BMJ  2003;327:E6 (4 October), doi:10.1136/bmjusa.01020005 (published 5 September 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

The received wisdom about ovarian cancer is that symptoms don't develop until the tumour is at an advanced stage, delaying diagnosis and reducing the chances of a cure. Respondents to one survey, however, reported a high incidence of symptoms, mostly related to the abdomen and gut, for months before the diagnosis. Gynaecological symptoms were much less common ( Cancer 2000;89:2068-75[CrossRef][ISI][Medline]). Women ignored their symptoms for a median of 2-3 months before finally presenting to a doctor.

An entomologist from California writes that brown recluse spiders are unfairly blamed for inflicting necrotic bites on the state's inhabitants. Only 10 of these spiders have been spotted there since records began ( Western Journal of Medicine 2000;173:357-8[Medline]). Ticks, fleas, and bed bugs are far more likely to bite people than recluse spiders, which are imported by accident from the southeastern states where they live. Doctors should exclude well established causes of skin necrosis, including herpes zoster, staphylococcal skin infections, and syphilitic chancre, before implicating arthropods at all.

Next time you have a few pints and feel like challenging someone to an arm wrestle be sure to pick an opponent with a shorter forearm, thereby giving yourself that essential moment-torque advantage. A chartered surveyor from northwest London challenged a man with longer forearms, who snapped his humerus only 10 seconds into the competition ( British Journal of Sports Medicine 2000;34:461-2[Abstract/Free Full Text]). The surveyor was losing at the time, but only by about 10° off the neutral upright position.

Two papers by the same authors test the anaesthetic action of topical tetracaine (amethocaine) gel in newborn infants ( Archives of Disease in Childhood Fetal and Neonatal Edition 2000;83:F207-10[Abstract/Free Full Text]). Their randomised trial shows that it works better than placebo, substantially reducing infants' reaction to venepuncture. The second study finds that it has an analgesic action after only half an hour's contact with the skin, although the analgesia lasts longer if the gel is left on for an hour. Tetracaine gel may be a better option than the traditional alternative, EMLA, which has been disappointing in small infants.

Minerva was interested to read which food fads Boston chefs were tiring of (Stuff@night, 7-20 November 2000). One chef singled out the sudden explosion in food allergies, complaining that "everybody's allergic to something and needs things to be specially made." Restaurants have survived the withdrawal of their welcome to cigarette smokers; will they now feel emboldened to warn: "This restaurant does not cater for food allergies. Susceptible patrons should bring their own adrenaline?"

Obesity is a particular problem for people with asthma, making their impaired lung function even worse. Moderate weight loss can improve symptoms, however. In a recent small study, successful dieting led to better lung volumes, increased peak expiratory flow rates, and reduced airways resistance ( Chest 2000;118:1315-21[Abstract/Free Full Text]). Participants, whose mean body mass index decreased from 37.2 to 32.1 kg/m², also had less variable peak flow rates, presumably because of improved pulmonary mechanics.

Encouraged by their success in a pilot study, researchers from Japan conducted a large randomised trial of intrathecal steroids in patients with post-herpetic neuralgia ( New England Journal of Medicine 2000;343:1514-9[Abstract/Free Full Text]). It worked. Patients given intrathecal methylprednisolone and lidocaine took 70% fewer analgesics in the four weeks after treatment. Symptoms did not improve in controls given lidocaine alone or no treatment. Pain relief in the intervention group lasted throughout the two years of follow up and caused few side effects—a remarkable result, say the authors.

Metal allergy may contribute to restenosis in some patients who have had coronary angioplasty with placement of a stainless steel stent. Preliminary data reported in the ( Lancet 2000;356:1895-7[CrossRef][ISI][Medline]) shows a link between allergy to metals, particularly nickel and molybdenum, and stenosis in the stent six months after insertion. The researchers say their findings are significant enough to prompt allergy testing for all patients with stenosed stents if a repeat procedure is planned.

American doctors are notoriously bad at asking for help from other doctors. Surgeons, hospital physicians, and pathologists were the worst offenders in one survey ( Archives of Internal Medicine 2000;160:3209-14[Abstract/Free Full Text]). Six years later, doctors without a "regular source of care" were more likely than others to have missed out on preventive measures such as screening for prostate and breast cancer and vaccination against influenza. Doctors in this group were also more likely to be fatalistic about their health.

View larger version (98K): [in this window] [in a new window]   While on holiday in Turkey an 8 year old boy decided to have a "henna tattoo" on his back. The pattern is made using a vegetable dye and usually rubs off after a couple of weeks. In his case, the dye triggered acute dermatitis with erythema, vesiculation, and irritation. By the time he returned home the irritation was starting to subside, but the image of the " little devil" he had chosen was still clearly visible. His brother had a tattoo at the same time but had no reaction. Jonathan Sleath, general practitioner, Kingstone, Herefordshire HR2 9EY, UK

Law abiding Americans who carry guns often argue that they would use a gun only in self defence. Not all of them know how to defend themselves legally, however ( Injury Prevention 2000 ;6:263-7[Abstract/Free Full Text]). A panel of judges examining responses to two national surveys declared most reports of self defence illegal—shooting at the ground to scare off trespassers, for example. In these surveys, guns were used three times more often to threaten or injure than to defend victims against attack.

Most readers in clinical practice already get plenty of exercise running around the wards and cycling to visits, but those who don't should try fidgeting. Sitting and fidgeting uses a third more energy than lying motionless, although the exact amount of the difference varies between individuals ( American Journal of Clinical Nutrition 2000;72:1451-4[Abstract/Free Full Text]). To work off 200 kilocalories—the cookie you had with your coffee—you need to fidget about 2.5 hours.

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