Minerva: July 2001
Sir Douglas Black, known for the 1980
"Black report" on equalities in health,makes
the point that what one can do may depend
on available resources.Watching a man give
another man an intravenous injection in
Bengal during the war, Sir Douglas asked
what he was doing. "Giving him calcium"
was the reply. Pursuing the matter further,
Sir Douglas asked, "Why?" He received the
conclusive answer: "Calcium is what I have
got" (SK Goolamali. Twice Daily after Meals.
London: MediDerm, 2001).
Using a protein "glue" and short, synthetic,
single strands of DNA, scientists at the
National Cancer Institute have invented a
new system of molecular ``cutting and
pasting" for repairing intracellular DNA.
Their method can apparently remove single
base mutations and longer sections of rogue
genetic material, and it should provide interesting new ways of studying the genomes of
various organisms (Proceedings of the National
Academy of Sciences 2001;98:67426).
Unhappy doctors thinking about leaving the
profession should reconsider. Work related
stress is positively associated with high blood
pressure, according to a retrospective cohort
study of over 2300 adults in California. Taking baseline psychosocial, behavioural, and
demographic factors recorded in 1974 and
performing fancy mathematics on them 20
years later, the researchers identified job
insecurity, unemployment, and low self
reported job performance as the top predictors of hypertension in men. Low status
work independently predicts hypertension
in women (Archives of Internal Medicine 2001;
151:13418).
Golfing history was made last week when
the US Supreme Court ruled that a disabled
professional golfer can ride around golf
links in a cart, rather than be made to walk
the courses. Citing the Americans with
Disabilities Act, the hearing ended the
golfer's four year battle by finding that there
is nothing fundamental about the requirement to walk around a golf course. The rule
can be waived in individual cases, the court
concluded, if walking is "beyond their capacity" (New York Times 30 May).
Caesarean section rates are rising in the
West. In a questionnaire survey of 278 Finnish women and their partners, psychologists
identified several factors that increase
pregnancy related anxiety and fear of
vaginal delivery (British Journal of Obstetrics
and Gynaecology 2001;108:4928). These
include general anxiety, neuroticism, vulnerability, relationship problems, and lack of
social support. Rather optimistically, the
authors hope that by offering special family
classes to women who seem unusually
anxious, the number of requests for caesarean sections will fall.
A 16 year old girl cut her knee on coral while in
Egypt. The representative of the holiday company
squeezed lime juice onto the inflamed area to relieve
the irritation, and the girl spent the rest of the day
sunbathing. She went on to develop acute erythema
and blistering extending down the leg, which
resolved leaving florid postinflammatory
hyperpigmentation. Lime juice contains psoralens
that can photosensitise the skin, leading to
phytophotodermatitis. It may touch the skin by
accident or be applied intentionally, as in this case.
T A Chave, specialist registrar,
R H Thomas, house officer,
J E Osborne, associate specialist,
R D R Camp, professor, department of dermatology, Leicester Royal Infirmary, Leicester LE1 5WW
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consent to publication from the patient.
Minerva watched surgeons deal with anal
fissures as a house officer and is interested in
the use of glyceryl trinitrate ointment to
bring about chemical sphincterotomy.
Although promising, this approach has
been disappointing, with undesirable side
effects. Assessing topical 2% diltiazem in 71
patients with active fissures, surgeons report
in the
British Journal of Surgery (2001;88:
5536) that 75% healed within three months
of continuous application, and many nonresponding fissures healed after extended
use. Participants reported few side effects -
one headache and four cases of dermatitis -
suggesting that compliance with diltiazem
may be better.
As doctors we're not very consistent about
the advice about driving we give to patients
who've sustained traumatic head injuries.
Interviews with 563 patients found that
many of those who had returned to driving
reported problems with vision, coordination, anger, and irritability as often as those
who stopped driving. They also admitted
that they used common sense or got advice
from relatives, rather than their doctors,
about their ability to drive safely (Journal of
Neurology, Neurosurgery and Psychiatry 2001;
70:7616). More stringent medical assessments are clearly needed.
Fatty fish such as salmon, mackerel, and herring are high in omega3 fatty acids and are
standard fare in Scandinavia. Epidemiologists used data from a large prospective
Swedish twin study with a follow up of more
than 30 years to show that men who eat no
fish are up to three times as likely to develop
prostate cancer than men who consume
large quantities (
Lancet 2001;357:17656).
Inhibition of arachidonic acidderived
eicosanoid biosynthesis is one proposed
mechanism of protection.
A 45 year old man presented with a 12 month
history of left sciatic nerve irritation. Lumbar spine
imaging showed degenerative changes but no nerve
root compression. Nine months later the patient,
who remained symptomatic, developed a lump in the
posterior aspect of the distal third of his left thigh. A
magnetic resonance scan of his thigh showed a
lesion within the sciatic nerve. The lesion was
excised; histological examination showed that it was
a benign neurilemmoma. The patient made an
uneventful recovery. Sciatic nerve tumours are rare,
but this case illustrates the need to consider
compression of the sciatic nerve at all levels.
P McArthur, specialist registrar,
M Murison, consultant, department of plastic surgery, Morriston
Hospital, Swansea SA6 6NL
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studentBMJ 2001;09:217-260 July ISSN 0966-6494
