BMJ  2006;332:60 (7 January), doi:10.1136/bmj.332.7532.60

Minerva

Minerva

Dignity in Dying is the new name for the Voluntary Euthanasia Society, which was set up by doctors and clergy in 1935. The society campaigns for greater patient choice at the end of life, a statutory backing to "living wills," and a change in the law so that a terminally ill, competent adult who is suffering can ask for medical assistance to die. A new name was called for in recognition of the wider breadth of work now done by the society.

A British company has launched a national will register. The register records the location of a person's latest will, and it's hoped will help dispel the confusion caused by lost wills and the family wrangles that often follow. The register also helps prevent outdated wills being used maliciously, and maintains a copy of each will in case the original is destroyed by fire or flood. People can register online for a small fee at www.willdata.info (Pharos International 2005;71: 20).

Men and women who use marijuana often change their habit when they get married. The interesting thing is that wives seem to influence their husbands more often than the other way around: husbands are more likely to start using marijuana if their wives use it, but wives are not more likely to start using marijuana if their husbands use it. Husbands are also more likely to stop if their wives are not users (Journal of Drug Issues 2005;35: 409-30).

New research about the effects of the oral contraceptive pill indicates that long term users may be exposed to low levels of "unbound" testosterone, which could lead to persistent sexual, metabolic, and mental health problems even after users have stopped taking the pill. Sex hormone binding globulin (SHBG) is the protein that binds testosterone, and in a retrospective study, levels of SHBG in continuous users were four times higher than those of women in the study who had never taken the pill. Levels remained higher in women who stopped taking the pill than in women in the group who had never used the pill (Journal of Sexual Medicine 2006;3: 104-13[Medline]).

A life saving response to low blood sugar relies on the body's ability to sense the level of circulating glucose and to secrete glucagon quickly. The central nervous system is vital to this response—but which part? By drawing on earlier work showing that mice lacking glucose transporter type 2 (GLUT2) protein lose the hypoglycaemic sensing response, scientists stumbled on a hitherto unknown role of glial cells. They found that glucose sensing and subsequent glucagon secretion are restored if GLUT2 protein is re-expressed in glial cells, but not in neuronal cells (Journal of Clinical Investigation 2005;115: 3403-5[Medline]).

If the digestive system can be "woken up" earlier after colon surgery, patients may be able to leave hospital faster. Gum chewing acts as a form of "sham feeding," where chewing and swallowing stimulate the hormones involved in making the gut work. A study of chewing gum after surgery reports that patients who chewed gum after laparoscopic procedures went home a day earlier than patients who didn't chew gum, but chewing gum made no difference to patients who underwent open surgery (www.usatoday.com/news/health/2005-12-14-gum-colon-patients_x.htm).

An otherwise well 54 year old woman was admitted with acute onset unilateral facial pain and headache. Results of nasendoscopy, full blood count, renal function and C reactive protein tests and chest x ray examination were normal. A computed tomography scan showed unilateral opacity of the sinuses, but antral wash-out was clear. Three weeks later, nasendoscopy showed granulations in the middle meatus and a biopsy showed granulomatous disease. Investigations including screenings for antineutrophil cytoplasmic autoantibodies (ANCA) and cytoplasmic ANCA were normal, but thoracic computed tomography showed nodules, which led to a diagnosis of Wegener's granulomatosis. Three months later, the patient developed a saddle nose deformity and the ANCA tests became positive. She responded well to immunosuppressants. Niranjan Raghava (hrullekha{at}hotmail.com), registrar, Kate Evans, consultant, ear, nose and throat department, Gloucester Royal Hospital, Gloucester GL1 3NN

Treatment using bee stings (given as a series of stings at regular intervals) is increasingly pursued by patients with multiple sclerosis, probably because conventional medicine has so little to offer them. Honeybee venom has anti-inflammatory properties and a polypeptide that crosses the blood-brain barrier and helps regulate neuronal activity. But, a randomised crossover trial published in Neurology (2005;65: 1764-8)[Abstract/Free Full Text] found that, despite being surprisingly well tolerated, bee sting therapy didn't reduce disease activity, disability, or fatigue, or improve quality of life.

Coronary artery bypass grafting has a risk of cerebral injury, and of retinal microvascular damage in particular. Using fluorescein angiography and fundal photography to assess retinal damage, and measuring protein S levels and using transcranial Doppler ultrasonography (to detect emboli) to assess cerebral injury, a team from Bristol reported that off-pump bypass grafting has a significantly lower risk of retinal microvascular damage and cerebral injury than cardiopulmonary bypass grafting. The authors say the absence of angiographic abnormalities in patients undergoing off-pump procedures, and the Doppler results and high levels of protein S found in those undergoing cardiopulmonary bypass grafting, support the interpretation that cardiopulmonary bypass causes cerebral damage (Circulation 2005;112: 3833-8[Abstract/Free Full Text]).

A 45 year old man with blocked ears was staying on a small island. He had no access to an ear syringe so he borrowed a Super Soaker water gun from a local child. The device successfully delivered mildly pressurised jets of water, and hard lumps of cerumen slid from both ears (with just two refills of the device) but his tympanic membranes were left intact. The only disadvantage was the "backsplash" on the operator because the device had to be held about 5 cm from the ear due to its size. Despite publishing this case history, the journal of the Canadian Medical Association has issued a "do not try this at home" disclaimer (CMAJ 2005;173: 1496-7[Free Full Text]).

A large, observational, population based study of elderly people living in London concludes that there does seem to be a relation between energy inefficient housing and winter respiratory disease, resulting in hospital admissions. Proving a link between cold homes and health as cause and effect is notoriously difficult, but the data in this study strengthen the public health argument for energy efficient improvements to be offered to people with reduced resources (Journal of Public Health 2005;27: 353-8).

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