BMJ  2004;328:E294 (17 April), doi:10.1136/bmj.328.7445.E294

BMJ USA: Minerva

Minerva

Minerva

Some advice for fishermen (and women) who suffer the agony of getting fishhooks stuck in fingers and arms ( Trout Fisherman August 2003: 32). Rather than pushing the hook through, cutting the barb off, and pulling the shank out, you are advised to let someone else pass a string around the hook; while holding both ends in their hand, they should press down on the hook to release the barb, then pull on the string ends to remove the hook. Removal from other body parts should be referred to hospital.

Minerva enjoyed reading about thyroid nodules, and what they're all about, in a commentary entitled "Thyroid incidentaloma: the ignorant in pursuit of the impalpable." Should they be systematically biopsied and removed, or can some just be left alone? Ultrasound has brought the issue of occult thyroid carcinoma into the clinical domain of the incidental finding. All this is reminiscent, of course, of the prostate and the cervix, and what informed consent to investigate actually means ( Clinical Endocrinology 2004;60: 18-20[CrossRef][Medline]).

Neonatal jaundice, caused by an accumulation of bilirubin, is usually treated with phototherapy, but drug treatment might be the way of the future. A Chinese herbal remedy for jaundice (Yin Zhi Huang), which is taken in the form of an herbal tea, is now known to activate a liver receptor that enhances the clearance of bilirubin ( Journal of Clinical Investigation 2004;113: 23-25[CrossRef][Web of Science][Medline]).

Emergency departments have to schedule cover 24 hours a day, seven days a week. Different shifts are perceived to offer different levels of stress, both personally and professionally. A two year study of scheduling at one American teaching hospital found that despite scheduling changes designed to improve equality, no improvement in perceived stress could be identified. The authors say the next step is to identify other predictors of stress, fairness, and job satisfaction within emergency medicine faculties ( Academic Emergency Medicine 2004;11: 111-114[Web of Science][Medline]).

Inflammatory mechanisms have been implicated in the pathogenesis of Alzheimer's disease, possibly via the cyclo-oxygenase-2 enzyme. But a one year randomized, blinded controlled trial of a selective COX-2 inhibitor (rofecoxib) failed to show that it slowed the progression of the disease. Possibly the disease process is too advanced to modify in people with established dementia, but it may be that the role of COX-2 is simply not as important as has been thought ( Neurology 2004;62: 66-71[Abstract/Free Full Text]).

People who perceive their psychosocial work environment negatively have more complaints about the indoor environment and attribute more symptoms to the indoor air, according to a questionnaire survey of over 11 000 employees ( Occupational and Environmental Medicine 2004;61: 143-149[Abstract/Free Full Text]). The association is robust and was found across both sexes, all ages, and smokers and non-smokers. Association with job classification couldn't be examined, however, as not enough respondents had replied to the question about their role in the organization they work for.

Fresh data from the Baltimore longitudinal study of aging seem to indicate that calculated free testosterone concentrations are lower in men who develop Alzheimer's disease and that the difference occurs before diagnosis. The obvious question is, do higher endogenous free testosterone concentrations protect against the disease in older men? ( Neurology 2004;62: 188-193[Abstract/Free Full Text]).

An international round-up of the latest cremation rates around the world shows that Japan has the highest rate per population (99.5%) and Cuba has the lowest (0.5%). Great Britain comes in at 71.9%, and the United States at just 27.8%. The variation may depend on several factors, including geographical space, cultural beliefs, and the number of crematoriums available. Japan has 1600, while Cuba reports just one ( Pharos International Winter 2003: 24-36).

Getting people to cough while you're taking blood from them is a neat little trick that acts as a good pain reliever. In 20 healthy male volunteers taking part in a randomized crossover study the reported intensity of pain they experienced was significantly lower when they coughed, whereas other variables such as hand withdrawal, palm sweating, blood pressure, heart rate, and serum glucose concentrations changed insignificantly. The mechanism is unknown ( Anesthesia and Analgesia 2004;98: 343-345[Abstract/Free Full Text]).

Despite the popularity of optimism among some health care workers, having a positive attitude didn't improve the survival rate of 179 patients with a common form of lung cancer. Reporting a paper published in the latest edition of Cancer, one of the researchers said, "We should question whether it is valuable to encourage optimism if it results in the patient concealing his or her distress in the misguided belief that this will afford survival benefits" ( Tallahassee Democrat, February 9, 2004).

View larger version (117K): [in this window] [in a new window]   A 79 year old woman presented with sudden onset right eye blindness and a painful tongue. Examination revealed central retinal artery occlusion and an infarcted left hemi-tongue with ulceration. A diagnosis of giant cell arteritis was confirmed by temporal artery biopsy and she was treated with high dose corticosteroids. Her eyesight improved with complete healing of the tongue ulcers. Giant cell arteritis is a systemic disease of unknown origin affecting medium and large sized vessels. Somaiah Aroori surgical research fellow Cancer Research Centre, Queen's University Belfast BT30 6JA, UK Parthasarathy Reddy staff grade Charles Jack consultant Sudheer George Jacob consultant, department of medicine, Downe Hospital, Downpatrick, Belfast, UK

Soccer injuries seem to beget more injuries, according to a prospective cohort study from Iceland reported in the American Journal of Sports Medicine ( 2004;32[suppl]: 5S-16S)[Abstract/Free Full Text]. Previous hamstring strains and previous groin strains predispose to further hamstring and groin injuries, and any previous injury was identified as a risk factor for knee and ankle sprains. Age is another risk factor.

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