Minerva

Hangover assay
Ethanol is quickly metabolised in the blood stream, but there are several other metabolites of alcohol which, though more challenging for the laboratory to measure, make longer lasting markers of excessive drinking. A review in the American Journal of Clinical Pathology (1999;112:443-50) says that the most promising single marker of intoxication in the previous few days remains fatty acid ethyl esters (FAEEs). Adding this to a panel of neutrophil phosphatidylethanol, acet-aldehyde adducts, and transferrins may give greater diagnostic confidence.

Water fills you up
Such is the exquisite precision of the body's appestat--which links energy requirements and satiety--that very small excesses in caloric intakes on a regular basis will result in considerable weight gain over time (American Journal of Clinical Nutrition 1999; 70:448-55). Reducing the energy density of food by adding extra water during its preparation seems to be effective in enhancing its satiating effects: eat soup for lunch.

Medline falls short
Medline is the best known medical bibliographic database, but it is not all-inclusive. A study in Health Libraries Review (1999; 16:151-6) that used Ulrich's International Periodicals Directory (which indexes 150000 serials from 80000 publishers in 200 countries) as a gold standard showed that a Medline search in psychiatry would retrieve only half the relevant journals. Cross searching four databases--Psychlit, Medline, Biosis, and Embase--retrieved 90% of electronically indexed papers, but (obviously) none of the 96 journals categorised by Ulrich's as academic but not indexed by any service.

Aids to flexible thinking
Although new technologies provide potential solutions to old problems, they will be of little use unless the healthcare system is capable of innovation. A paper in the Annals of Internal Medicine (1999;131:438-44) describes a few simple mental techniques to encourage innovative thinking which can be used by anyone. One way of escaping the obvious, for example, is to try and solve a problem in an imaginary world where all the obvious solutions are illegal.

Uses for discarded foreskins
Human foreskins may or may not be useful to their owners, but they are certainly useful to an American bioengineering firm that uses them to manufacture tissue engineered skin grafts. Archives of Dermatology (1999;135:1219-22) reports a dramatic recovery in a single case of neonatal epidermolysis bullosa treated with the grafts; the condition did not subsequently recur in treated areas.

Endoscope improvements
Refinements to endoscopy are on the way, according to a review in Endoscopy (1999;31:557-62), with improvements coming to the lights, the camera, and the assistant. A second angled light added to the endoscope produces more natural images and less glare, which should improve depth perception and therefore ease of performance of minimally invasive techniques; the resolution of the light sensitive, charge coupled device at the camera end of the scope continues to improve. And the assistant? A robot, naturally.

Imaging has role for hernia
Most hernias are still diagnosed accurately using clinical means, but a review in the British Journal of Surgery (1999;86:1243-50) suggests that cross sectional imaging may have a role in some cases. The increasing quality of both computed tomography and magnetic resonance imaging over the past decade provides increasingly accurate assessment of the neck of the sac and its contents, enhancing diagnostic accuracy in obese patients with intestinal obstruction.

Distant therapist preferred
Minerva sometimes wonders whether telemedicine is anything more than hype generated by telecommunications companies keen to sell bandwidth. A South African project connecting psychologists with a clinic 500 km away, however, shows that clients are more comfortable with the therapist at a distance than actually present in the room (South African Journal of Psychiatry 1999;5:14).

View larger version (94K): [in this window] [in a new window]   VIRTUAL SPORT: REAL INJURIES  Two young men presented to our fracture clinic with injuries sustained during an arcade game of virtual reality football. One had twisted his ankle while taking a "shot" at goal, causing an undisplaced fracture of the left lateral malleolus. The other had fractured two toes of his right foot kicking a metal bar on the side of the machine. Players of virtual reality football should remember that, as with all sports, it is important to warm up properly and wear appropriate footwear. Graham Tytherleigh-Strong, specialist registrar, Pedro Catarino, senior house officer,department of orthopaedics, Wexham Park Hospital, Slough SL2 4HL

View larger version (75K): [in this window] [in a new window]   PERILS OF PIERCING   This 12 year old girl had the helical region of her left ear pierced. Three weeks later she came to our outpatient department with this abscess, which required incision, drainage, and extensive debridement under general anaesthetic. She remained in hospital for 10 days having intravenous antibiotics. The current fashion for piercing areas of the ear that contain cartilage can result in this kind of trauma. Severe cosmetic deformity is the inevitable consequence. Henry Sharp, specialist registrar, Francis Du Toit, senior house officer, David Mitchell, consultant, department of otolaryngology, Kent and Canterbury Hospital, Canterbury CT1 3NG