Minerva: August 2002

A young woman aged 16 presented with iron deficiency anaemia and a palpable mass the size of an orange in the left upper quadrant of her abdomen. An ultrasound scan showed a distended abdomen with no abnormality. This led us to investigate further with a barium meal (top), which indicated a trichobezoar (hair ball of the stomach). The trichobezoar formed a cast of the stomach and was removed at laparotomy (bottom). The patient made a good recovery and was discharged from the clinic four months later.

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Anorexia nervosa is spreading frighteningly in Western countries. Its classified as deliberate weight loss and is a progressive “pursuit of lightness.” Looking at contexts where lightness is celebrated—in music, literature and the arts—one writer suggests anorexic behaviour is much more than a pattern of psychiatric symptoms. Instead, he says, it should be thought of a meaningful behaviour expressing ethical values deeply rooted in Western culture (Medical Humanities 2002;28:3-8).

Haemodialysis patients say they notice poor saliva production, which can be distressing. In an effort to identify the most important factors associated with stimulated salivary flow, 50 patients were allocated to either long duration dialysis or short duration dialysis and asked to chew paraffin wax. The researchers found no difference between the two groups in terms of the duration of their dialysis treatment, but salivary flow rates increased among those who smoked (Nephron 2002;91:210-14).

New techniques bring short term complications that should settle down with experience. The use of tension free vaginal tape to support the urethra is gaining favour as a method to reduce stress incontinence in women. The overall subjective success rate in one Swedish case series was 88%, but 15% of women developed bladder perforation and urinary retention early on, which were put down to inexperience of individual surgeons (British Journal of Obstetrics and Gynaecology 2002;109:566-9).

To test or not to test? Regardless of the approach used, theres no consensus yet on the cost effectiveness of screening for prostate cancer. But one thing is clear—prostate cancer is an expensive disease. The direct financial burden of prostate cancer in California in 1998 was estimated by the Institute for Health and Aging to be $180 million. Indirect costs due to lost productivity from premature death came in at another $180 million (Cancer 2002;94:2906-13).

Once a cheat, always a cheat? Psychologists at one university found that when referees were told that a football team had a reputation for aggressive and foul play, they were more likely to give red and yellow cards against that team when a player committed a foul (The Psychologist 2002;15:301).

In mice, the gene for HIF-2α pushes up production of vascular endothelial growth factor, which in turn improves the maturation of their lungs by producing surfactant. Without the gene, preterm mice get fatal respiratory distress syndrome). Instilling the growth factor to preterm mice while they are in the womb or at birth stimulated the conversion of glycogen to surfactant, protecting them from respiratory distress syndrome. Scientists think the growth factor may prove equally useful in preterm infants (Nature Medicine 2002; http://dx.doi.org/10/1038/nm721).

Heres a snippet from the South African Medical Journal (2002;92:332) from 100 years ago. A “provision ... stating that a chemist is no longer allowed to practise medicine any more than any other unqualified man, is urgently needed ... Scores of chemists undertake continuous treatment of chronic as well as acute serious cases, to such an extent that in many towns the doctor is practically a consultant.”

World Cup fever may have abated, and as Minerva was as infected as everyone else her attention was drawn to a small study in the British Journal of Sports Medicine (2002;36:218-21. It found that high intensity, endurance, interval training can be carried out in a more soccer specific way than plain running, and that heart rate is a valid and reliable indicator of oxygen uptake in small group play as well as on the dribbling track.

Giving antibiotic prophylaxis before surgical procedures is not a new idea, but applying the drugs to the nose is a little more novel. For the 3864 patients enrolled in a randomised double blind placebo controlled trial, prophylactic intranasal mupirocin didnt significantly reduce Staphylococcus aureus at any of the surgical sites investigated, but it did significantly decrease the rate of all hospital acquired S aureus infections among the patients who were carriers of the organism (New England Journal of Medicine 2002;346:1871-7).

A disproportionately high percentage of people in smoking cessation programmes have a lifetime history of major depression. A study of what happens to peoples mood while trying to give up smoking identified two main symptom patterns: “increasers” and “decreasers”: 40% fell into the group whose depressive symptoms increased while quitting, while 47% found their depressive symptoms improved. Not surprisingly, the abstinence rate among the increasers was poor (Journal of Consulting and Clinical Psychology 200270:356-61).

Long life begets long life, and siblings of very old people live longer than the general population. Analyses of data collected from 444 families in which at least one member lived beyond the age of 100 found that sisters of centenarians had half the risk of dying at any age and so (apart from during the teenage and young adult years) did brothers. The stability of the survival advantage over ones lifetime suggests that genetic influences are stronger than environmental influences (Proceedings of the National Academy of Sciences 2002;99:8442-7).