The diagnosis of tumours and other lesions of the small bowel has remained difficult, while for years the colon and the stomach have been accessible to reliable imaging techniques. This disparity may be on its way out, however, with the development of a capsule containing a video device which is swallowed by the patient (Endoscopy 2003;35: 865-8). A small series of five patients investigated in Portugal for unexplained gastrointestinal bleeding confirmed that swallowing the capsule was not a problem, but the authors said that one drawback was the inability of the investigator to manoeuvre it. The bottom line was that in each case the lesion was successfully removed.

Subacute sclerosing panencephalitis is a disease of the central nervous system that is invariably fatal. The pathogenesis is thought to be incomplete elimination of the measles virus by the immune system. Fortunately the disease is rare, with an incidence below six per million in most countries. Papua New Guinea is an exception. The rate there was 56 per million in 1990, and a new study (Epidemiology and Infection 2003;131: 887-98) identified 80 possible cases, of which 55 were confirmed. The likely explanation is thought to be a local, highly neurotropic, measles virus.

A throwing fracture is a spiral fracture of the shaft of the humerus …