Breast feeding mothers avoid taking medication in case the drug gets into their milk. As antidepressants are usefully prescribed during this time, Minerva was interested to read that a study of three commonly used antidepressants found them safe during lactation (British Journal of Psychiatry 2001;179:163-6). No drug was detected in any infant exposed to paroxetine or fluvoxamine. Sertraline showed up in a quarter of babies exposed to it, although this tended to be in those whose mothers were taking high doses.

A study in the Journal of Clinical Pathology (2001;54:605-7) challenges the commonly held perception that a synovial biopsy in non-specific joint disease is a “last resort” when the synovial fluid is unhelpful. The authors conclude that the diagnostic usefulness of a biopsy is about the same as, and sometimes exceeds, that of a fluid. They were unable to predict, however, the cases in which a biopsy turned out to be more useful than the fluid.

Going for the dream job apparently induces one in three people to produce dishonest curriculum vitae. The most common exaggerations are about qualifications, leisure pursuits, and work experience (Financial Times 6 August 2001). A survey of 2000 people conducted by a television recruitment channel found that 1 in 3 men lied on their resumé, as did 1 in 5 women. Dishonest resumé writers could be bad news for business; they might be fatal for the health service.

Stem cells have been isolated from the central nervous system, bone marrow, and blood of adults. They usually generate differentiated cells from the same line as their cell of origin, but some are capable of developing in vivo into cells from different embryonic lines. Scientists have now added skin to this list: stem cells isolated from rat skin differentiated into neurons, glia, smooth muscle, and fat cells (Nature Cell Biology 2001;3:778-84). The accessibility of skin clearly offers a natural advantage over embryos and internal organs as a source of stem cells.

Christ's crucifixion probably did not kill him, according to Modern Medicine and the Bible (Ortho Books, Bridgend, Wales, 2001). Jesus died suddenly after only six hours on the cross, and he was fully conscious at the end. His legs were unbroken, but when a spear was thrust into his side, blood and water flowed out. This suggests that death came from the spear, which probably released a pleural effusion and then penetrated a large blood vessel or the heart.

Carers of people with dementia have strong views about medical treatment. The majority of 100 non-professional carers in one survey agreed that quality of life should take priority over prolongation of life. They proffered strong support for “living wills” on the basis that these could subsequently reduce the sensitivity surrounding questions of passive euthanasia—and importantly, they were able to distinguish between the concepts of active and passive euthanasia (Medicine, Science and the Law 2001:41:237-40).

Carers again; this time an entirely community based study attempting to quantify the time costs of looking after children with disabilities. It shows that most mothers with disabled children cannot take on paid work (despite having a desire to do so, and the family's need for income) because of the significantly greater levels of personal care needed, including attending the children overnight. These needs don't reduce with age, and they leave families poorer than peer families, even when state benefits are included (Developmental Medicine and Child Neurology 2001:43:529-33).

Years ago Minerva was taught to assess gestational age using fruit size comparisons. Despite the increasing availability of ultrasound scanning, she is curious to see that fruit size is still considered useful. A small study of health professionals found reasonable agreement that non-pregnant uteruses feel like unripe pears, an eight week pregnant uterus resembles a large orange, and 12 week pregnancies compare well with grapefruits (Obstetrics and Gynaecology 2001;98:341-4). Independent fruit measurements provided validation for the tool.

Ten roaming “pee inspectors” have hit the streets of Siteki, Swaziland's third largest city, to catch and fine anyone caught urinating in public. Despite “scores of public toilets, men still insist on just whipping it out and urinating on our pavements” reports the city manager (www.swazinews.co.sz/index.htm 6 August 2001). The initiative follows a similar venture in Swaziland's capital, where city fathers threatened to hire sangomas to “bewitch” human faeces found on pavements. The spells would cause the culprits' bottoms to swell, thus allowing their identification.

Oesophagitis in cats should help scientists understand the finer points of human gastro-oesophageal reflux. By performing myotomy at the gastro-oesophageal junction, an American team has come up with a cat model that mimics chronic oesophagitis in humans (Scandinavian Journal of Gastroenterology 2001;36:904-9). Previous animal models have shed light only on the acute situation.

Placebo responses are often useful but not thought to be mediated by any physical or chemical effect. An in vivo study of dopamine release in response to a biologically inactive placebo in Parkinson's disease indicates that a neural mechanism is involved. The placebo induced a significant release of dopamine from the damaged striatal neurons, detectable by positron emission tomography. Placebo and active drug together, however, were no better than drug alone (Science 2001;293:1164-6).

Figure.

We admitted an 83 year old woman with ischaemic chest pain who had been taking long term prednisolone 5 mg for Crohn's disease. She received standard doses of aspirin and low molecular weight heparin but after minimal trauma to her left hand she developed a tense haematoma. This was decompressed and the overlying skin sloughed off, leaving a large defect that finally healed by secondary intention after six weeks. Low molecular weight heparins are widely used to treat unstable angina and thromboembolic disease, where the potential therapeutic benefits of anticoagulation are thought to outweigh its risks. Extreme care should be exercised in the use of such heparins in elderly patients, especially those taking long term steroids.

Alan Shand, specialist registrar, Shareen Siddiqi, senior house officer, Rinki Singh, house officer, Directorate of medicine, Western General Hospital, Edinburgh EH4 2XU