The challenge to clinicians caring for men with carcinoma of the prostate is to separate out those with low risk cancers who can simply be watched from those with high risk tumours who need early aggressive treatment. One useful measure (Mayo Clinic Proceedings 2001;76:571­2; 576­81) is the doubling time for the concentration of prostate specific antigen. It seems especially helpful in men whose disease has recurred: a long doubling time is associated with local recurrence whereas a short doubling time suggests systemic recurrence.

Soft drinks are often full of sugar, but cola drinks carry an additional health risk. A report in the Internal Medicine Journal (2001; 31:317­8) describes a patient with chronic caffeine toxicity manifesting as hypokalaemic myopathy. The patient presented with a year's history of muscle weakness, nausea, vomiting, diarrhoea. and weight loss. She admitted drinking 8 litres of cola every day for the past two years, amounting to at least 1 g of caffeine daily. Toxicity can occur at levels as low as 500 mg a day.

A 46 year old mechanic said, while undergoing magnetic resonance scanning of his knee, that he felt a foreign body in his right eye. The procedure was abandoned and he was referred to an ophthalmologist. Examination showed a very small metallic foreign body on his right inferotemporal conjunctiva; it was removed easily at the slit lamp. The foreign body was not visible on plain orbital radiography performed beforehand. Scanning was subsequently completed without further complication. This case highlights potential problems facing patients who undergo magnetic resonance imaging and indicates that plain films are not sufficient to exclude ocular foreign bodies.

Clifford R Weir, specialist registrar in ophthalmology,
A G Shabanni, specialist registrar in radiology,
P Duffy, consultant radiologist,
W Wykes, consultant ophthalmologist, Southern General Hospital, Glasgow G51 4TF

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Several of Minerva's young relatives have caught chicken pox this summer—and been given the standard advice that infection in infancy is a good thing. Complications may occur, however, and a review in Archives of Disease in Childhood (2001;85:83­90) argues convincingly that vaccination is both safe and cost effective. Even the litigious North Americans recommend use of the vaccine, as does the World Health Organization.

The International Shark Attack File, administered by the American Elasmobranch Society and the Florida Museum of Natural History, has data on over 3000 attacks by sharks (Injury 2001;32:445­53). Of the 370 species of shark only 32 have been documented as having attacked man, but even sharks as small as 45 cm may be dangerous. Around 70­100 attacks occur worldwide each year, with 5­15 deaths. Bees, wasps, and snakes are responsible for many more deaths.

Medical opinion on the effects of unilateral cryptorchidism has changed. A symposium reported in Hormone Research (2001;55:1­ 56) warns that the contralateral testis is usually also abnormal but that early treatment with luteinising hormone releasing hormone analogues is able to induce an increase in the numbers of germ cells and their differentiation and so to enhance later fertility.

Sexual activity in elderly people has been boosted by the availability of hormone replacement treatment for women and effective treatment of erectile dysfunction in men. A study of elderly patients who referred themselves to a genitourinary medicine clinic (Sexually Transmitted Infections 2001;77:289­91) found that the men mostly wanted a check after an extramarital or casual sexual liaison whereas the women were mostly wanting help with symptoms causing difficulty with their regular partners. The authors say that clinics have a valuable role to fill in this age group.

A survey in schools in southern Georgia and Tennessee was completed by all 674 athletes questioned. Three quarters of them were aware that creatine might enhance their per­ formance and 16% had used the supple­ ment (Southern Medical Journal 2001;94:608­ 12). If this substance is to be used, say the authors, it should be given under medical supervision.

Interstitial cystitis has become more widely recognised through use of the term “painful bladder syndrome” but its cause and its treatment remain uncertain. Many patients seem to respond well to cimetidine by mouth (British Journal of Urology Inter­ national 2001;88:183­6), but the benefit it gives cannot be explained by an action on histamine­like immunoreactivity. The drug may have a local anaesthetic or an immunosuppressive action.

Runner's anaemia is a rare diagnosis; this haemolytic anaemia is due to the mechani­ cal damage to red cells that results from the pounding of the feet on the road surface. A case report in JAMA (2001;286:714­6) describes a woman of 41 who complained of chronic fatigue and was found to have a mild haemolytic anaemia. She had been running 8 km every other day and agreed to stop running for a month. Her packed cell volume rose slightly—enough to convince her of the diagnosis but not to control all her symptoms.

A 59 year old woman underwent colonoscopy for a family history of carcinoma of the colon. An incidental finding was that the vessels in the rectal mucosa had an appearance of “silver wiring”—which is usually noted at fundoscopy, and which was subsequently found in this patient. Investigations confirmed a diagnosis of essential hypertension and treatment was started.

T Satyadas, research fellow, university department of surgery, Royal Free Hospital, London NW3 2QG,
C A Akle, consultant surgeon, The London Clinic, London W1N 2DH

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