Minerva: June 2002

A 28 year old patient with a history of personality disorder and deliberate self harm presented to casualty having swallowed a radio aerial. Three weeks before this, he had swallowed more objects including stationery.

The patient was asymptomatic and an abdominal x ray showed air throughout the bowel, the aerial in four sections, and pens in the region of the stomach. No foreign bodies were seen in either the small or large bowel. The patient had to undergo a laparotomy as endoscopy was unsuccessful. Foreign bodies retrieved included two pens, six sections of a radio aerial, a pen refill, and a pencil.

Ingestion of foreign bodies is uncommon when done with the intent to cause self damage; liquids such as caustic agents, detergents, poisons, etc, are more common.

Corneal tattoos provide an interesting solution for disfiguring corneal scars. Varying shades of drawing ink can be put into the anterior corneal stroma by using punctures made by a conventional spatula needle. For a week after the operation patients notice a moderate sensation of a foreign body and have conjunctival redness, but they seem happy with the results (British Journal of Ophthalmology 2002;86:397-9).

Oxidative stress increases significantly in people undergoing dialysis and is a risk factor for accelerated atherosclerosis. Korean doctors devised a randomised controlled study to see if hormone replacement therapy had any impact on oxidative stress and antioxidant capacity in 70 postmenopausal women undergoing dialysis. They found that hormone replacement therapy had a favourable effect, concurring with its effects in the general population (Renal Failure 2002;24:49-57).

Minerva recalls the days when some junior doctors ill advisedly used skateboards to navigate the long corridors of hospitals. Now its scooters. A randomised crossover experiment to see if dashing with scooters to in-hospital emergencies offers any benefits over conventional running found that riders pulse rates were significantly lower on arrival. Manual dexterity and response times, however, were not improved (Resuscitation 2002;52:293-6).

A writer in Surgery (2002;131:228-9) recalls a novel way of trying to preserve donated kidneys before transplantation. Reading the contents label on a coffee creamer carton, a colleague wondered about the purpose of the monoglycerides and diglycerides it contained. On hearing they were emulsifiers to help keep lipid materials in solution, he tried using coffee creamer to solubilise the fats in the kidney perfusion solution. Sadly (but perhaps not surprisingly) the attempt failed.

Alzheimers disease and amyloidosis share a common molecular foundation: protein misfolding. Scientists took harmless proteins from cattle and bacteria and pushed them into new shapes. The new forms made the proteins highly toxic to cells in culture before they turned into large insoluble clusters. Finding ways to break up rogue proteins before they aggregate could prove critical (Nature 2002;416:507-11).

Whats the first bit of the brain to go in Alzheimers disease? Not surprisingly, three dimensional magnetic resonance mapping of what areas of brain atrophy over time has show that the parts of the brain involved with memory have rapid tissue loss early on. The parts of the brain implicated in functions such as speech and perception take longer to atrophy. These observations will provide a useful tool for assessing the efficacy of potential treatments (Proceedings of the National Academy of Sciences 2002;99:4703-7).

Women with irritable bowel syndrome say their symptoms often get worse around the time of their period. A small study of women with the syndrome found that their rectal sensitivity changes around the time of menstruation, whereas in healthy women it does not. The authors say these cyclical changes suggest that women with irritable bowel syndrome respond differently to changes in levels of sex hormones (Gut 2002;50:471-4), and that this may shed light on some of the mechanisms of visceral sensitisation.

For reasons that are largely unknown, endometriosis causes impaired fertility, and surgical removal improves the situation. Despite attempts to surgically clear endometriosis, most women end up falling into one of two groups—complete and incomplete surgery. Japanese surgeons found that complete clearance offers a better fertility outcome, and have developed novel laparoscopic techniques to clear the deeper pelvic and rectal areas, which are often out of reach (Gynecologic and Obstetric Investigation 2002;53(suppl l):12-8).

Paternal, but not maternal, longevity seems to protect men against coronary disease. A Swedish prospective follow up study of over 6000 men aged 51-59 has found that their death rate from heart disease decreased continuously with increasing age of the father, while the effect of an ageing mother was less striking. The relation holds independent of cardiovascular risk factors (including a history of myocardial infarction) among the fathers (Journal of Internal Medicine 2002;251:258-67).

The feasibility and cost effectiveness of school health screening programmes are hotly debated. Some countries have stopped these altogether. Adolescent screening for orthopaedic problems in one Israeli high school identified previously undiagnosed abnormalities (especially spinal deformities) in 14.8% over five years. As osseous maturation is almost complete in 14-18 year old girls, the authors say that screening is ideally carried out between the ages of 10 and 12 (Public Health 2002;116:30-2).

Kings College Hospital in London runs Europes largest liver transplant programme and has recently celebrated its 2000th liver transplant. The unit is pleased to announce that the heaviest liver removed weighed 10 kg, the most blood lost during a transplant is 160 litres, the longest current survivor was operated on 25 years ago, and the longest operation took 16 hours.

The Cremation Society of Great Britain has announced that the 2002 cremation conference will take place in Torquay in July. Minerva was amused to read that the conference hotel has a “cliff top position” and that one of the talks to be given by a social anthropologist is entitled “Where have all the ashes gone?”

An article in the Times (28 September 1982) explained the reason why contraceptives were often ineffective in Asia. Apparently, remote Asian villagers were shown how to wear condoms by demonstrating on a bamboo pole. It turned out that women were still getting pregnant because men wore the condoms on a finger or put them on bamboo poles. They were also boiled or swallowed by some people. The common pitfall with the pill was that men were taking it, instead of women.