Minerva

The received wisdom about ovarian cancer is that symptoms don't develop until the tumour is at an advanced stage, delaying diagnosis and reducing the chances of a cure. Respondents to one survey, however, reported a high incidence of symptoms, mostly related to the abdomen and gut, for months before the diagnosis. Gynaecological symptoms were much less common (Cancer 2000;89:2068-75). Women ignored their symptoms for a median of 2-3 months before finally presenting to a doctor.

An entomologist from California writes that brown recluse spiders are unfairly blamed for inflicting necrotic bites on the state's inhabitants. Only 10 of these spiders have been spotted there since records began (Western Journal of Medicine 2000;173:357-8). Ticks, fleas, and bed bugs are far more likely to bite people than recluse spiders, which are imported by accident from the south eastern states where they live. Doctors should exclude well established causes of skin necrosis, including herpes zoster, staphylococcal skin infections, and syphilitic chancre, before implicating arthropods at all.

Next time you have a few pints and feel like challenging someone to an arm wrestle be sure to pick an opponent with a shorter forearm, thereby giving yourself that essential moment-torque advantage. A chartered surveyor from north west London challenged a man with longer forearms, who snapped his humerus only 10 seconds into the competition (British Journal of Sports Medicine 2000;34:461-2). The surveyor was losing at the time, but only by about 10 degrees off the neutral upright position.

Two papers by the same authors test the anaesthetic action of topical amethocaine gel in newborn infants (Archives of Disease in Childhood Fetal and Neonatal Edition 2000;83:F207-10). Their randomised trial shows that it works better than placebo, substantially reducing infants' reaction to venepuncture. The second study finds that it has an analgesic action after only half an hour's contact with the skin, although the analgesia lasts longer if the gel is left on for an hour. Amethocaine gel may be a better option than the traditional alternative, EMLA, which has been disappointing in small infants.

When antarctic seal pups started dying at twice the normal rate Swedish researchers suspected that human activity in the region was to blame. They went to Bird Island in Georgia to investigate and found a large increase in the number of fur seals carrying salmonella species (Epidemiology and Infection 2000;125:257-62). The researchers are unsure where the salmonella came from, but examination of the different serotypes suggests that the pathogen has only just arrived in the region.

Two thirds of Canadians take too little exercise, and the resulting ill health costs over $2 billion a year—2.5% of Canada's total health care costs (Canadian Medical Asssociation Journal 2000;163:1435-40). Increasing activity levels by 10%, a government target, would save about $150 million a year, say researchers from Toronto, partly by preventing a third of deaths from coronary artery disease, colon cancer, and type 2 diabetes.

Encouraged by their success in a pilot study, researchers from Japan conducted a large randomised trial of intrathecal steroids in patients with post-herpetic neuralgia (New England Journal of Medicine 2000;343:1514-9). It worked. Patients given intrathecal methylprednisolone and lignocaine took 70% fewer analgesics in the four weeks after treatment. Symptoms did not improve in controls given lignocaine alone or no treatment. Pain relief in the intervention group lasted throughout the two years of follow up and caused few side effects—a remarkable result, say the authors.

A 50 year old woman had bilateral ventriculoperitoneal shunts inserted to relieve hydrocephalus caused by a colloid cyst in the third ventricle. Three weeks later she presented as an emergency with headache, vomiting, and drowsiness. A plain skull radiograph and computed tomography of the brain showed pneumocephalus. The shunts were removed and she made a good recovery. Thinning of the skull secondary to chronic raised intracranial pressure allowed air to enter when the pressure was relieved by drainage.

Kanna K Gnanalingham, specialist registrar, Andre DesEtage, senior house officer, Robert Bradford, consultant, department of neurosurgery, Royal Free Hospital, London NW3 2QG

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Metal allergy may contribute to restenosis in some patients who have had coronary angioplasty with placement of a stainless steel stent. Preliminary data reported in the Lancet shows a link between allergy to metals, particularly nickel and molybdenum, and stenosis in the stent six months after insertion (2000;356:1895-7). The researchers say their findings are significant enough to prompt allergy testing for all patients with stenosed stents if a repeat procedure is planned.

American doctors are notoriously bad at asking for help from other doctors. Surgeons, hospital physicians, and pathologists were the worst offenders in one survey (Archives of Internal Medicine 2000;160:3209-14). Six years later, doctors without a “regular source of care” were more likely than others to have missed out on preventive measures such as screening for prostate and breast cancer and vaccination against influenza. Doctors in this group were also more likely to be fatalistic about their health.

Law abiding Americans who carry guns often argue that they would use a gun only in self defence. Not all of them know how to defend themselves legally, however (Injury Prevention 2000;6:263-7). A panel of judges examining responses to two national surveys declared most reports of self defence illegal—shooting at the ground to scare off trespassers, for example. In these surveys, guns were used three times more often to threaten or injure than to defend victims against attack.