Surfers’ myelopathy and other stories . . .

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8332 (Published 12 December 2012) Cite this as: BMJ 2012;345:e8332

Novice surfers can have non-traumatic injuries to the spinal cord, known as “surfers’ myelopathy.” In a retrospective review from Hawaii, all 19 novice surfers had sudden onset of pain in the lower back while surfing, followed by bilateral leg numbness and paralysis for 10-60 minutes. For 17 surfers, this happened the first time they had gone surfing. Surfers with worse spinal injury scores had minimal improvement at follow-up. The cause is unclear, but the rapidity of symptom onset and restricted diffusion on magnetic resonance scans suggest ischaemic injuries (Neurology 2012;79:2171-6, doi:10.1212/wnl.0b013e31827595cd).

Patient controlled sedation using propofol brings a risk of oversedation. An anaesthetic team has developed a reaction time monitor that, when incorporated into the handset of the patient controlled sedation system, allows patients to be sedated safely while preventing oversedation (Anaesthesia 2012, doi:10.1111/anae.12036). Twenty healthy volunteers deliberately attempted to overadminister propofol to themselves. All participants successfully sedated themselves, but none reached an unsafe endpoint, maintaining verbal contact throughout the experiment.

It you want to know what someone is feeling, look at their body rather than their face. Researchers tested participants’ ability to gauge real life intense emotion. They found that looking at the faces of tennis players who had just won or lost an important point shed little light on the winners or losers (Science 2012;338:1225-9, doi:10.1126/science.1224313). But when participants also saw the players’ bodies, they correctly guessed the players’ emotions. And when asked to mimic the faces they saw, participants actually mimicked the players’ bodies.

Frederick Treves’ description of the Elephant Man (1923) and Christian Barnard’s description of the first heart transplant (1967) were both first published as case reports, the oldest method of communicating medical evidence. Now, BioMed Central’s Cases Database has arrived (www.casesdatabase.com), which also incorporates metadata mined from thousands of articles in BMJ Case Reports. It is free to access and opens up a vast library of cases from new contributors who report, debate, and collaborate on medical management of patients.

While the United Kingdom prepares to introduce a minimum price per unit of alcohol, Minerva was interested to read a focus group study that broadly rejects the proposal. Objections from the 28 focus groups were based on scepticism that minimum pricing would help cut harmful consumption of alcohol, general dislike for a policy perceived to “punish” moderate drinkers, and concern that such a policy would exacerbate existing social problems. Scepticism was the most significant barrier to public support (BMC Public Health 2012;12:1023, doi:10.1186/1471-2458-12-1023).

A novel filter designed to prevent thromboembolism during endovascular surgery was tested in vitro (in a model using silicone tubing to simulate aortic branches and polystyrene microspheres to simulate embolic particles) and in vivo (implanted into the carotid, visceral, and renal arteries of five dogs). The in vitro studies showed high capture efficacy, and the in vivo studies demonstrated easy deployment of the implanted filters for five hours, followed by complication free retrieval using a snare catheter (Journal of Thoracic and Cardiovascular Surgery 2012;144:1399-403, doi:10.1016/j.jtcvs.2012.01.025).

Ninety per cent of children with sickle cell disease (SCD) experience silent cerebral infarcts. One theory suggests that these occur during episodes of acute anaemia. In a prospective study of children admitted to hospital with illnesses associated with acute anaemia, 18.2% of 22 with SCD and 6.7% of 30 without SCD had cerebral events. Children with cerebral events had significantly lower haemoglobin concentrations than those without. The estimated incidence of cerebral events in children with SCD was much higher than previously reported. One in four events may have been reversible (Blood 2012;120:3891-7, doi:10.1182/blood-2012-01-406314).

Concentrations of B vitamins are inversely associated with blood pressure. Researchers analysed a large amount of data from the International Study of Macro/Micronutrients and Blood Pressure and the US National Health and Nutrition Examination Survey. Dietary phosphorus, magnesium, iron, and vitamins B9, B2, and B1 were inversely associated with systolic blood pressure. Nutrient intake from supplements in addition to foods gave similar results, but attenuated the association of vitamins B9, B2, and B1 with blood pressure (Circulation 2012;126:2456-64, doi:10.1161/circulationaha.112.114058).

A self administered analgesic drug that patients can “sniff” while prostate biopsies are taken could provide better analgesia than periprostatic infiltration of local anaesthetic, the currently recommended yet little used strategy. Inhaled methoxyflurane gives transient light headedness and has a sickly sweet taste. In 42 consecutive men undergoing transrectal prostate biopsy guided by ultrasonography, use of methoxyflurane proved popular and effective (median pain score 3, on a 0-10 scale). All participants were happy to undergo the same procedure again using the “green whistle” device (British Journal of Urology International 2012;110:85-8).


Cite this as: BMJ 2012;345:e8332