BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1486 (Published 03 September 2008) Cite this as: BMJ 2008;337:a1486

Yellow nail syndrome, which consists of dystrophic nails with a yellowish discoloration, along with lymphoedema and sometimes respiratory abnormalities such as pleural effusion, bronchiectasis, and sinusitis, is rare and poorly understood. A retrospective case series (Chest 2008;134:375-81, doi:10.1378/chest.08-0137) provides a few answers: the condition is acquired rather than familial, and the yellow nails may return to normal if the respiratory problems are treated successfully. Pathogenesis, however, remains a mystery.

It’s 30 years since the first study linked high birth weight with an increased risk of a brain tumour in childhood—but later investigations found conflicting results. Meta-analysis shows that the discrepancies can be explained by differences between the major histological subtypes of primary brain tumours. Although the risk of both astrocytomas and medulloblastomas rose with increasing birth weight, no association was found for ependymoma (American Journal of Epidemiology 2008;168:366-73, doi:10.1093/aje/kwn144).

Book 9 of the Iliad concerns the unsuccessful attempt by Agamemnon’s emissaries to obtain the help of Achilles during the siege of Troy. At first sight, this hasn’t much to do with the practice of medicine, but an essay in Medical Humanities (2008;34:30-4, doi:10.1136/jmh.2008.000264) argues that the story encapsulates the problems and difficulties of communicating with patients. The authors draw attention to the way in which conversations are shaped by the previous relationships of the speakers, how reason is often eclipsed by emotion, and how even the best prepared scripts can end in failure.

The tumour necrosis factor α inhibitor, etanercept, is licensed for use in patients with severe rheumatoid or psoriatic arthritis who fail to respond to disease-modifying antirheumatism drugs. It is known to have several side effects, including an increased risk of severe infection. A report of new onset psychosis in three patients without previous mental health problems is a warning that etanercept may precipitate psychiatric adverse events too (Rheumatology 2008;47:1254-55, doi:10.1093/rheumatology/ken212).

Although physical activity is generally good for the heart, there’s some evidence that high intensity exercise increases the risk of atrial arrhythmias in young and middle aged adults. Since the incidence of atrial fibrillation increases steeply with age, it’s worth asking whether exercise increases risk in elderly people too. Fortunately, a large American longitudinal study finds that light and moderate physical activity protects quite substantially against atrial fibrillation in people over 65 (Circulation 2008;118:800-7, doi: 10.1161/CIRCULATIONAHA.108.785626). Analysis of the relation between intensity of exercise and risk, however, suggests that moderate exercise is better than going to extremes.

An oral dose of aspirin achieves almost total inhibition of platelet aggregation within minutes. An editorial in the Postgraduate Medical Journal (2008;84:337-8, doi:10.1136/pgmj.2008.068221) wonders why people being trained in first aid or cardiopulmonary resuscitation aren’t encouraged to carry aspirin and give it to people with chest pain who may have had a myocardial infarction. They also say that patients at high risk of coronary events should be advised to carry tablets and chew one immediately they experience severe chest pain.

Although many people believe that emotional stress raises blood pressure, the results of a longitudinal study from Norway indicate that the reverse is true (British Journal of Psychiatry 2008;193:108-13, doi:10.1192/bjp.bp.107.045013). In more than 30 000 people, high scores on measures of anxiety and depression at baseline actually predicted low systolic blood pressure at follow-up 11 years later. What’s more, changes in symptom levels of anxiety and depression between baseline and follow-up were inversely associated with change in systolic blood pressure.

Elderly people, especially if they are socially isolated, have always been an easy target for fraudsters and conmen. Minerva was appalled to learn that organised crime has now moved in on this vulnerable group. In one US scam, thieves posed as government and insurance workers updating their files. Using foreign call centres, they worked their way through lists of retired people, persuading them to reveal details of their bank accounts. Sometimes it’s only after an elderly person becomes a victim of fraud that relatives suspect cognitive impairment (Dementia 2008;7:283, doi:10.1177/1471301208093284).

Wittenoom, in Western Australia, is now a ghost town. Once it was a centre for the mining and milling of blue asbestos, but production came to an end in 1966. Most of the people who worked in Wittenoom were there for only a few months. But even this brief period of high exposure to asbestos put them at risk of pleural and peritoneal mesothelioma. In 1980, follow-up of a cohort of 7000 former workers found that 33 had died from this cancer. By the end of 2000, the figure had risen to 222 (Occupational and Environmental Medicine 2008;65:541-3, doi:10.1136/oem.2007.034280).


Cite this as: BMJ 2008;337:a1486

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