BMJ  2005;331:300 (30 July), doi:10.1136/bmj.331.7511.300

Minerva

In addition to hosting the 2012 Olympic Games, London is also celebrating the opening of a brand new hospital—the beautiful University College Hospital. Despite the hospital boasting 12 operating theatres, Minerva has heard a rumour that there's just one (unisex) toilet for theatre staff and no rest room (theatre staff have to share the one used by the intensive care unit). Oh, and the architects apparently forgot to include any changing rooms.

A man with a prodigious capacity to generate the correct weekday of any given past date within a few seconds has had his brain examined using positron emission tomography. He performs this trick despite severe behavioural and cognitive impairment and has been doing so since the age of 4. Being unable to work with future dates, it was hypothesised that his calendar abilities were sustained by memory processing. The bits involved proved to be the left hippocampus, the left frontal cortex, and the left middle temporal lobe, which is similar to the cerebral circuit involved in memory retrieval tasks ( British Journal of Psychiatry 2005;187: 83-6[Abstract/Free Full Text]).

People who have received kidneys from living donors are apparently reluctant to accept them before they have had a chance to talk to the donors. Their main concern is to establish for themselves that the donor genuinely wants to give the organ—because of the impact that the donation may have on the donor's health. Donors, on the other hand, make instant voluntary decisions about becoming donors, and don't regret doing so. Further findings of this interview study will be presented at the annual conference of the British Sociological Association's Medical Sociology Group in September in York.

Intraoperative transoesophageal echocardiography of patients with severe aortic stenosis (and controls with other conditions) has shown that the stenosis group had significantly higher rates of aortic atheromas than the control group. The vast majority of the aortic atheromas were located in the aortic arch and the descending aorta. The findings suggest that aortic stenosis is a manifestation of the atherosclerotic process generally, and the authors say that patients with aortic stenosis should have aggressive atherosclerosis risk factor modification ( Journal of Thoracic and Cardiovascular Surgery 2005;130: 29-32[Abstract/Free Full Text]).

For most of us, alcohol makes it harder for us to walk in a straight line, but not so in people with essential tremor. Before alcohol, gait analysis showed that in those with essential tremor more missteps were taken than in those without tremor, and ataxia scores were higher. Alcohol intake produced the interesting effect of reducing the number of missteps and improving ataxia scores. One explanation is that alcohol has a reversible effect on receptors involved in the pathology of essential tremor ( Neurology 2005;65: 96-101[Abstract/Free Full Text]).

The newly launched Review of Contemporary Poetry is an anthology of poems for general consumption but also aims to raise funds for the Stroke Association. Unlike most books of poetry, this one includes a selection of poems from people who have been affected by stroke as well as poems by well known poets. The stroke poets were selected by the Poet Laureate, Andrew Motion (www.stroke.org.uk).

A huge review of data taken from over 300 000 patients followed up in cohort studies from the Asia-Pacific region, and for whom cardiovascular risk factors were recorded, has identified two critical risk factors for subarachnoid haemorrhage. These are smoking and raised blood pressure. High cholesterol, body mass index, and alcohol intake were not related. The strength of the associations between these risk factors and subarachnoid haemorrhage was similar in both Asian and Australasian populations ( Stroke 2005;36: 1360-5[Abstract/Free Full Text]).

Some Londoners may experience symptoms of post-traumatic stress disorder over the coming weeks and months, but little is known about the natural course of the disorder. A German study of 125 young people and adolescents followed up for up to 50 months reports that half showed no significant remission. These subjects were more likely to experience new traumatic events during the follow-up and were more likely to report help seeking ( American Journal of Psychiatry 2005;162: 1320-7[Abstract/Free Full Text]).

Scientists have found how to deliver tiny molecules of RNA targeted against the hepatitis B virus at doses safe enough for humans ( Nature Biotechnology 24 Jul 2005; doi: 10.1038/nbt1122). The technique involves incorporating "small interfering" RNAs (siRNA) into lipid particles that protect them against being broken down by digestive enzymes in the blood. This maintains their stability and avoids the need for higher doses. In mice the encapsulated siRNAs showed persistent activity for up to six weeks, when given just once weekly.

The incidence of acute postoperative infectious endophthalmitis after cataract surgery was lower than expected in one UK hospital over 10 years. The authors (in Eye 13 Jul 2005; doi: 10.1038/sl.eye.6701996) say this could be due to several reasons, including good preventive measures and possible discrepancies in the way cases were retrospectively ascertained. The incidence was certainly lower than the figure reported in the National Cataract Audit, a UK multicentre prospective audit. The authors say that data could be used to inform patients about local quality of care and that the present focus on productivity in cataract surgery remains a concern.

This 11 year old girl presented to our accident and emergency department having woken in the middle of the night with gross swelling of the lips. Her airway was secure and she was otherwise well. She was immediately treated with chlorphenamine, prednisolone, and adrenaline (epinephrine) without any rapid effect. She was admitted for observation and tested for C1 esterase inhibitor deficiency. This protein deficiency is a rare but important cause of angio-oedema and should be considered in any patient presenting like this with no obvious cause of anaphylaxis. Moiz Moghal (moizmoghal{at}hotmail.com), senior house officer, accident and emergency department, Barnsley Hospital NHS Foundation Trust, Barnsley S75 2EP

Standard treatment of hepatitis C in the United Kingdom involves interferon and ribavirin given in a prolonged protocol to reduce the relapse rate. By modelling sustained response rates with one-off treatment courses and cyclical treatments, a Dutch team has calculated that, even with the most unfavourable assumptions, repeated six month treatment (compared with a single 12 month treatment) lowers the average treatment duration from 9.6 months to 7.5 months, without lowering overall effectiveness ( Medical Hypotheses 2005;65: 238-42[Medline]).

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Other possible causes of lip swelling.

Mark F Devlin, et al.
bmj.com, 24 Aug 2005 [Full text]