BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7448.1142 (Published 06 May 2004) Cite this as: BMJ 2004;328:1142

An 18 year collection of data from a teaching hospital in Nigeria (Tropical Doctor 2004;34: 34-6) found that 178 men had been admitted with “acute scrotum.” Acute torsion of the testis accounted for half the cases: it was more common during the harmattan season, a time of cold air and low relative humidity. Similar findings from Canada, Ireland, and Japan suggest that cold air can stimulate exaggerated contraction of the cremasteric muscle. Retraction of the testis may also be associated with exercise, coitus, or a sudden fright.

Enthusiasm for resurfacing the hip joint has come and gone since the days of pioneers such as Judet and Charnley; the attraction of the technique is that it might prove better for young patients, in whom revision is to be expected. A review in the Journal of Bone and Joint Surgery (2004;86B: 157-8) says that new materials seem likely to improve the results; some research teams are claiming that metal to metal resurfacing may give four year survival rates of close to 100%. The conclusion is that current models of hip resurfacing are a considerable improvement on earlier versions—but whether they prove better than total arthoplasty in the long term remains to be seen.

People with painful knees can often avoid surgery by having their kneecaps taped to correct abnormal patellar tracking, allowing them to engage in exercise without pain. But after researchers took 18 healthy women, taped their knees, and then got them to take vigorous exercise, multiple resonance imaging showed that they lost normal medial gliding. One reason might be that the method of taping may only work under controlled rehabilitation conditions, in which exercise is less intense (American Journal of Sports Medicine 2004;32: 621-8).

Athletes who have chronically misused anabolic steroids sustain longer term changes than perhaps they realise (Heart 2004;90: 496-501). Doppler echocardiography and blood pressure measurements at rest and during exercise found that athletes who had long since stopped using steroids were left with a slight concentric left ventricular hypertrophy when compared with athletes who hadn't used steroids.

You've heard about face lifts and tummy tucks—now we've got voice lifts. It's the latest vanity surgery to hit the United States, another way surgeons have found to disguise the inevitable passage of time. Implants of fat or collagen are typically used to help people who've lost the ability to speak due to illness or injury. Now such techniques are being used to tweak vocal cords simply for cosmetic reasons (Good Morning America 2004 April 22).

Long term energy intake restriction protects adults from developing atherosclerosis. The diet simply consisted of eating two thirds of the calories in a normal US diet, and the 18 participants kept to it for an average of six years. Matched on all the usual variables with 18 other adults, the restricted group had significantly lower blood pressure, lower total cholesterol, and a lower risk of atherosclerosis generally. They also had lower C reactive protein levels, suggesting that they had less inflammation, and they had no thickening of the carotid arteries (Proceedings of the National Academy of Sciences 2004;101: 6659-63).

Currently, in the United Kingdom an emergency ambulance is dispatched when someone has a cardiac arrest. Is there any point in distinguishing those who are “dead beyond resuscitation” at the point of the call and then sending a non-urgent team? On the evidence from current systems, the answer seems to be no: 3% of patients who were deemed beyond help by the dispatcher turned out not to be. Allocating an “obvious death” code represents a significant risk (Emergency Medicine Journal 2004;21: 367-9).

London has had a higher incidence of HIV infection among homosexual and bisexual men than other parts of the United Kingdom, but the incidence of HIV outside London has more than doubled, from 1% in 2001 to 2.5% in 2002. In 2002 the estimated overall incidence of HIV in gay and bisexual men attending genitourinary medicine clinics was 3.5%, an increase from 2.5% in 2000 and 2001 (Communicable Disease and Public Health 2004;7: 11-4).

As cholesterol levels are an easy sort of thing to measure and monitor, family doctors in Belgium admit they focus on cholesterol levels and don't really have a systematic approach to assessing a more global estimate of cardiovascular risk (Acta Cardiologica 2004;59: 119-25). Both the potential fatality of myocardial infarctions and the prevalence of high cardiovascular risk in the community were significantly underestimated, and 80% of the doctors surveyed said they thought the total cholesterol level adequately reflected the individual's cardiovascular risk.

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A healthy 10 year old girl presented to the casualty department with a 48 hour history of non-itchy, rapidlyspreading facial lesions unresponsive to flucloxacillin and fucidic acid cream. Further treatment with a combination cream that included topical steroid, antibiotic, and nystatin was also ineffective. By day 10, both she and her mother had similar lesions on the trunk.Dermatological examination showed erythematous discoid plaques, initially studded with multiple vesicles and pustule, and later scaly, suggesting dermatophyte infection. The lesions clearedcompletely with topical terbinafine. Skin scrapings subsequentlyconfirmed Trichophyton mentagrophytes infection, a zoophilic dermatophyte, commonly acquired by contact with rodents. Further history revealed that the girl had recently acquired a pet rat.

J E Gach, specialist registrar, A Salim, specialist registrar, M I Ogboli, consultant, C Moss, consultant, department of dermatology, Birmingham Children's Hospital, Birmingham B4 6NH

Scientists have achieved something that was previously thought to be impossible—they have produced live mice without using sperm or male chromosomes. They developed the parthogenetic mice (which grew to adulthood) by knocking out a key gene in the donor unfertilised egg. This affected “imprinting,” the process by which one of the two copies of a gene are switched off, and shows that the incorrect expression of imprinted genes is one of the major reasons why natural parthenogenesis in mammals has not been possible (Nature 2004;428: 860-4).

Guidance at bmj.com/advice

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