Minerva Minerva


BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7353.1592 (Published 29 June 2002) Cite this as: BMJ 2002;324:1592

Patients with fibromyalgia tell you it isn't just about having aching muscles; they also feel weak. Using a dynamometer to assess grip strength and tests of muscle fatigue resistance, researchers compared 16 women with fibromyalgia syndrome and 85 healthy women. They confirmed a 40% reduction in all muscle function tests in the fibromyalgia group compared with controls (especially during aerobic exercise) and an 80% reduction for static endurance (Joint Bone Spine 2002;69:293-9).

The Japanese are prone to stomach cancer. But small cell stomach cancer is rare, and as it carries a poor prognosis suitable treatment has yet to be established. A report in the International Journal of Clinical Oncology (2002;7:128-32) describes the case of a Japanese patient with small cell stomach cancer and a solitary liver metastasis. Rather than cut it out, and because of poor liver function, the surgeons fried the liver with microwave therapy. Nearly three years later the patient is alive with no sign of recurrence.

Here's one writer's recipe for success that all healthcare systems can aspire to. “Successful organisations are likely to be those where there is clear purpose and initiative, where concordance and trust have been developed, where there is high-calibre leadership supported by sufficient capable people and resources, and suitable rewards for commitment, and a track record of successful actions” (Medical Teacher 2002;24:320-6).

Differences between the sexes apparently start as far back as the level of the gamete. Evidence of “quality control” during cell division (meiosis) shows that 90% of chromosomal abnormalities in human fetuses come from meiosis problems in females. The discrepancy, say the authors, may occur because females seem to “soldier on,” producing less than perfect eggs when cell division is disrupted. Sperm production, on the other hand, is completely halted when cell division problems are detected (Science 2002;296:2174-6).

Constipation is often diagnosed in accident and emergency departments. A retrospective trawl through the notes of 142 cases of constipation identified at one hospital found the diagnosis was often based on x ray findings that were not confirmed by radiology review. Two thirds had no recorded change of bowel habit and no evidence of faecal loading on rectal examination. Despite this, most patients were discharged with laxatives or suppositories (Emergency Medicine Journal 2002;19(suppl 1):A20).

Family practice training in the United States currently takes three years. Given changes in practice, new technology, and possible interventions available, some say it's time for a shake up. A survey of training programme directors, trainees, and family doctors found that one third favoured extending the course to four years, as long as the extra year was spent in practice, rather than hospital. Potential loss of income and delay in paying off student debts were perceived as barriers to change (Journal of the American Board of Family Practice 2002;15:201-8).

Some useful advice on how to protect yourself in the “allergy season” comes from Preventive Medicine (2002;34:409-10). If you have to go outdoors, do it early in the morning (pollen counts rise throughout the day). Keep windows closed, and bathe before going to bed (particularly if you've been outside, collecting pollen on your skin). If you have pets, keep them inside or outside, but not both. Minerva can cope with most of these, but thinks the last may prove difficult.

You're on Australia's east coast, catching a wave. And then the nightmare happens. You develop central, crushing chest pain and stop breathing. Australian lifesavers undertake numerous resuscitation scenarios in the course of their training, but the standard teaching strategy is for the scenario to end with the return of spontaneous circulation and breathing. The result is that lifesavers tend to have exaggerated expectations of the chances of successful cardiopulmonary resuscitation—and these don't seem to change in the light of reality (Resuscitation 2002;53:159-65).

People with systemic lupus erythematosus are at high risk of developing cancer, according to a 30 year follow up of a Swedish cohort. The overall risk was increased by 25%, with lymphomas (mainly non-Hodgkin's) making up the vast majority. There was also an increased risk of skin cancers and lung cancer (Scandinavian Journal of Rheumatology 2002;31:66-71). The authors say the underlying mechanism is unknown, but Minerva wonders if the treatment is more culpable than the disease.

Full body armour might be thought to pose a problem for radiological studies. Put to the test in a simulated casualty situation, researchers found that military helmets contain metal screws and clips in the headband, but diagnostic computed tomographic images could still be obtained. Kevlar (the chief component of soft armour) has favourable photon attenuation characteristics, while plate armour of composite material also does not limit radiographic studies (Military Medicine 2002;167:267-71).


A 28 year old Zambian woman presented to our mission hospital with severe, painful herpes zoster of the mandibular division of the trigeminal nerve. Involvement of the anterior two thirds of the tongue reminded us that the fifth cranial nerve supplies sensation here. Taste fibres from the anterior two thirds of the tongue are, however, carried in the chorda tympani, which joins the seventh cranial nerve. Herpes zoster is a common presentation of HIV disease in sub-Saharan Africa.

D Elphick, H Elphick, specialist physicians, St Francis's Hospital, Katete, Zambia

The British cup of tea may one day be compared to the French glass of red wine. A 3.8 year prospective cohort study of 1900 patients admitted to hospital with a confirmed heart attack has found that self reported tea consumption in the year before acute myocardial infarction is associated with lower mortality after infarction (Circulation 2002;105:2476-81).

We don't want to depress readers, but Christmas is just six months away—please spare a thought for the BMJ. We like to think ahead and get organised. Any suitable material for the all singing, all dancing Christmas issue of the BMJ should reach us by the end of August.


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