Minerva: May 2000
Facing certain death from an unresectable and aggressive lung
tumour, a 47 year old woman from Florida embarked on a cruise and a
course of germanium, a controversial alternative treatment for cancer
(Chest 2000;117:591-3). Her tumour and her symptoms
disappeared, and she remains well four years after diagnosis.
Oncologists are baffled. They had definitive histology of a spindle
cell carcinoma, so must choose between two equally implausible
explanations: spontaneous remission of the tumour or a real treatment
effect from a toxic elemental metal that has failed to work in clinical
trials of breast, prostate, and renal cancers. It's unlikely we will
ever know.
Plain skull
radiographs should be abandoned as a screening tool for intracranial
bleeding in people with a mild head injury, write Dutch investigators
after their meta-analysis showed that it has a sensitivity of only 38%
(Journal of Neurology Neurosurgery and Psychiatry
2000;68:416-22). The low sensitivity means that a normal skull
radiograph does not rule out serious internal bleeding, which occurs in
about 8% of cases. The cornerstones of management are clinical triage,
observation, and computed tomography for those at high risk, the
authors say.
An
observational study in Thorax finds a link between
paracetamol consumption and asthma in adults (2000;55:266-79). It's
possible the link is causal, but prospective trials will have to rule
out other explanations first, including the possibility that people
with asthma take more paracetamol because they get more headaches, or
that people with asthma use paracetamol when others might use aspirin
and other non-steroidal anti-inflammatory drugs. In the meantime, a
commentary in the Pharmaceutical Journal (2000;264:459)
advises people with asthma who are heavy users of paracetamol to cut
down.
Dogs and cats
travelling to Britain can now fly on British Midland into Heathrow,
where they will be reunited with their owners at the airport's new
animal reception centre (Veterinary Record 2000;146:358).
British Midland, the first airline to join Britain's new pets travel
scheme, carried its first doggie passenger on 19 March in a specially
heated and ventilated part of the hold. Reassuringly, the airline
insisted that the dog's container was labelled "This way up."
Last week,
scientists caught their first glimpse of marijuana's anticancer
properties in real tumours (Nature Medicine 2000;6:313-9).
Encouraged by experiments in cell cultures, a team from Madrid tested
the active ingredient in marijuana against malignant gliomas in rats.
The cannabinoids shrunk some tumours and slowed growth in others, but
only when applied directly via an intracerebral catheter. The
scientists hope their findings will eventually be useful against human
disease. Median survival for patients with malignant gliomas remains
depressingly brief even after aggressive treatment.
As an
unusually short person-5 feet and one eighth of an inch on a good
day-Minerva was bound to notice a paper asking "Does height
influence progression through primary school grades?" An oblique look
at height and age data in nearly 3000 children suggests that it does,
but only in boys (Archives of Diseases in Childhood
2000;82:297-301). Boys who repeat a year at primary school seem to
be shorter than the others, possibly because taller boys are allowed to
progress so they won't stand out in a younger class.
Scottish
people must be used to hearing about their increased risk for
myocardial infarction. The good news is that, in young women at least,
they are more likely than English people to survive the experience
(Journal of Epidemiology and Community Health
2000;54:293-8). The finding, which came out of an analysis of
government statistics, was a surprise to researchers, who attribute it
to factors operating before the patient gets to hospital.
Love it or
loathe it, email is here to stay. Learn to use it creatively, writes a
science management consultant, and watch your scientific output go up
(biomednet.com/hms beagle/75/notes/adapt). It seems to work
particularly well for women. Remember, though, that email is quick and
easy, but it's also the fastest way to get ignored if your message is
buried beneath 50 others in the same inbox. Use it in tandem with
other, more expressive media, he says, such as speech.
Evidence is
mounting that non-steroidal anti-inflammatory drugs can precipitate
heart failure, particularly in people with pre-existing heart disease
(Archives of Internal Medicine 2000;160:777-84). In a
case-control study from Australia, patients admitted with heart failure
were twice as likely as controls to have taken these drugs in the week
before admission. The odds ratio increased to 10.5 for patients with a
history of heart disease on their first admission with heart failure.
The strength of the association increased with the dose taken,
suggesting that the effect is causal. The authors estimate that these
drugs could account for up to a fifth of hospital admissions for heart
failure.
The
plant family Euphorbia is well known for its irritating sap
(Minerva, February 12). One species, however, has attracted the
attention of urologists looking for new treatments for detrusor
hyperreflexia (Urology News 2000;4:14). Randomised trials
are under way of resiniferatoxin, an active ingredient from the sap of
Euphorbia resinifera, which grows in the Anti-Atlas
mountains of Morocco. King Juba the Second of Mauretania was the first
to notice the plant's medicinal properties more than 2000 years ago.
Today, urologists hope it will inhibit reflex bladder contractions when
put directly into the bladder.
This 38 year old man attended his local hospital with an
apparently minor head injury after a work colleague dropped a nail gun
on his head. His small scalp wound was dressed, and he was discharged.
Ten days later he had a grand mal fit. On examination he had no
neurological deficit but a positive Babinski's sign on the left. A
computed tomogram of the head showed a 7 cm nail embedded in the right
cerebral hemisphere. It was removed via a burr hole, and he made a full
recovery.
Arup Ray, registrar,
Aloke Sen, senior house officer,
A T King, consultant,
John Thorne, registrar, department of neurosurgery, Hope Hospital, Manchester M6 8HD
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studentBMJ 2000;08:131-174 May ISSN 0966-6494
