BMJ  2005;330:608 (12 March), doi:10.1136/bmj.330.7491.608

Minerva

Travellers who have persistent diarrhoea on returning from exotic places don't always carry infection. A case report in the Scandinavian Journal of Gastroenterology ( 2005;40: 112-4)[CrossRef][Medline] describes a 40 year old woman who returned from East Timor with what she was convinced was an unidentified bug. In fact she gave a classic history for a small bowel malabsorption syndrome and responded rapidly and dramatically to a gluten free diet. Infectious organisms may start malabsorption processes, but anti-infectious agents do little to stop them.

Ever wanted to know what to do with that old packet of unused condoms you found hidden away in your father's belongings? The soon to be opened Museum of Contraception in Vienna (www.contraceptive-museum.org) could well be interested in hearing from you. They've put out a call for historical devices, instruments, films, posters, leaflets, documents, and books on the subject of contraception before these get thrown away or lost forever.

Arthritic hips, hands, and backs tend to run in families but, strangely enough, arthritic knees do not. A Dutch study of middle aged sibling pairs with osteoarthritis reported in the Annals of the Rheumatic Diseases ( 2005;64: 438-43)[Abstract/Free Full Text] found that the risk of having arthritis at the same site among siblings was striking for spine and hips, but almost absent for arthritis of the knee. Minerva presumes this suggests more of a genetic component for hips, hands, and spine, and a more mechanical trigger for arthritic knees.

"Binkie flutter" is the phenomenon of rapid vibratory movements of a "dummy" or pacifier in the mouth of an unstressed infant. A paediatrician describes how his pet dog shows a similar phenomenon when clasping an object in her teeth. He speculates that as well as probably being intrinsically pleasurable, it's also a likely mechanism for achieving better control through rapid microadjustments of the set of the jaws in response to high frequency feedback signals (Pediatrics 2005;115: e367-9)[Abstract/Free Full Text].

Analysis of data from the Baltimore longitudinal study of ageing confirms that blood pressure and cognitive function are not linearly related, but the association is more U shaped or J shaped. Both low and high diastolic pressures in people who are not taking antihypertensive drugs were associated with poorer performance on a battery of cognitive tests, particularly among less educated and older people, and the mechanism may involve inadequate cerebral perfusion (Hypertension 2005;45: 374-9)[Abstract/Free Full Text].

Home blood pressure monitoring is popular, but a report from Hong Kong indicates a poor lack of agreement between mercury sphygmomanometers and the automated devices used at home. As a tool for screening for high blood pressure, the home devices had a sensitivity of 81% and a specificity of 80%. A fifth of devices had been bought on medical advice, but just 11% of participants in the trial knew that the cuff should be level with the heart, that they should rest for five minutes before taking their blood pressure, and that the size of the cuff is important (Journal of the Royal Society of Medicine 2005;98: 111-3)[Abstract/Free Full Text].

A trial designed to help paramedics decide if they should deliver prehospital thrombolysis in cases of suspected heart attack proved disappointing ( Emergency Medicine Journal 2005;22: 209-15[Abstract/Free Full Text]). Decision making was aided by telemetry units transmitting continuous 12 lead electrocardiogram traces from the ambulance to the local coronary care unit, where a senior house officer could ask questions, and relay a decision on suitability for thrombolysis, via a text messaging system. Call to treatment times were significantly reduced, but this study identified only a small proportion (14%) of those actually eligible for thrombolysis.

Minerva cynically wonders if new treatments are tried out on old conditions just to find a use for them. First it was short wave lithotripsy, and now it's botulinum toxin injections for tennis elbow. A double-blind randomised controlled trial of botulinum versus normal saline injections found no difference between the groups in terms of pain, grip strength, and quality of life ( Journal of Bone and Joint Surgery 2005;87A: 503-7). Minerva thinks she'll stick to physiotherapy.

And now for a somewhat gruesome subject: suicide by hanging. Data from coroners' records over six months in 2001 show that 6% of hanging cases took place in prisons or psychiatric units. Ropes, belts, and cables were commonly used, swung over beams, girders and trees, limiting prevention as all these are easily located in community settings. In 52% of cases, both feet were off the ground with the victim fully suspended ( British Journal of Psychiatry 2005;186: 260-1[Abstract/Free Full Text]).

Prolonged space flight places extreme forces on the bodies of astronauts. One interesting finding of a study conducted aboard the international space station is that serum iron, ferritin saturation, and transferrin were decreased, and serum ferritin increased, but other acute phase proteins remain unchanged after the flight. These data suggest that the changes in iron metabolism are not likely to be solely a result of an inflammatory response to prolonged space travel ( Journal of Nutrition 2005;135: 437-43[Abstract/Free Full Text]).

An 81 year old woman presented with angina secondary to iron deficiency anaemia. Endoscopic examination of the oesophagus, stomach, and duodenum showed gastritis, and sigmoidoscopy showed a benign colonic tubular adenoma. The barium enema was normal. Ten months later she presented with a weeping nodule in her umbilicus. Biopsy confirmed this was a metastatic adenocarcinoma, also known as Sister Mary Joseph's nodule. Further investigation of her bowel by colonoscopy found a primary adenocarcinoma in the caecum. Sister Mary Joseph's nodule is a rare form of skin metastasis that usually derives from a neoplasm of the digestive tract or from a gynaecological malignancy. S K Chan (Shiu.chan{at}addenbrokes.nhs.uk), specialist registrar in dermatology, J Woodward, consultant in gastroenterology, N P Burrows, consultant in dermatology, Addenbrooke's Hospital, Cambridge CB2 2QQ

Medical schools have long recognised the need for diversity among their intake, and many have made concerted efforts to address the imbalance between the sexes and different minority groups. But according to the editor of the Journal of Clinical Investigation ( 2005;115: 480)[Medline], in the United States such diversification has not been tackled on basic science PhD programmes, leading to a dearth of people from underrepresented groups on university faculties. Pegging money to the levels of diversity achieved may be one way forward, he says, but the greatest reward comes from students whose lives are touched by someone who makes an effort.

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