BMJ  2005;330:102 (8 January), doi:10.1136/bmj.330.7482.102

Minerva

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Minerva's roving eye was drawn to a randomised, double blind, controlled trial that involved exposing 79 healthy volunteers to hydrochloric acid aerosols of various pH. Perhaps not surprisingly, significant bronchospasm developed after inhalation of the acid at pH 2, 3, and 5. However, acid inhalation had no effect on non-specific bronchial reactivity, except in people who had taken propranolol (a blocker), which caused adrenergic inhibition ( CMJ 2004;45: 709-14).

The phenomenon of sleepwalking is little understood, but a theory described in Medical Hypotheses ( 2005;64: 28-32)[Medline] suggests the serotonergic system may link sleepwalking with sleep disordered breathing (such as apnoea). Serotonergic neurons might take such a role, say the authors, because they are activated by hypercapnia (high levels of carbon dioxide), they influence the activity of motoneurons, and they are not necessarily influenced by the level of arousal.

Two new meta-analyses support the view that depression is still a risk factor, albeit a declining one, for death from any cause in established coronary heart disease. But they fly in the face of a number of recent reports that have failed to find such relationships. The discrepancy could be accounted for by publication bias (in favour of trials with positive results being published earlier than trials that have negative results). Another explanation may be that therapeutic advances for heart disease over the past 10-15 years may themselves have weakened the physiological and behavioural pathways that make depression a risk factor ( Psychosomatic Medicine 2004;66: 799-801[Free Full Text]).

The Lord cementless hip prosthesis has a long and loyal following among orthopaedic surgeons. A follow up of still living patients of one Norwegian centre in whom the prosthesis was inserted reports that, over an average of 17.5 years, the femoral component has an excellent survival rate (98%). However, there was a substantial rate of proximal femoral bone loss. The acetabular cup component fared less well over time, with many patients having a loose implant but fortunately few symptoms. Close monitoring is advised, so that early revision can be offered ( Journal of Bone and Joint Surgery 2004;86A: 2636-41[Abstract/Free Full Text]).

Children who watch major sporting events on television may be exposed to unsafe and violent behaviour when they watch the advertisements. A US study of televised sports and their 1185 commercials, aired before 9 pm, found that 14% of the advertisements showed unsafe behaviour and 6% depicted violence. A shocking 49% of each of the 322 commercial breaks that were assessed contained at least one dodgy advert. Parents are advised to supervise and switch off ( Pediatrics 2004;114: e694-8[Abstract/Free Full Text]).

Broken legs are more common in women than men in the United Kingdom. Road collisions are associated with the highest relative risk for leg fractures, although they account for only 3.1% or less of the population attributable risk for specific fracture types in people of any age. In a general practice cohort, the relative risk of leg fracture associated with a diagnosis of dementia was 2.3, whereas other medical diagnoses had relative risks lower than 2. Current use of steroids, antipsychotics, antidepressants, and sedatives all increased the risk of fracture ( Injury Prevention 2004;10: 368-74[Abstract/Free Full Text]).

Patients at London's Charing Cross Hospital are being treated like goods at a supermarket check out. They're being swiped—or rather, their bar coded wrist bands are. Familiar technology in a new setting is helping nurses deliver the correct drugs to inpatients. The scanner identifies the patient and then opens an individual drawer in a state of the art drugs trolley. The bar code is also linked to a computer based prescriptions system and a robotic arm in the pharmacy that automatically stocks a drugs cabinet. Jokes about "sell-by dates" are doing the rounds ( AMSPAR Professional 2004;19: 17).

Bedside ultrasonography is non-invasive, simple to use, offers a rapid image, and in the right hands could be highly accurate. In other words it stands to offer itself as an ideal diagnostic test for diagnosing epiglottitis. In a prospective study of 100 adults without a history of known throat diseases or surgery, the epiglottis was successfully visualised in all participants. The study showed no significant correlation between epiglottis thickening and height. The next step is to use ultrasound on patients with epiglottic disease to see how well it can detect pathological enlargement ( Academic Emergency Medicine 2004;11: 1358-60[Medline]).

View larger version (267K): [in this window] [in a new window]   A 7 day old baby girl was referred to the ear, nose, and throat department because she was having difficulty taking feeds. A nasal blockage was suspected. Physical examination disclosed a smooth swelling (polyp) which was occluding the vestibule of the left side of the nose. Magnetic resonance imaging confirmed that the fluid filled cystic structure was a nasal encephalocele. These lesions are not true cerebral herniations and they are rare (1:40 000 live births in the West). The absence of brain tissue within the herniated sac is the single most favourable prognostic feature for survival. S K Duvvi, clinical research fellow, L Thomas, registrar, K T V Reddy, consultant, department of otolaryngology, Warrington Hospital, Warrington WA5 1QG

Psychiatry lags far behind all other specialties when it comes to attitudes towards it as a choice of career among medical students. The reasons for not choosing it were numerous: "it's boring," "unscientific," "depressing," "stressful," and "frustrating—all of which Minerva thinks could describe every single field within medicine on a bad day. A family history (although not a personal history) of mental illness was significantly associated with making a positive choice of psychiatry ( Psychiatric Bulletin 2004;28: 444-6[Abstract/Free Full Text]).

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