elbow spectrum and their reported results have been inconsistent. Tennis elbow is largely a self-limiting condition. The prime aim of treatment should be based on Hippocrates' first tenet of medicine--first do no harm. Therapy should start with the simple and conservative before progressing to the more complex and invasive therapies. It should be acceptable to the patient, cost-effective and where invasive therapy is recommended, the potential benefits should clearly outweigh the risks. The principles of therapy for tennis elbow are to relieve pain, microbleeding and inflammation, promote healing, rehabilitate the injured arm and try to prevent recurrence. The most effective modalities of treatment are found to be cryotherapy in the acute stage then nonsteroidal anti-inflammatory drugs and heat in its various modalities including ultrasound. This is combined with rest which is best defined as the absence of painful activity. Injection of a depot preparation of cortisone is effective although patient reports are not as flattering as those of doctors. There is no advantage and in fact considerable disadvantage in using more than 2 such injections. Therapies such as acupuncture and chiropractic have not been evaluated. Nevertheless they cause no harm, may result in good and should be tried before resorting to more invasive therapy. Rehabilitation should run parallel to treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Nutrition in the Australian aborginines--effects of the fortification of white flour.

The nutritional status of 66 part Aborginines was re-examined in 1974--with particular reference to blood levels of haemoglobin and vitamins--after white bread fortified with iron and the vitamins B1 and PP (niacin) had been available for six and half months to the population of Bourke, New South Wales. The results found in 1971 and 1974 are compared. A significant improvement from deficient to acceptable blood levels of vitamins B1 and B6 was found in 44% and 52% of the subjects respectively. This attributed to the comsumption of fortified bread since the levels of the other vitamins had remained either unchanged or worsened. The biochemical improvement in vitamin B6 is attributed to the sparing effect of vitamin PP on vitamin B6 requirement because the conversion of tryptophan to niacin is impaired in vitamin B6 deficiency. Iron deficiency anaemia in children had decreased by 50% but this could have been due to many other factors besides the iron which had been added to the bread. Clinically there was a marked decrease in angular stomatitis and skin xerosis which could be related to the biochemical improvement of the two B-vitamins and a decrease in active trachoma and suppurative otitis media probably due to intensive treatment received since 1971. The results of this study and the extent of biochemical vitamin B1 and B6 deficiency found in other groups, indicate that fortification of bread may be of benefit to the community as a whole.