Minerva

doi:10.1136/bmj.333.7558.104

BMJ 2006;333:104 (8 July), doi:10.1136/bmj.333.7558.104

Minerva

What induces malignant melanomas in people without sun damage?US scientists report that fair skinned people who inherit variantsof MC1R, which encodes a pigment receptor, have a higher riskof developing melanomas with mutations in the BRAF gene, anoncogene associated with melanomas that occur with little chronicdamage to the skin. They think there's a link between the twogenetic variants, but the mechanism is still unknown (www.sciencexpress.org/29June2006/Page1/10.1126/science.1127515).

A 79 year old man with recurrent haemoptysis was admitted to the medical ward. Investigations of his chest and upper gastrointestinal tract were normal. He was referred to the ear, nose, and throat department to rule out other local causes of bleeding. On examination, he had several lingual varices on the ventral surface of his tongue. The varices were cauterised and he was given a blood transfusion. His postoperative recovery was uneventful and his haemoglobin was around 100 g/litre on discharge. Lingual varices are unusual and can easily be missed on clinical examination; they can cause subtle and potentially dangerous bleeding.

Abdul Nasir (dranasir{at}goolemail.com), senior house officer, D Gupta, trust surgeon, G McBride, consultant, Department of Ear, Nose, and Throat Surgery, Altnagelvin Area Hospital, Londonderry, Northern Ireland

Guidelines for safe recreational water environments have beenproduced by the World Health Organization in an effort to reducethe incidence of infections, injuries, and death from swimmingin public places. The problems stem from poor design, maintenance,and management of public swimming pools, and the solutions offeredinclude setting maximum permitted concentrations of specificcontaminants and a set of recommended best practices (www.who.int/water_sanitation_health/bathing/bathing2/en).

Traumatic experiences may cause young people to increase theirtobacco consumption (Addiction 2006;101: 1044-50[CrossRef][ISI][Medline]). The evidencecomes from a cohort of young adults who were followed up ina long term study of health behaviour in Australia. About 80%of the 2063 participants reported exposure to a major bushfirethat raged around Canberra in 2003, and over the next four years13% began, resumed, or increased their tobacco consumption.

Why are we are drinking more and more bottled water, even inplaces where tap water is considered safe and acceptable? Themain reasons for choosing bottled water are dissatisfactionwith the taste and smell of tap water and health concerns. Otherinfluencing factors are demographic variables, the perceivedquality of the water source, and lack of trust in water companies(Journal of Water and Health 2006;4: 271-6[Medline]).

The University of Bath is offering a new postgraduate socialscience course in "death and society." It covers the rituals,theories, and symbolism of death and how social practices arecurrently changing. There's a focus on policy and practice,and the course is open to people of all persuasions, but itmay be of particular interest to the cremation industry saysPharos International (2006;72: 8).

A 15 year study that prospectively collected data on all casesof bacterially confirmed deep infection after hip and knee replacementsin a specialist orthopaedic hospital in the UK found deep infectionsin 0.57% of hips and 0.86% of knees. Only 64% of these infectionsdeveloped within one year of surgery. The authors say thesefigures confirm the benefits to infection control of ring fencingelective orthopaedic beds (Journal of Bone and Joint SurgeryBr 2006;88; 943-8).

Some researchers have suggested that previous regular use ofaspirin may be linked to more severe strokes, but others reportthe opposite. An analysis of almost 18 000 patients in the internationalstroke trial found no evidence of a link between previous aspirinuse and severity of stroke at baseline. It suggests that previouslyreported positive or negative associations may be attributableto chance in small samples, confounding factors, or other biases,rather than any biological effect of aspirin (Stroke 2006;37:1737-40[Abstract/Free Full Text]).

"Naturally occurring retirement communities" are popular inthe US and can provide a low cost approach to facilitating healthyageing. People tend to be healthier in communities where thephysical and social environment encourages greater activityand promotes feelings of wellbeing. Governments should takenote—it's not just the provision of medical or socialservices that keeps people healthy (American Journal of PublicHealth 2006;96: 1164-70[Abstract/Free Full Text]).

A man who hanged himself continued to bleed after death, andblood leaked into his underwear and clothes, and also on tothe floor. The police took this to be a sign of self inflictedinjury or possible homicide before suspension of the body. Theautopsy, however, found that it had been caused by ulceratedhaemorrhoids that started to bleed as a result of gravity (Journalof Clinical Forensic Medicine 2006;13: 277-9[CrossRef][Medline]).

Eradication of Helicobacter pylori could improve the effectof l-dopa in Parkinson's disease. Thirty four patients withParkinson's disease took part in a double blind trial of H pylorieradication and those in the eradication group showed a significantincrease of l-dopa absorption and a significant improvementin clinical disability (Neurology 2006;66: 1824-9[Abstract/Free Full Text]). The drugpresumably reduced active gastritis and duodenitis, which modifiedthe pharmacokinetics of l-dopa.

Electroconvulsive therapy is an effective treatment for severedepression but can induce prolonged cognitive impairment. Astudy in Anesthetics and Analgesia (2006;103: 76-80) investigatedan alternative treatment, magnetic seizure therapy, which reducesthe side effects of therapy induced seizures by inducing more"focal" seizure activity. In a case matched series of 20 patients(10 patients for each treatment), magnetic seizure therapy wasassociated with a lower requirement for muscle relaxants anda speedier recovery of cognitive function than electroconvulsivetherapy. The antidepressant efficacy of this therapy at levelsof cerebral stimulation comparable to those used for electroconvulsivetherapy has yet to be established.

There's a new "risk calculator" that can predict risk of coronaryheart disease over 10 years for populations with a high prevalenceof diabetes and albuminuria. The equations were derived fromdata taken from American Indian tribes (Circulation 2006;113:2897-905[Abstract/Free Full Text]). Results of validation measures indicate that thecalculator has good internal validation and calibration. Formore information go to http://strongheart.ouhsc.edu.