MinervaBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1510 (Published 04 December 1999) Cite this as: BMJ 1999;319:1510
Readers with technology fatigue will welcome a celebration of the humble physical examination in the Canadian Medical Association Journal (1999;161:1117-8). An internist from Montreal writes that physical examination will endure simply because it is a cheap, convenient, efficient, and reliable way of getting information about disease processes. Also, human touch is more reassuring than penetrating beams. New technologies and physical examination should go forward together, he concludes.
Readers without technology fatigue might be interested in a virtual reality prostate simulator for training urologists in transurethral resection (Journal of Urology 1999;162:1633-5). Using a dummy resectoscope, trainees can chip away at the virtual prostate, widen the virtual lumen, and spill virtual blood. The team at University College London that developed the simulator is keen to point out, presumably for legal reasons, that trainees should also be taught on real people.
Italy, Sweden, Great Britain, Norway, and the Netherlands have national guidelines on the management of gastro-oesophageal reflux in primary care (European Journal of General Practice 1999;5:88-95); all but one were developed by specialists. A review of all the guidelines concludes that they agree on most things except which drugs to use first. They also share the same gaps in the evidence. Studies on the predictive value of symptoms are particularly scarce.
Minerva, like many others, has a weakness for chocolate. This is less to do with greed and personal insecurity than with the potent cocktail of neuroactive substances in every mouthful, say dietetics experts from Tucson (Journal of the American Dietetic Association 1999;99:1249-56). Chocolate is also loaded with fat, sugar, and magnesium, which adds to its appeal, particularly in people who are short of trace elements. Combine all this with a seductive taste and texture and it's hardly surprising that some of us would sell our husbands for a Mars bar.
Women report more motion sickness than men, but aeronautical researchers failed to find a biological reason for the difference in experiments on volunteers (Aviation, Space, and Environmental Medicine 1999;70:962-5). Students from Pennsylvania State University were awarded extra course credits for volunteering to sit in a rotating drum for quarter of an hour while researchers measured their gastric reactivity. The recordings were similar in men and women, but women retrospectively reported feeling worse. Interestingly, the women did not report worse symptoms while the drum was rotating.
Doctors who enjoyed the BMJ's study of fly fishing last Christmas will find likeminded anglers in the American Medical Fly Fishing Association (www.amffa.org). Every year members meet in Yellowstone National Park for three days of rod bending and argument about the relative merits of the Black Gnat, Cinnamon Sedge, and Lunn's Particular. New recruits are welcome.
Doctors in Missouri don't know much about natural family planning (Obstetrics and Gynaecology 1999;94:672-8) —but then they don't tend to use it themselves (Obstetrics and Gynaecology 1999;94:666-71). A nationwide survey found that women doctors in the United States liked oral contraceptives best, followed by condoms and diaphragms. The rhythm method was their least favoured contraceptive option.
Few readers will be surprised that losing a spouse is associated with heavy drinking in older men (Australian and New Zealand Journal of Psychiatry 1999;33:740-7). An understandable reaction to the pain of bereavement, perhaps? Not according to one controlled study, which found that drinking was not linked to psychological distress. The authors suggest that recently widowed men drink more because their wives are no longer around to stop them.
Collectors of science trivia will be interested to learn that air flows faster through one nostril than the other, and that the fast flow switches between nostrils every few hours (Nature 1999;402:35). The effect of this nasal oddity is that smells are perceived differently through each nostril. No one knows why we have evolved this way, but scientists guess that it has something to do with expanding our repertoire of perceptible smells.
An anaesthetist from Heidelberg has developed a placebo acupuncture needle that looks and feels like the real thing but does not penetrate the skin (Pain 1999;83:235-41). Armed with a reliable way of blinding patients in acupuncture trials, a team from the city's university tested acupuncture against placebo in rotator cuff tendinitis. The real thing worked better, suggesting that acupuncture's effects critically depend on puncturing the skin.
Non-specific abdominal pain accounts for up to 40% of emergency surgical admissions in the United Kingdom, but early laparoscopy can improve the chances of a definitive diagnosis (British Journal of Surgery 1999;86:1383-6). A randomised trial compared laparoscopy with the more traditional “wait and see” option in 120 patients for whom the routine workup had drawn a blank. A diagnosis rate of 80% in the laparoscopic group was significantly higher than the 36% achieved in controls. Early laparoscopy had no impact on morbidity, mortality, or duration of hospital stay.
Men with erectile dysfunction after a radical retropubic prostatectomy may respond to Viagra (sildenafil), particularly if they had nerve sparing surgery (Journal of Urology 1999;162:1614-7). In an open series of 84 patients, about half had improved erections when taking sildenafil. Unsurprisingly, the improvement depended on the sexual function they had to start with, and on a reasonable nerve supply to the penis.