BMJ  2005;331:854 (8 October), doi:10.1136/bmj.331.7520.854

Minerva

Is psoriasis an immune disorder that affects the skin, or a skin condition with immunological implications? A new mouse model created by European scientists and engineered to lack the equivalent mouse gene to the human gene JunB (which has decreased expression in human psoriatic lesions) developed a skin disease almost identical to psoriasis in humans. The condition developed independently of immune cells, supporting the hypothesis that psoriasis is an "outside-in" disorder ( Nature 2005;437: 369-75[CrossRef][Medline]).

One year on, a third of 94 survivors of severe acute respiratory syndrome (SARS) still have impaired lung function. The main determinants of the cause of prolonged chest problems have not been identified, but all these survivors had poorer general health than the healthy population ( Chest 2005;128: 1393-400[Abstract/Free Full Text]).

The Royal Medical Benevolent Fund's Christmas appeal needs your help to support medics and their families who have unexpectedly fallen on hard times. To be considered for help a person must be a doctor registered with the General Medical Council or bona fide dependant, resident in the UK, unable to work, and with little in the way of income or savings. Examples of people the fund have helped can be found on www.rmbf.org and include young doctors on short term contracts who have been in car crashes or become seriously ill, doctors and doctors' widows needing to retrain for new careers after an incident, illness, or bereavement, and dependants (from a 4 month old baby to a 108 year old widow).

A femoral cannula designed to get blood flowing into more distal regions is described in the Journal of Thoracic and Cardiovascular Surgery ( 2005;130: 684-6)[Abstract/Free Full Text]. Compared with the standard device, which produced distal flow in only one of five pigs tested, the distal flow cannula achieved good distal flow and tissue perfusion in all five animals. The vascular surgeons who designed it say their device might reduce the sort of distal limb ischaemia seen with conventional devices.

It's not just chatting on mobile phones that impairs driving performance—holding the phone to the ear can cause problems because it reduces the probability of head movements, which in turn reduces the ability to monitor the surrounding visual environment. When 26 people were tested sitting down, wearing baseball caps with sensors attached to them, most of them showed that changed head positions were less probable in the "with phone" position. But the study didn't assess eye movements, nor did it test what happens during car driving ( Neurology 2005;65: 754-6[Abstract/Free Full Text]).

A study in the American Journal of Gastroen-terology ( 2005;100: 1780-7)[CrossRef][ISI][Medline] describes how budesonide capsules have been found to be effective at sustaining periods of remission for people with Crohn's disease. A daily dose of 6 mg proved sufficient to prolong the time before relapse and to significantly reduce relapse rates. The authors say this dose is well tolerated and produces a side effect profile similar to placebo.

The main causes of morbidity and death among people infected with HIV are opportunistic infections. A paper presented at the Palliative Care Association of Uganda conference held in August 2005 describes how 45 000 people in Uganda currently receive prophylaxis with daily co-trimoxazole. This has been shown to have beneficial effects on their CD4 cell count, viral load, and morbidity and mortality. It's also proved highly cost effective in rural areas, generating savings to use elsewhere in the healthcare system.

A 19 year old woman burnt her left hand when she was 2 years old. The burn was treated with a full thickness skin graft harvested from her groin. During puberty, the graft became hyperpigmented and some hair grew. Deep palm burns in children are often left to heal by secondary intention. Skin grafts, which are commonly harvested from the groin in children, are sometimes necessary. When selecting a donor site in children, it's important to consider how grafts may mature with age. Annette Loffeld (Annette.loffield{at}blueyonder.co.uk), locum consultant, Irshad Zaki, consultant, department of dermatology, Heart of England NHS Foundation Trust, Solihull B91 2JL

An editorial in Brain ( 2005;128: 2217-8)[Free Full Text] sings the praises of the 3000 experts who review manuscripts for the journal each year. Apparently, the quality of the reviews is outstanding and the attention to detail meticulous. Minerva thinks this must be unique. She is just back from Chicago where, at the international conference on peer review, she heard editors worry how the personal biases and conflicting interests of reviewers—especially when they report anonymously—subvert fair and transparent assessment of papers.

Anaphylaxis during anaesthesia is rare, but when it does occur it's important to find out what caused it to prevent re-exposure. Correct identification may be harder than it seems. A study from Denmark found that when such cases were carefully investigated, fewer than 10% of the substances suspected by the anaesthetists of being responsible turned out to be the culprits. ( British Journal of Anaesthesia 200595 : 468-71[Abstract/Free Full Text]).

Sporadic Creutzfeldt-Jakob disease usually presents as a rapidly progressive dementia accompanied by myoclonus and pyramidal tract signs. Occasionally, however, the initial symptoms are visual—decreased visual acuity, field defects, tunnel vision, or distorted colour perception. In a series of 594 pathologically proved cases that were reported to the UK national surveillance centre, 22 had isolated visual symptoms at onset. Ophthalmologists need to be aware of this unusual presentation, known as the Heiden-hain variant, because surgical intervention risks spreading the disease. Two of the patients had undergone cataract extraction before the correct diagnosis was made ( British Journal of Ophthalmology 2005;89: 1341-2[Abstract/Free Full Text]).

Colchicine is well known as an effective treatment for acute attacks of gout. The results of a randomised controlled trial from Italy indicate that it is useful in acute pericarditis as well. When added to conventional treatment with aspirin, colchicine shortened the duration of symptoms and reduced the recurrence rate. The researchers found no serious adverse effects ( Circulation 2005;112: 2012-6[Abstract/Free Full Text]).

Richard Dawkins, the evolutionary biologist and explainer of science, is concerned about the mind altering and addictive properties of gerin oil (geriniol). He believes that, although low doses are mostly harmless (even serving as a social lubricant on occasions such as marriages, funerals, and ceremonies of state), larger amounts can distort perceptions of reality, cause hallucinations, and lead to delusional states. He is particularly worried by its easy availability. But those without an eye for anagrams may miss his point ( Prospect 2005 October; www.prospectmagazine.co.uk).

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