Minerva

Men's kidneys have larger glomeruli than women's and they have a greater glomerular volume. These relationships, says a paper in Nephron (2002;90:139-44[Medline]), are not due to genetically determined differences in renal structure but instead reflect differences in body surface area and body weight. What is still uncertain is whether these structural differences contribute to the increased susceptibility of men to progressive renal failure.

Sudden cardiac death accounts for around 30% of cardiovascular mortality in developed countries, so any data on its prevention are valuable even if they may not be very new. A literature review in the European Heart Journal (2002;23:277-85[Medline]) highlighted the protection given by eating at least two large helpings of fatty fish each week. The other acknowledged protective factor is a low intake of saturated fat; it can be replaced with olive oil. On antioxidants and a moderate intake of alcohol the verdict is "not harmful."

Vexing as it must be for orthopaedic surgeons who want to try the latest design, patients treated with the old Charnley total hip replacement and followed for 20 years report excellent results. A study from the United States which began in 1976 found that the original prosthesis was still in place in 312 of 353 hips at the time of death or at the latest follow up (Journal of Bone and Joint Surgery 2002;83A:1840-8[Abstract/Full Text]). Of 91 hips in 82 patients who had survived for at least 20 years, 85 were voted as satisfactory by the patients.

Up to 30% of the blind children in India are blind from preventable conditionsvitamin A deficiency, ophthalmia neonatorum, congenital rubella and birth hypoxia (Journal of the Indian Medical Association 2001;99:557-60). The control of blindness in children is one of the objectives of Vision 2020, a global initiative for eliminating avoidable blindness. As is so often the case in medicine, the knowledge is there, but the problem is putting it to practical use.

Most studies of people with mild asthma look at the effect of inhaled steroids in non-smokers. A study in Thorax (2002;57:226-30[Abstract/Full Text]) has assessed the efficacy of inhaled steroids in people with asthma who continue to smoke and found that smoking impairs the usefulness of steroid therapy. The take home message is that smoking cessation is as critical for people with mild asthma as for those with more severe disease.

Any doctor who has been provided with "cook-chill" food as a poor excuse for a meal while on-call may be interested in the latest experiments to make these foods more palatable. Foods containing starch often lose their consistency during the freezing and thawing process. Using "antisense" genetic technology to alter the starch composition and structure of a potato, scientists have now come up with an environmentally friendly starch that can withstand up to five freeze-thaw cycles (Nature Biotechnology 2002;20:295-9[Medline]).

To try to reduce the duration of rehabilitation (and length of stay in hospital) after hip surgery, patients in one hospital were randomised to receive either routine or intensive physical therapy. But over half of those in the intensive group dropped out after two weeks, leaving the authors to conclude that intensive therapy may be of limited value. Enhanced physical rehabilitation in the community might help cut hospital stays (Danish Medical Bulletin 2002;49: 70-2).

Vaginal microbicides looked promising in animal and in vitro studies but seem less successful in human trials. A total of 1251 women at high risk of contracting sexually transmitted infections were randomised to use either nonoxynol-9 gel with condoms, or condoms alone. The gel group had 116 diagnosed gonoccocal and chlamidial infections compared with 100 in the condom only group. There were also five new cases of HIV infection in the gel group and four among the controls (JAMA 2002;287: 1117-22 [Medline]).

View larger version (116K): [in this window] [in a new window]   An unwell 62 year old woman presented with symptoms initially suggestive of meningitissevere neck pain and stiffness with fever. Blood cultures grew Staphylococcus aureus, and she reported having had extensive root canal surgery the previous week. Subsequent magnetic resonance imaging showed an epidural abscess extending from the spinal level of C3 to T4, a rare complication of dental surgery. Unfortunately, the dental pus was not cultured for comparison of organisms. She made a full clinical and radiological recovery after six weeks of antibiotic treatment. F O'Rourke, specialist registrar, R Barker, specialist registrar, S Khan, consultant, department of elderly care medicine, Lister Hospital, Stevenage SG1 4AB

Embolising uterine arteries to treat symptomatic fibroids is catching on. Of 114 consecutive women with embolisation treated in a UK hospital, 91% said their symptoms had resolved or improved after treatment. Contrary to established wisdom that suggests that fibroids with a diameter greater than 8.5 cm predict failure with this technique, 56% of the women in this series had fibroids greater than 8.5 cm (British Journal of Obstetrics and Gynaecology 2002;109:129-35[Medline]).

An epidemiologist trying to match an infection source with infection target cultured two entirely different strains of listeria from different body sites in a patient with listeriosis. This rare phenomenon may be clinically irrelevant, but it did cause difficulties with interpretation (Epidemiology and Infection 2002;128:107-9).

Claims for the association between male circumcision and HIV infection have led to calls for circumcision to be considered as a strategy to reduce the prevalence of HIV. A qualitative study on the Luo, a traditionally non-circumcising ethnic group in western Kenya, found high levels of acceptability. Both men and women wanted clinical circumcision services to be available to improve hygiene and reduce risk of infection (AIDS Care 2002;14:27-40[Medline]). Cultural identification, fear of pain, and bleeding were primary barriers to acceptance of male circumcision.

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