Minerva

Transplantation of the pancreas in patients with diabetes who are undergoing kidney transplantation leads to an improvement in their hypertension (Circulation 2001;104:563-9). This improvement is not seen in patients when only the kidneys are transplanted. The report argues that these results—in 111 patients undergoing double transplantation—underscore the importance of the metabolic changes associated with diabetes in causing hypertension in patients with diabetic nephropathy

Occult metastatic cells in the bone marrow of patients treated for carcinoma of the breast are (not surprisingly) associated with a worse prognosis (Cancer 2001;92:46-53). Bone marrow biopsies may prove to be useful both in determining which women are most likely to benefit from adjuvant chemotherapy and in monitoring the response to treatment.

Diagnosing viral infections by listening is an interesting idea. Quartz crystals vibrate when placed in magnetic fields. When virus particles are attached to the crystal via antibodies and the vibrations are amplified, there comes a point when the virus ruptures away from the crystal. The crystal doubles as a miniature microphone and detects the rupturing event. The inventors say their system can detect a single virus in a drop of fluid and can monitor worsening infections or the effectiveness of antiviral treatment (Nature Biotechnology 2001;19:833-7).

Another novel device: a bottle cap that reminds patients to take their tablets. A Hong Kong company has produced the Remind Cap, which bleeps and flashes when it's time to take a pill. It can be programmed to emit up to four reminders a day, lasts about 36 days, and is about to be launched in the United States (http://www.reutershealth.com/, 21 August 2001). Minerva presumes that its success relies on the patient remembering to carry the pill bottle at all times.

Myocardial infarction rates are higher in younger men at the weekends than during weekdays in France. Older men tend to die from myocardial events on Mondays. Data taken from the French MONICA registers indicate that only first time events followed this pattern. A letter in Heart (2001;86:341-2) offers the hypothesis that vigorous exercise is more commonly taken at weekends.

Guidelines designed to help decisions on whether children need to be admitted to hospital in the developing world seem to work. Nurses and assessing doctors applying the triage guidelines to 2281 children seeking emergency help in one hospital in Malawi found a discrepancy in the decision about admission in just 6.2% of cases, and most of these did not need admission subsequently. Doctors and nurses differed hugely, however, in allocating emergency and priority signs (Archives of Disease in Childhood 2001;85:208-13).

Minerva was once prescribed treatment for asymptomatic Helicobacter pylori infection and ended up with pseudomembranous colitis. Now we know better. The relation between gastro-oesophageal reflux disease (GORD) and H pylori evidently consists of more than the presence of the bug. Indeed, recent studies confirm a protective role of H pylori for reflux oesophagitis which is in line with epidemiological data from the Western world showing an increase in GORD, a decrease in gastric cancer, and a decline in H pylori infection (Gut 2001;49:319-20).

Athletes who do not have asthma inhale β2 agonists in the belief that these drugs will enhance their performance. French researchers have now put a damper on this theory by using a small prospective double blind crossover trial of salbutamol versus placebo to show that neither endurance time nor bronchodilation after exercise differ between treatments. Oral or injected salbutamol is also commonly used and may be productive for athletes—but inhaled bronchodilators, say the researchers, should be reserved for athletes known to have asthma (Thorax 2001;56:675-9).

Some new mothers think that expressing milk is an arduous task. A sequential randomised controlled trial of simultaneous pumping (both breasts simultaneously) versus sequential pumping (one breast, then the other), with and without breast massage, produced unequivocal results. In mothers of preterm babies, the volume of milk produced and the amount of fat is highest with simultaneous pumping and is enhanced by breast massage (Archives of Disease in Childhood (Fetal and neonatal edition) 2001;85:F91-5).

A 58 year old man was referred to the surgical clinic with a swelling in the natal cleft thought to be a pilonidal mass or abscess. Magnetic resonance imaging showed a sacral chordoma. This rare malignant tumour of the notochordal remnants is slow growing, with late metastases. If the tumour is mistaken for an abscess, incision would be disastrous, as exposure increases rates of local recurrence and mortality. There was no neurological deficit, and the tumour was excised by using a posterior approach.

Adrian Davis, senior house officer, James Forrest, consultant surgeon, North Staffordshire Hospital, Stoke on Trent ST4 6QG

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The global prevalence of blindness in children is about 0.8 per 1000 children. According to the British Journal of Ophthalmology (2000;85:1025-7), if this can be reduced to a global average of 0.4 per 1000 (matching that of the world's richer countries) the number of blind children in 2020 will be half the current number. To achieve this we need to eliminate corneal scarring due to vitamin A deficiency and measles, provide earlier and better management of cataract and glaucoma, and control retinopathy of prematurity.

“The Three Graces,” painted by Rubens between 1638 and 1640, clearly depicts scoliosis, a positive Trendelenberg sign, hyperextension of the metacarpal joints, hyperlordosis, and flat feet. The sitters for the painting were presumed to be Rubens's second wife and her sisters, supporting the view that hypermobility is a familial condition (Annals of the Rheumatic Diseases 2001;60:894-5). Close observers of nature thus recorded the condition well before doctors recognised it.