Finding an antihypertensive drug that suits the individual not only improves compliance but in some people could be critical for the safety of other people. Losartan, an angiotensin II blocker, came up trumps among aircrew taking part in a placebo controlled, double blind comparison with a calcium channel blocker and an antihistamine. Unlike all the other drugs in the trial, losartan made no difference to performance or measures of sleepiness (Aviation, Space and Environmental Medicine 2001;72:1096-101).

Receiving a false positive result in screening programmes has undesirable results. One month before the next screening round was due, women who had been given the “all clear” (after having had abnormal results on mammography and being referred for more tests three years earlier) remained significantly more anxious than those who had previously had a normal result. This was sufficient to deter 15% of them from attending at all next time around (Journal of Public Health Medicine 2001;23:292-300).

Although alcohol consumption is a causative factor in head and neck cancers, drinking is apparently significantly associated with better physical functioning and an improved quality of life in people treated for such cancers. In addition, such patients find that alcohol consumption is associated with less fatigue, less pain, less difficulty in swallowing, and less of a dry mouth (Oral Oncology 2002;38:81-6). Minerva is curious that anyone thought it necessary to ask about this in the first place.

Babies with a low birth weight or retinopathy of prematurity are at risk of long term visual impairment. Half of a UK cohort of children born in the mid-1980s with low birth weight and retinopathy of prematurity now have some sort of ophthalmic morbidity (squints, myopia, defects of visual field and colour vision) compared with a fifth of a control group of children born at the same time. Those who had had just mild retinopathy of prematurity seem prone only to squints (Pediatrics 2002:109:12-8).

One reason for the long waits in the accident and emergency department is the queue to gain access to an examination cubicle. One UK department introduced a system where a doctor saw all patients with minor injuries that did not need an examination couch or an urgent intervention. The chance of waiting more than one hour to be seen decreased by 32%, and this improvement was not at the expense of patients with more urgent needs (Emergency Medicine Journal 2002;19:28-30).

Hysterectomy is a recognised risk factor for osteoporosis, although not for osteoarthritis. Indeed a German study suggests that for patients undergoing hip or knee replacement for severely osteoarthritic joints, a previous hysterectomy seems to be associated with a reduced risk of generalised osteoarthritis. Despite the hypothesis that hormonal irregularities affect the risk of osteoarthritis, previous or present use of hormone replacement therapy was not associated with specific patterns of osteoarthritis (Scandinavian Journal of Rheumatology 2001:30:340-5).

A Scandinavian study shows how conservative treatment dramatically reduced the need for surgery to arthritic thumbs. Thirty three patients on the surgical waiting list were randomised to receive either technical accessories or accessories plus splints, alongside extensive support on how to deal with the activities of daily living. After just seven months, 70% no longer required surgery, and over the next seven years, only two of the remaining 19 patients still wanted an operation (Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 2001;35:415-7).

Minerva recalls having to dash around the hospital on more than one occasion with a warm syringe of blood up her sleeve to find the nearest blood gas analyser. The problem is that oxygen diffuses through the wall of plastic syringes, so as time goes by, and if the oxygen concentration is high to start with, the final readings may be unreliable. Oxygen in blood samples taken into pre-heparinised glass capillary tubes don't suffer the same fate, and as such tubes dispense with the need to aspirate blood, very slender needles can be used (Chest 2001;120:1651-4).

Human asthma is associated with an infiltration of T helper lymphocytes into the airways. Scientists think this activity may be linked with an abnormality of the T-bet gene, or loss of the transcription factor that is expressed by the T-bet gene. Mice that have the T-bet gene knocked out develop spontaneous airway inflammation similar to that seen in human asthma. Lung T cells from people with asthma contained significantly less T-bet than those from people with asthma (Science 2002:295:336-8).

Figure.

A 76 year old man was admitted to hospital with abdominal pain and diarrhoea. He developed hypotension and progressed into renal failure but responded well to antibiotics and supportive care. Nine days after his admission we noted two erythematous, circumscribed lesions (3 cm diameter) associated with bruising on his abdomen. We suspected an adverse reaction to subcutaneous injection of low molecular weight heparin (Clexane). Injection at a distant site developed into a similar lesion. All the lesions progressed to skin necrosis within two days and we stopped the heparin.

Adverse reactions to low molecular weight heparin are rare. Several possible mechanisms have been postulated, including type I hypersensitivity reaction, vasculitis (type III Arthus reaction), and delayed type IV hypersensitivity reaction. If skin necrosis occurs, low molecular weight heparin should be replaced by alternatives such as danaparoid sodium or hirudin.

Anand Gidwani, senior house officer, Damien Magee, consultant, department of surgery, United Hospitals HSS Trust, Belfast BT37 9RH