BMJ  2004;328:E285 (13 March), doi:10.1136/bmj.328.7440.E285

BMJ USA: Minerva

Minerva

Breast cancer is found largely in older women; women aged over 65 account for 13% of the female population but for two thirds of all deaths from breast cancer ( Annals of Internal Medicine 2003;139: 835-842[Abstract/Free Full Text]). Few studies have looked closely at these figures, but the available evidence shows that screening using mammography every two years would reduce the death rate at an acceptable cost.

A new use has been found for lidocaine cream (Emla). Some patterns of self injury may be reinforced by the sensory stimulation, rather than social or psychological stimuli. A report in Developmental Medicine and Child Neurology ( 2003;45: 769-771)[CrossRef][Web of Science][Medline] describes a child with autism who slapped his cheek at a rate of 45 slaps a minute. When the cheek was numbed with Emla the rate of slapping fell to 20 a minute, blocking the sensory response.

A study in Boston of adult cyclists who needed hospital treatment for road accidents found that the numbers seen rose by 30% between 1994 and 1999 ( Injury 2003;34: 825-829[CrossRef][Web of Science][Medline]). Thirty five of the 222 people studied had raised blood alcohol concentrations and half those with closed head injuries had not been wearing helmets. The lessons, say the authors, are obvious; what is less clear is how to get people to modify their behavior.

"Watchful waiting" was promoted as one answer for men found to have asymptomatic elevated concentrations of prostate specific antigen (PSA). A meeting of the American Urological Association has now been told that as many as half the men who started on watchful waiting have chosen to have active treatment. "Men just can't stand watching their PSA gradually rise," the meeting was told; either the patient or the doctor loses his nerve. Yet the pioneer study in Sweden still supports "wait and see," and watchful waiting doesn't lead to impotence or incontinence.

People with high blood pressure are warned to check with their doctor before using a jacuzzi or hot tub, although there's little evidence for such warnings. When 21 patients with stable, treated hypertension were immersed in a hot tub for 10 minutes their blood pressure lowered, but no more than in normotensive controls. Blood pressure returned towards baseline within 10 minutes after they got out of the tub. Heart rates rose in both groups ( CMAJ 2003;169: 1265-1268[Abstract/Free Full Text]).

Computed tomography colonography—or virtual colonoscopy—is gaining ground as a minimally invasive technique for visualizing the colon and screening for early neoplasms. Unfortunately, the images of the colon are accompanied by images of the other abdominal organs, bones, blood vessels, and soft tissues. These unwanted data may irritate the clinician, who has no choice but to consider other diagnoses. A study of 75 patients in Denmark ( Gut 2003;52: 1744-1747[Abstract/Free Full Text]) found that 49 had extracolonic abnormalities and 12% needed further investigation. Two patients needed surgery.

It may be hard to believe, but soccer referees get dehydrated during matches. A study of 12 male Brazilian referees and assistants in the British Journal of Sports Medicine ( 2003;37: 502-506)[Abstract/Free Full Text] found that the total body water loss during a match was 1.6 liters, equivalent to 2.05% of body weight. Water intake during half time replaced only a quarter of the bodily fluids lost during the match. The assistants lost just 0.25% of their body weight.

For those of you who watch what you eat and drink, and worry about heart disease, here is the truth—according to a joke currently doing the rounds. The Japanese eat very little fat, while people in Mexico eat lots. Both groups suffer fewer heart attacks than the British or Americans. Africans drink very little red wine, while the Italians drink large volumes of the stuff—but both these groups too have fewer heart attacks. An epidemiological conclusion might be that you should eat and drink what you like: speaking English seems to be what kills you.

When a 67 year old woman on a flight bound for Florida developed crushing central chest pain radiating down her left arm, not one but 15 cardiologists leapt to her assistance. They were all en route to a cardiology conference in Orlando. Apart from the fact that she had more cardiologists in attendance than the average patient anywhere in the world, Minerva is curious to know whether they all wanted to follow the same protocol (BBC News Online January 2, 2004).

Having an itch is frustrating, and trying to measure its intensity objectively is apparently more so. A device called a perceptual matching unit electrically stimulates the skin of the fingers, and the stimulus can be stopped when the amplitude of the sensation corresponds to a person's experience of itch caused by histamine iontophoresis in the forearm. The test is limited because it induces distinct sensations other than itch, but the reported test-retest reliability is excellent ( Journal of Investigative Dermatology 2003;121: 1301-1305[CrossRef][Web of Science][Medline]).

View larger version (116K): [in this window] [in a new window]   A 67 year old man presented with lower urinary tract symptoms and many episodes of near-acute urinary retention, which he found, by trial and error, he avoided by standing on his head for 5-10 minutes each time his stream was cut off, finding then he was able to void again. X ray examination showed multiple bladder calculi, which undoubtedly obstructed his dependent bladder neck while he was standing but not while he was upside down. At open cystolithotomy more than 300 stones, weighing over 400 g, were removed. Alun Thomas specialist registrar F X Keeley consultant urologist, department of urology, Southmead Hospital, Bristol BS10 5NB, UK

In developed countries the standard treatment for peptic ulceration is based on eradication of Helicobacter pylori. This approach is of little use in developing countries, in which the prevalence of infection with H pylori may be as high as 70-90%. A study in Peru ( Journal of Infectious Diseases 2003;188: 1263-1279[CrossRef][Web of Science][Medline]) found that treatment seemed to eradicate the infection, but within 18 months 30% of patients had become reinfected.

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