Minerva

Minerva

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7371.1046 (Published 02 November 2002) Cite this as: BMJ 2002;325:1046

Humans may have two nostrils, but these don't necessarily share the same sense of smell. Elusive scents may be detected by one nostril but not the other. According to a brief communication in Nature(2002;419:802) individual nostrils that are initially non-detectors can be trained through repeated exposure to pick up unusual odours. This implies that although separate nerve supplies connect the nostrils to the brain, there must be some exchange of information going on in the brain's olfactory centre.

Myocardial injuries commonly happen when coronary stents are inserted. The extent of the damage depends on local platelet aggregation, inflammation, and increased oxidative stress. Since statins have an effect on these elements, in addition to their lipid lowering effects, cardiologists tested the idea that giving a statin before carrying out stenting procedures might reduce the extent of myocardial damage (Circulation 2002;106:2180-3). Giving statins before the procedure was associated in this small study with a reduced incidence of larger infarctions related to stenting.

Some people believe that impaired circulation of cerebrospinal fluid has a role in the high incidence of Alzheimer's disease in elderly people, by encouraging the deposition of amyloid and tau protein in the brain. Draining cerebrospinal fluid may sound a bit far fetched as a treatment, but a pilot study of low flow drainage reported in Neurology (2002;59:1139-45) claims some success. The patients with shunts declined less on a cognitive function test over one year. The range of adverse events in the treated group was consistent with those observed in elderly patients treated for hydrocephalus.

Head lice are surprisingly bad at jumping. An in vitro study shows that when a hair is rubbed for a second or two against a head louse sitting on another hair, the louse transfers to the second hair only around 7% of the time. When it does transfer, it grabs the hair with one leg, and is more likely to do so if the hair is rubbed along the louse's lateral surface (Journal of Investigative Dermatology2002;119:629-31).

Ankylosing spondylitis is one of those conditions that make life difficult, but conventional treatment offers little benefit. As in other immune mediated disorders, agents that target tumour necrosis factor α (a cytokine that mediates inflammatory and regulatory activities) are beginning to be used in ankylosing spondylitis, and several international trials have reported positive results. TNFα directed therapy produces significant improvements in disease activity, function, and quality of life (Annals of the Rheumatic Diseases 2002;61(suppl iii):51-60).

Enthusiastic claims are often made for glucosamine sulphate as an over the counter treatment for osteoarthritis, and it's good to see that it stands up to scientific scrutiny. The results of a three year, randomised, placebo controlled double blind study of glucosamine in knee osteoarthritis confirm a significant improvement in symptoms, and also that it retards disease progression (Archives of Internal Medicine 2002;162:2113-23)

Trying to predict life expectancy in cancer patients is fraught with difficulties, and doctors rarely get it right. Now there are two new mathematical models of cancer that claim to give much more accurate cancer survival rates over 20 years. The tobacco cancer risk and the absolute cancer cure models require one to six years of follow up of patients, rather than the 14 year follow up needed for earlier statistical models. The models have been validated using about 6000 cases from the National Cancer Institute (www.iop.org/EJ/PMB).

Figure1

A 10 year old boy with previously well controlled type 1 diabetes mellitus presented with ketoacidosis. No precipitating causes were identifiable. He responded well to a saline and insulin infusion and was restarted on his insulin pen device. Despite giving himself an increased dose he soon developed hyperglycaemia and ketonuria. His pen device was fairly new and was considered to be working well. On closer inspection, however, a crack was found in the phial, which still contained insulin. Replacing the phial rectified the problem. Minor cracks are difficult to detect in modern pen devices because of limited views through to the phial.

Nitin Shastri, senior house officer, M Yadav, consultant, department of paediatrics, Bolton Hospitals NHS Trust, Bolton BL4 0JR

A child who suffered multiple injuries in a road traffic accident in Italy was given subcutaneous injections of nerve growth factor in a last ditch effort to save an ischaemic leg. The experimental treatment paid off. The authors argue that the nerve growth stimulated production of vascular endothelial growth factor, which in turn promoted the growth of new blood vessels. The editors dealing with this case for Archives of Disease in Childhood (2002;87:446-8) say they knew they had received something innovative because they had problems finding suitably informed reviewers to assess the study's originality and importance.

Legislation about the retention and use of human organs is under review. The issues being scrutinised are those around gaining consent, respecting human dignity, and showing sensitivity towards bereaved relatives. But what happens during an outbreak of a severe, unexplained infection, where the immediate priority is to treat and prevent further cases, all of which may rely on gaining information rapidly from postmortem examination? Public health doctors warn that any changes to legislation must be very carefully thought out (Communicable Disease and Public Health 2002;5:253-6)

Asked to “draw a picture of a family physician,” each of 20 second year family practice residents produced a picture of a doctor who was the same sex and similar age to themselves. Most included a stethoscope; some wore white coats, and one doctor appeared to be wearing open toe sandals. Some illustrations included multiple arms and more than one head, which presumably represents the multitasking and the wearing of many hats needed to practise family medicine (Family Medicine 2002;34:696-8)

Murder rates seem to be critically linked to the overall wealth and economic development of a country, particularly murders of young men. According to a huge study involving data from 61 countries, redistributing the wealth of a country without increasing the gross domestic product per capita brings about smaller reductions in homicide than does overall economic development (Bulletin of the World Health Organization 2002;80:797-805)

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