A man aged 78 presented with an acute onset of thoracic kyphosis over a period of 10 weeks. During this time he found walking to be progressively more difficult, and he also had difficulty driving his car as he was unable to look far enough straight ahead. The differential diagnosis on magnetic imaging included the possibility of a neoplasm, but further investigations confirmed osteoporotic collapse. Rarely, osteoporosis can present as an acute onset of kyphosis.

Opioid addicts account for around a third of new cases of AIDS reported in the United States. Needle sharing cannot explain the high levels of infection in people who are addicted, says an article in the Journal of Infectious Diseases (2002;185:1826-9). It offers another possible explanation, reporting research on Rhesus monkeys which showed that those given opioids long term were more susceptible to simian immunodeficiency virus than those not given the drugs.

Scabies is known to be a pointer to the diagnosis of AIDS, and the association has been studied further in Brazil (AIDS 2002;16:1292-3). Severe, crusted scabies and Norwegian scabies should both arouse suspicion of retroviral infection with HIV or HTLV-1, or both.

Visitors to Mexico expect to get travellers diarrhoea, but they may not realise that one source of the infecting bacteria may be the sauces found on tables in most restaurants. Tests on green and red sauces in Guadalajara (Annals of Internal Medicine 2002;136:884-7) found that 47 of 71 specimens were contaminated with Escherichia coli. As a control, 25 specimens of sauces from restaurants in Houston, Texas, were tested, and only 10 were found to be contaminated. The level of bacterial contamination was, moreover, 1000 times higher in the infected specimens from Mexico than in those from Texas.

Orthodox Jewish law permits abortion only when fewer than 40 days have passed since conception. This creates problems, as the optimum time for chorionic villus sampling is accepted as being 10-12 weeks—but in practice the outcome is not too bad. A report in the American Journal of Obstetrics and Gynecology (2002;186:1133-6) gives the results in 82 orthodox Jewish patients who chose to have the test done at less than 63 days gestation, accepting the increased risk of adverse effects. The procedure was successful in all cases, and only three women later miscarried.

Inits 80 year history, BCG vaccination against tuberculosis has beengiven to more people than any other vaccine—despite its failure to give protection against pulmonary tuberculosis in adults. A note in JAMA (2002;288:35) reminds us that tuberculosis still claims two million lives a year. The World Health Organization has pushed back its target date for 70% detection and 85% cure until 2005.

Despite the consistent association between a light to moderate intake of alcohol and a reduced risk of major coronary heart disease events virtually all authorities recommend that those people who do not drink should not take up drinking. Thiscomment is prominent in the discussion of findings showing that light to moderate drinkers are at reduced risk of developing diabetes (Journal of Epidemiology and Community Health 2002;56:542-8). For the cautious clinician the clinching argument is the same: drinking may reduce the risks of heart disease and diabetes but it does not reduce overall mortality.

Living donor liver transplantation is now established as a source of high quality organs, but the procedure is demanding for the donors. Nevertheless, a follow up of 24 donors one year after they had had the right lobes of their livers removed found that 21 had found the decision to donate either “easy” or “not very difficult,” and all but two said they would donate again (Transplantation 2002;73:1799-804). There were some downside findings: on average, donors needed nine weeks off work to recover, and nine had had financial problems as a result of their donation.

In her long career Minerva has witnessed a good many 180 degree turns in the management of common disorders. One of the most dramatic has been the abandonment of bed rest as a treatment for low back pain and its replacement by early activity and exercise. Some doubts persist about the value of exercise, but experience with athletes has shown (Southern Medical Journal 2002;95:642-6) that active participation by the patient is crucial for the success of exercise, which should be started early and be progressive in intensity. In other words, the patient has to want to get better fast.

It may not be too remarkable that horse riders are more likely to be injured than motorcyclists, but Minerva was surprised to read in Spinal Cord (2002;40:267-71) that a motorcyclist may expect a serious incident once in every 7000 hours on his or her bike, whereas a horse rider may expect one every 350 hours. The British Horse Society is aware of around eight incidents a day, and one third of these result in head injuries.

The surgical correction of myopia is now routine, but no consensus exists for patients with moderate hypermetropia who want a surgical solution to their visual problem. A panel of expert opinion convened by the British Journal of Ophthalmology (2002;86:815-22) concluded that the best surgical solution is still evolving and that for younger patients one important option is to wait for further developments.

Hepatitis C affects as many as 170 million people world wide, and most of these have persistent infection and chronic liver disease. Losing weight seems to be an effective treatment (Gut 2002;51:89-94). Liver biopsies on 19 patients who lost an average of 6 kg showed a reduction in steatosis, an improvement in fibrosis, and a shift towards normal in liver enzymes.

People with fungal infections of the toenails are unlikely to get better if given only topical treatment. A review of research reports (Archives of Dermatology 2002;138:811-16) found clear evidence that the most effective regimen was oral terbinafine for three months. There was one caveat: most of the published research was funded by the pharmaceutical industry.

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