BMJ  2006;333:710 (30 September), doi:10.1136/bmj.333.7570.710

Minerva

Minerva

Skiers who have had their anterior cruciate ligament reconstructed may be wise to wear a knee brace next time they are on the slopes. A prospective cohort study of people with reconstructed ligaments working in the skiing industry compared 257 who wore braces with 563 who did not. Braced skiers had significantly lower rates of subsequent knee injuries than their non-braced counterparts. Mathematical modelling identified non-bracing as an independent risk factor for subsequent knee injury in skiers with reconstructed ligaments (American Journal of Sports Medicine 2006;34: 1581-5[Abstract/Free Full Text]).

The low cholesterol concentrations required to protect patients at high risk of coronary heart disease will not be attained with statins bought over the counter, say two Australian doctors. In addition, they argue that for low risk patients, serious adverse events may exceed the benefits and that over the counter statins will reduce the likelihood of identifying people at high risk because they have a low concentration of high density lipoprotein, the protective cholesterol. Logically, they say, statins should be prescription only (Circulation 2006;114: 1310-4[Free Full Text]).

Biodegradable polymer nanoparticles offer a novel method for delivering combined drug and genetic therapies directly to cancers. The polymer of hydrophilic and lipophilic molecules spontaneously forms nanoparticles when placed in water, with the oil loving part hiding in the core and the water loving part lining the outside. Oil loving drugs placed in the water solution are incorporated into the core, while the outer shell binds DNA or RNA. Combined treatment of mouse tumours with this technology significantly slowed the growth rate compared with genetic therapies or drugs alone (Nature Materials 24 Sep 2006; doi: 10.1038/nmat1737).

A 59 year old woman presented with erythema and swelling over her right supraclavicular fossa. She had cervical lymphadenopathy and a solitary thyroid nodule. Fine needle aspiration of the nodule showed carcinoma. Computed tomography confirmed the thyroid nodule plus abnormal cervical and mediastinal lymph nodes. Specimens from a total thyroidectomy and skin biopsy showed Hurtle cell carcinoma of the thyroid. The lymph nodes and skeletal muscle also contained Hurtle cell carcinoma. This uncommon presentation of cutaneous metastasis is carcinoma erysipeloides—red indurated skin simulating cellulitis, without fever. It was first described by Rasch in 1931 and is more commonly seen in inflammatory breast cancer. A L Thorne (thornea{at}doctors.org.uk), specialist registrar, general surgery, Queen Alexandra Hospital, Portsmouth, Hants PO6 3LY, A A Evans, consultant, breast and endocrine surgery, Poole Hospital NHS Trust, Dorset

A field study of 16 white collar workers who worked one week with normal eight hour working days and one week with 12 hour working days reports that working overtime was associated with higher levels of exhaustion and less total sleep. But cortisol concentrations, which are a marker of physiological stress, followed a circadian pattern and were not related to the workload (Scandinavian Journal of Work, Environment and Health 2006;32: 318-27).

A related issue is what happens to the performance of commercial drivers when they have had insufficient sleep. Researchers evaluated the effects of sleep apnoea and short duration of sleep on sleepiness in drivers. Both severe sleep apnoea and less than five hours' sleep a night affected objective sleepiness and impaired the drivers' performance, and, although apnoea is less common, both factors should be tackled (American Journal of Respiratory and Critical Care Medicine 2006;174: 446-54[Abstract/Free Full Text]).

Qualitative interviews with 29 general practitioners about their drinking habits and their alcohol intervention practices showed some interesting variation. For some general practitioners, identifying patients with similar drinking practices increased their empathy. Many, however, regarded themselves as distinct, separating their drinking behaviour from that of their patients. Possibly the more worrying finding was that some general practitioners identified patients as at risk only if the patients drank more than them or differently. (Family Practice 2006;23: 481-7[Abstract/Free Full Text]).

Around half a century after bidets first appeared in bathrooms, colorectal surgeons still respect them. Several anal conditions, such as pruritis ani, are reported to be related to poor hygiene, and a daily shower is no substitute for plunging your bottom into a bidet after evacuating a stool (Diseases of the Colon and Rectum (2006;49: 1080-1[CrossRef][ISI][Medline]). Only 13% of Britons and 6% of Germans have a bidet at home, and many of them admit to using them to wash feet or clothes.

A Canadian survey shows that apart from being aware of conception difficulties, many women are ignorant of the potential complications of delaying starting a family, including multiple births, caesarean section deliveries, preterm deliveries, and low birth weight. Factors associated with poor awareness were smoking, no higher education, and age 35-39 years, which suggests that opportunities are being missed for preconception counselling (Canadian Journal of Public Health 2006;97: 330-4[ISI][Medline]).

Photodynamic therapy is potentially valuable for moderately severe acne. In a randomised controlled study of 30 patients aged 15-28, topical methyl aminolaevulinate significantly reduced the total inflammatory lesion count compared with placebo at three months, but it was associated with more pain than placebo (British Journal of Dermatology 2006;155: 608-13[CrossRef][ISI][Medline]).

Does adenotonsillectomy in children increase susceptibility to upper respiratory tract infections as a result of reduced serum immunoglobulin titres? A comparison of surgery with watchful waiting found similar falls in serum immunoglobulin titres over one year. Immunoglobulin A initially fell more in the surgical group but rose to levels comparable with those in the watchful waiting group among children who had frequent upper respiratory tract infections. The remaining mucosa associated lymphoid tissue seems to compensate for the loss of tonsils and adenoids (Annals of Allergy, Asthma and Immunology 2006;97: 251-6).

Misoprostol is a synthetic prostaglandin analogue useful for cervical ripening and inducing labour. A trial of two doses of oral misoprostol and a control preparation after premature rupture of membranes found that in primiparous women both doses of misoprostol reduced the time from rupture to delivery, but the duration of the first stage of labour was significantly reduced with only the higher dose. There were no differences in neonatal or maternal outcomes among all three groups, and no effect was seen in multiparous women (Acta Obstetricia et Gynecologica (2006;85: 1128-33).