Minerva

British Medical Journal,  April 8, 2000  

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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 miler 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 new 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 preexisting 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.