The effects of oral steroids on bone density are well documented, but it now seems that inhaled steroids may also put bones at risk. A three year prospective study of 109 premenopausal women with no known con? ditions that cause bone loss, and who used inhaled steroids for their asthma, has found a small but significant dose related reduction in bone density at the hip and trochanter. Serum and urine markers did not predict the degree of bone loss (New England Journal of Medicine 2001;345:941-7).

Lots of people take statins to lower their cholesterol levels, despite being at relatively low risk of a fatal coronary event. A group of pharmacologists has calculated that the risk of mortality from the drugs alone may be 1% in 10 years of use. This, they suggest, would be sufficiently large to negate the beneficial effect on coronary related mor? tality in people with a risk of less than 13% over 10 years (British Journal of Clinical Pharmacology 2001;52:439-46).

Millions of years ago, an Australian desert tree called Acacia victoriae developed “avicins” to protect itself from predators. These killed by inducing apoptosis or by reducing oxidative stress in the plant. Both actions are suppressed in cancer develop? ment. Giving avicin to mice before exposing them to carcinogens resulted in fewer than 30% of them developing a malignant skin cancer. Those that did develop cancer had 90% fewer tumours than in the untreated mice (Proceedings of the National Academy of Sciences 2001;98:11551-6).

General surgeons are unsuited to looking after head injuries in hospital, according to a recent report. Care should be handed over to neurosurgeons and emergency specialists. A survey sent to 265 accident and emergency departments in Britain and Ireland (80% response rate) found that one third of departments already take on the role of looking after these patients and one third would take on the role if training and resources are provided. The remainder said they were unwilling to take on such responsibility (Emergency Medicine Journal 2001;18: 352-7).

Head injuries also feature in the latest edition of Journal of Neurology, Neurosurgery, and Psychiatry (2001;71:436-40). A Danish population study looking at rates of suicide among patients who have had a traumatic brain injury suggests that the increased risk of suicide in people with mild injuries may result from associated risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among more serious cases implicates the direct consequences of the injuries themselves.

An outbreak of legionnaires' disease occurred a year ago in a small town in northern Portugal, coinciding with the local annual festivities. Legionella pneumophila was not isolated from any of the suspected sources. Evidence from a case?control study showed that an aerosol produced by a decorative fountain in the main square during a rock concert was the likely vehicle. The prevalence of smoking was higher among cases than controls (Eurosurveillance 2001;6:121-4).

The risk of developing hay fever, eczema, and atopy is reduced if you have older siblings. But what if you are a twin? A birth cohort analysis of almost 30 000 children concludes that being a member of a multiple birth protects against all of these conditions and also against asthma diagnosed after the age of 2. The incidence of early asthma, however, rises when there are older siblings (Thorax 2001;56;758-62).

American scientists have come up with the theory that some types of antidepressant may slow down Parkinson's disease in its early stages (Science 2001;293:2465-70). Having discovered a compound that blocks dopamine transport, allowing the neuro? transmitter to build up rather than leak out between neurons, they say that similar compounds (many of which are used for treating depression) may have the same effect.

In the light of recent international tensions, Minerva was interested in the description of a new non?lethal weapon that has been developed and unveiled in the United States. The vehicle mounted active denial system (VMADS) utilises part of the electromagnetic spectrum, penetrates the skin to a depth of about 4 mm, and makes water molecules in the skin vibrate to produce heat and discomfort. Its aim, according to one reporter, “is to influence motivational behaviour” (Medicine, Conflict and Survival 2001;17:175-9).

Respiratory physicians seem to be divided about whether the bell or the diaphragm of a stethoscope should be used to examine the chest. An editorial in this month's Postgraduate Medical Journal (2001;77:617?20) concludes that the bell can be used for listening to normal lung or to detect abnormal lung. The diaphragm can be used to detect and characterise abnormal lung. You should ideally be young and apply the stethoscope firmly (or listen with your ear, ensuring first that your defence union subscription has been paid).

This is the face of a 69 year old man who was noted to have marked facial pigmentation when he was admitted to hospital with chest pain. He had been given amiodarone (200 mg daily) at another hospital 10 years earlier for atrial tachyarrhythmia. Amiodarone is described as causing blue-grey pigmentation in 2-26% of patients, particularly at higher doses. The discolouration recedes or disappears some 12-18 months after the drug is discontinued. One-off topical treatment with Q-switched ruby laser therapy may also produce resolution within a few weeks and is useful in patients who must continue taking the drug.
Davis Maxwell, consultant respiratory physician,
Neil Sulke, consultant cardiologist, Eastbourne NHS Trust, Eastbourne BN21 2UD

This hand belongs to a 79 year old man who attributed the cutaneous changes to purpura, secondary to long term corticosteroid therapy for rheumatoid arthritis. The hyperpigmentation in this case was due to minocycline, which he had been taking for rosacea. It is recognised by dermatologists as a side effect of treatment and is caused by deposition of iron in the dermis. Such patients should be advised to stop taking minocycline, although the pigmentation may not resolve completely.
Richard Goodwin, registrar,
Colin Long, consultant, department of dermatology, Llandough Hospital, Cardiff CF64 2XX

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