BMJ  2004;329:692 (18 September), doi:10.1136/bmj.329.7467.692

Minerva

Hearing becomes specialised very early on in life. Auditory regions in the left hemisphere of the brain generally dominate over the right when it comes to speech, and the right hemisphere regions tend to process music and tones. Scientists have now established that at least part of the difference in the brain arises from differences in the ears, and the hair cells in particular ( Science 2004;305: 1581[Abstract/Free Full Text]).

The World Association of Medical Editors has a policy on "geopolitical" intrusion. Editorial decisions should not, they say, be affected by the origins of the manuscript, including the nationality, ethnicity, political beliefs, race, or religion of the authors, and decisions to edit and publish should not be determined by the policies of governments or other agencies outside of the journal itself. There's a suspicion that at least one publisher is not adhering to this policy and WAME would like to hear from anyone else who believes that articles may be prevented from publication for such reasons (email Margaret_Winker{at}jama-archives.org).

The Epley manoeuvre is a complicated series of head movements designed to treat acute benign positional vertigo. A randomised clinical trial of the Epley manoeuvre performed on patients with benign positional vertigo presenting to an emergency department found that it was more efficacious than a placebo movement, although Minerva begs to differ over the description of it being a simple bedside manoeuvre ( Academic Emergency Medicine 2004;11: 918-24[CrossRef][ISI][Medline]). To see how it's done, go to (www.dizziness-and-balance.com/disorders/bppv/bppv.html).

The Blue Mountains eye study has been following up more than 3500 people in Australia aged 49 and over since 1992. It found that 3.2% of the participants had been diagnosed with amblyopia, and although having a squint doesn't seem to affect occupational class, fewer people in this group completed university degrees. Also, there was an almost threefold risk of visual impairment in the eye with better sight, highlighting the importance of childhood screening to reduce visual loss later in life ( British Journal of Ophthalmology 2004;88: 1119-21[Abstract/Free Full Text]).

A questionnaire sent to 20 well established medical herbalists about what they would "prescribe" for osteoarthritis produced a list of 11 herbs. Celery seed, devil's claw, dandelion root, meadowsweet, and white willow came out on top. Dietary advice included avoiding acid food, meat, and dairy products and increasing the amount of fish, fruit, vegetables, seeds, and whole grains. The 11 herbs will be included in a pilot double blind study of the effects of herbs in osteoarthritis ( European Journal of Herbal Medicine 2004;6: 5-13).

Whether and when to undergo total knee replacement can be a difficult decision, given their limited life. Data from a prospective two year study that looked at the rate of cartilage loss indicate that treatment targeted at reducing the rate of loss can delay knee replacement. For every 1% increase in the rate of tibial cartilage loss, there was a 20% increased risk of undergoing a knee replacement at four years ( Annals of the Rheumatic Diseases 2004;63: 1124-7[Abstract/Free Full Text]).

Mortality associated with hip arthroplasty after an acute fracture is almost 10 times that of elective hip surgery. In a study of 7774 patients conducted in a single hospital, mortality at 30 days was 2.4%. Factors linked to significantly higher mortality included use of a cemented implant, being female, being elderly, having a diagnosis of intertrochanteric fracture, and having cardiorespiratory problems. This study found no difference in mortality between total arthroplasty and hemiarthroplasty ( Journal of Bone and Joint Surgery 2004;86-A: 1983-8).

Having spent much of their professional lives with carers of people with severe mental illness, a psychiatrist and his GP wife became carers themselves when their adopted son developed an early onset bipolar disorder at the age of 12. They'd known that his biological mother had a bipolar disorder, but they'd hoped their careful parenting would protect him from developing any mental health problems. Nature, it seems, was stronger than nurture. Telling their story in Psychiatric Bulletin ( 2004;28: 332-3)[Free Full Text], they say it was much harder than they expected to be both "experts" and care recipients.

Forget the labours of nit removal and the application of neurotoxins. Now there's a new approach to head lice: it's non-toxic, dry-on pediculicides (DSPs) that suffocate and kill the little critters. Even without removal of the nits, trial results of DSPs indicate a 96% cure rate, and no adverse effects, and the results are better than those achieved by malathion, permethrin, and pyrethrin, the conventional medical treatment for lice ( Pediatics 2004;114: e275-9[Abstract/Free Full Text]).

Ginseng extract has been proved to promote wound healing, and to exert anti-tumour effects, through opposing actions on the vascular system. Using mass spectrometry to analyse the composition of ginseng, scientists identified different "sterol ginsenoside" fingerprints. A dominance of Rg1 leads to angiogenesis, whereas Rb1 has an opposing effect. It's been proposed that Rg1 could be a prototype for a new group of non-peptide molecules that could trigger therapeutic angiogenesis, such as in wound healing ( Circulation 2004;110: 1219-25[Abstract/Free Full Text]).

A 37 year old woman sustained 60% flame burns to her body. Towards the end of her three month inpatient stay she complained of undue stiffness in her left knee. A plain radiograph revealed extensive heterotopic ossification. Solitary areas of heterotopic ossification in patients with major burns are an uncommon but important complication. The precise aetiology is unknown, although predisposing factors include the degree of burn and the length of physical immobility, as in the case of prolonged mechanical ventilation. Most patients respond to conservative treatment, with spontaneous resolution in many. Surgery is reserved mainly for patients with appreciable loss of range of motion or nerve compression symptoms, as recurrence is common. P K Y Goon (Pat28g{at}yahoo.co.uk), senior house officer, Y Wilson, consultant, department of burns and plastic surgery, University Hospitals Birmingham NHS Trust, Selly Oak Hospital, Birmingham B29 6JD

Gambling for recreation is often thought to run alongside alcohol use and abuse, depression, bankruptcy, and incarceration. But older gamblers aged over 65 don't seem to have the same health profile as younger gamblers. Older gamblers have better health and wellbeing and tend to report larger maximum wins ( American Journal of Psychiatry 2004;161: 1672-9[Abstract/Free Full Text]).

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