Magnetic resonance scans showed a number of structural brain abnormalities in 17 children with school problems who had been exposed to alcohol in utero. Deviations in the development of the vermis were the most sensitive indicator of prenatal alcohol exposure, although no specific structural abnormality correlated with a particular cognitive deficit (Developmental Medicine and Child Neurology 2002;44:98-106).

Liver metastases associated with gastrointestinal malignancies tend to present late, and radiological investigations can give false negative results in the early stages. Looking for a simple laboratory technique to detect liver metastases, researchers hit on high molecular weight alkaline phosphatase (determined by electrophoresis). In a comparison of levels in 50 patients with gastrointestinal cancers with 20 healthy volunteers, this test offered 54% sensitivity and 88.5% specificity (Turkish Journal of Gastroenterology 2001;12:253-7). The authors say this makes it a useful marker. Others may disagree.

Antinuclear antibodies, commonly associated with autoimmune diseases, may in future join other tests for coronary atherosclerosis. Unaware of the artery status of 70 people, two observers scored positivity for the antibodies. Of those with known angiographically proven coronary disease, 70% were positive for antinuclear antibodies, compared with 17% of the group with no evidence of coronary disease. Epidemiologically this is poor performance for a diagnostic kit, but the authors say antinuclear antibodies should be considered in the context of existing serum markers for atherosclerosis (Annals of the Rheumatic Diseases 2002;61:110-4).

The outcome of medical negligence cases depends on the skills of the expert witness in court in explaining the scientific facts or uncertainties involved (British Journal of Surgery 2002;8:134-7). Two similar UK court cases of accidental pneumothorax after fine needle aspiration of the breast came to opposite conclusions. The first preferred the evidence of the defence's expert witness that pneumothorax is a rare but recognised complication of the procedure. The second followed the plaintiff's evidence that pneumothorax occurs as a result of poor technique.

Implicit rationing of medical care for people over 75 has been uncovered in a Swiss university hospital. Of 406 consecutive patients admitted with acute cardiac problems (for which there are well established, evidence based management guidelines), stress tests, angiography, and echocardiography were significantly underused in the older patients. The use of β blockers and angiotensin converting enzyme inhibitors tended to be better than in previous reports, but there was a trend towards the underuse of statins for high cholesterol (Swiss Medical Weekly 2001;131:630-4).

Radiofrequency ablation of the soft palate to cure snoring caused by palatal vibration has recently come into vogue. It's associated with less morbidity than either surgery or laser treatment, but it's an expensive technique and little is known about its efficacy. The early trials were promising, but over the longer term, subjective improvement remains low. Eighteen months after having the treatment, 78% said they were still snoring heavily (Journal of Laryngology and Otology 2002;116:116-8).

BMJ readers are invited to “work with others to improve access to information for health professionals in developing countries.” The Health Information Forum is a series of practical meetings held in London, organised by the International Network for the Availability of Scientific Publications (a non-profit organisation). Attendance is free, and meetings are now approved for continuing medical education by the royal colleges. For further information, see www.inasp.info/health/index.html#3. To join the “HIF-net at WHO” email discussion list, send your name and organisation to health@inasp.info

Removing indwelling urinary catheters at midnight seems to offer appreciable advantages over the conventional practice of removing them at 6 am. A prospective randomised trial of removal of catheter at midnight and 6 am found that patients resumed their normal voiding pattern earlier and were discharged from hospital when their catheters were removed at midnight. The authors say that a good night's sleep immediately after catheter removal reduces patients' anxiety, and that the bladder is more compliant when filling slowly overnight (British Journal of Nursing 2002;11:84-90).

Social mores may be contributing to the re-emergence of syphilis in Britain. An investigation of one recent outbreak of syphilis found that most of the infected participants were homosexual men who had unprotected oral sex. Asking partners to use condoms for oral sex was deemed unacceptable. “It's just not done,” said one man (Communicable Disease and Public Health 2001;4:253-8).

Paolo Martinovich, the director of Venice's San Michele cemetery, has a problem: his corpses aren't decomposing fast enough (Italy Daily 11 February:1). One theory is that corpses are no longer put on show for a few days, allowing bacteria and egg laying flies to settle on the corpse. Other theories include too much humidity, not enough worms, over-resistant coffins, and antibiotics prescribed before death. Signor Martinovich is experimenting with adding liquid or powder enzymes. The city government, meanwhile, is conducting post-postmortem research.

Figure.

A woman noticed black patches in her vision. Thinking this was caused by excess skin in her right upper eyelid, her doctor referred her to the eye services routinely. At presentation the pupils were equal and reactive, with normal visual acuity (the right pupil seems dilated here because we used tropicamide for the fundoscopy examination). The diagnosis turned out to be a large intraocular tumour. The patient's care was considerably delayed because simple fundoscopy was not performed at the time of the initial consultation. In view of the malignant nature of the condition this delay could have been life threatening. If a primary care doctor is not confident doing fundoscopy, a referral to an optician is reasonable to obtain a baseline visualisation of the fundus.

Amar Alwitry, senior house officer, Roger Holden, consultant, department of ophthalmology, Derbyshire Royal Infirmary, Derby DE1 2QY