Intended for healthcare professionals

Minerva Minerva


BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:134

Minerva publishes a lot of radiological images—many of them the right way up—but the radiologist who interpreted the image is rarely mentioned. Two practitioners from Edinburgh write that radiologists were acknowledged in only 7 out of 78 “radiological” cases published on this page over the past four years, and they urge their specialist colleagues (especially ear, nose, and throat surgeons) to give credit where it's due. They also say that radiologists in general should shout louder about their important role in patient care.

Cardiac surgeons have been performing heart transplant operations for 30 years, and patients' survival prospects continue to improve. In one German centre nearly 50% of patients survive for at least 10 years after surgery and most of those have good exercise tolerance (Heart 1999;82:47-51). Cancer is one of the biggest threats to patients who have any solid organ transplant. A quarter of the patients in this series had at least one malignancy during follow up.

Patients who survive a bone marrow transplant for leukaemia also have a good chance of long term survival, although their mortality remains much higher than that in a comparable normal population (New England Journal of Medicine 1999;341:14-21). In a cohort study of over 6000 patients with a variety of haematological cancers, 90% of patients who were free of disease for two years after transplantation survived for at least five years. Recurrent leukaemia and chronic graft versus host disease were the two biggest killers in this cohort.

Common sense tells us that polluted air is more damaging to people's lungs than clean air—but this is surprisingly difficult to prove. A study in Thorax (1999;54:597-605) takes the research a step closer by linking pollution figures with consultation rates in 45 London general practices. High levels of nitrogen dioxide and carbon monoxide increased consultation rates for asthma, but only in children. Particulate pollution was the only factor that affected consultation rates in adults. The effects of pollution were greatest in the summer.

Pre-eclampsia is common and dangerous, and its cause is unknown, but for once the answer is not in the genes (British Journal of Obstetrics and Gynaecology 1999;106:570-5). A study of 471 twin pairs failed to find a single pair that were concordant for the disease, suggesting that the mother's genes have little or nothing to do with this condition. Environmental factors under scrutiny include seminal antigens, previous failed pregnancies, and sex of the fetus.

Elsevier Science, a leading science publisher, came under fire last month when a referee for one of its journals resigned over relentless increases in subscription rates (Nature 1999;399:623). He blamed Elsevier and other avaricious publishers for the budget crisis at Florida State University's library, which has had to cut more than 2000 titles from its list because of annual price increases of 20%. Nuclear Physics A, the journal he resigned from, costs $7234 (fl14 252) a year. Other scientists should consider following his lead, he says.

Humans have an unwavering circadian rhythm of precisely 24 hours and 11 minutes, not the variable rhythm previously thought to set us apart from other animals (Science 1999;284:2177-80). Experiments in 28 volunteers who spent a month in a tightly controlled environment show that the human time clock is sophisticated, durable, and presumably important to our health and well being. Junior doctors with punishing on-call rotas now have an evolutionary argument as well as a moral one to beat their managers with.

Experiments have shown that women prefer men with slightly feminine faces, but scientists report in Nature (1999;399:741-2) that women's preferences switch during the follicular phase of the menstrual cycle, when they are most likely to conceive. The effect is most marked in women with steady partners, and is wiped out by oral contraception. The authors speculate that women have evolved a mating strategy that allows them a primary partner who invests heavily in their family (the feminine type) but doesn't necessarily father all their children.

Australian doctors who need an interpreter can contact a telephone service that provides interpreters in over 100 languages round the clock. In Britain, doctors often have to rely on relatives, even children, to interpret for them. A nationwide survey of accident and emergency departments found widespread support for a telephone interpreter service, particularly at night and over weekends, when regular services were not available (Accident and Emergency Medicine 1999;16:271-4). NHS Direct might be a good place to start, say the authors.

The “mayo culture” is not an egg based salad dressing which has been left out of the fridge too long but an institutional milieu at the Mayo clinic in Rochester, where with a little extra effort doctors can become “distinguished clinicians” (Mayo Clinic Proceedings 1999;74:635-7). Readers wishing to be distinguished should: become a role model to everyone, especially paramedical staff; be consistent, dependable, predictable, intuitive, hard working, and believe in God. They should also eschew arrogance and avoid whining. Being pompous, on the other hand, is compulsory


This T shirt belongs to a 35 year old woman with severe cerebral palsy. Her tendency to dribble has become substantially worse over the past year. She also has oesophageal reflux, and the holes in her T shirt are acid burns caused by hydrochloric acid from the stomach. An H2 antagonist improved her symptoms and prevented further damage to her clothes.

Natasha Arnold, senior registrar, A Ala, specialist registrar, N van Someren, consultant gastroenterologist, Chase Farm Hospital NHS Trust, Enfield EN2 8JL

Submissions for this page should include signed consent to publication from the patient.

In Tasmania, tobacco companies that lie about the health effects of tobacco face prosecution. Legislation has not yet reached South Australia, but in one survey over 90% of South Australian respondents would support a similar law (Australia and New Zealand Journal of Public Health 1999;23:240-4). The same respondents rated tobacco company executives as the least honest and ethical out of a list of professions that included lawyers, journalists, and used car salesmen.

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