Dietary phytoestrogens, found in soya bean and linseed, are thought to help relieve vasomotor menopausal symptoms. A study in 939 women (Journal of Nutrition 2002;132:276-82) has found that a high intake is also associated with a favourable metabolic cardiovascular risk profile. As with hormone replacement therapy, waist:hip ratios and concentrations of triglyceride and low density lipoprotein cholesterol were lower in women with high intakes. Minerva was glad to read that small concentrations of phytoestrogens are also found in bread, wine, and beer.

Surgeons performing thyroid surgery may no longer tie the knot. In a case-control study of 86 patients undergoing lobectomy or total thyroidectomy the harmonic scalpel, which works by using ultrasonic frictional heating to ligate vessels, shortened operative times by almost 30 minutes compared to the conventional “tie and clamp technique” time (Archives of Surgery 2002;137:137-42).

Minerva bids farewell to the birthplace of the BMA. The Worcester Royal Infirmary, in whose boardroom Sir Charles Hastings founded the BMA in 1832, closes this Saturday. In its place opens the new PFI Worcestershire Royal Hospital. Progress?

Some things don't change. A GP wrote to point out that the BMJ has been delivered to one particular private address in England for 119 years. The span of years covers three different general practitioners who have lived in the same house, the first from February 1883. Is this a record?

Long term cannabis use, defined as use of cannabis once a week for at least three years, has been found to cause impairments of memory that persist beyond the period of use and worsen with increasing years of regular cannabis use (JAMA 2002;287:1123-31). Long term users recalled 2.5 fewer words than controls on a delayed recall test. What these words were, Minerva cannot remember.

Can't always blame the weather. Many patients with fibromyalgia report that weather conditions influence their pain levels, but no significant relation was found between pain levels and weather conditions in a study of 55 female patients over the course of one month (Annals of the Rheumatic Diseases 2002;61:247-50). The authors conclude that the lack of association could be due to a small sample size, the timing of the pain assessment, or personality factors of the study group. Minerva notes that the study was on Norwegian, not British, patients.

Patients who participate in clinical trials seem to be satisfied with the amount of information provided by researchers, according to the Journal of Research Ethics (2002; 28:45-8). Of 78 patients participating in 14 different clinical trials, 94% felt that they had received the right amount of information, and just two would liked to have known more. However, only 50% felt they had actually understood the information given, and their levels of understanding were not formally assessed.

As in the human race, increasing numbers of dogs and cats are suffering from diabetes (Diabetic Medicine 2002;19:77-80). Increasing weight, decreasing physical activity, increasing psychological stress, and increased life expectancy are thought to be the main reasons. The authors call for the implementation of evidence based guidelines and for more education of animal owners. Well, it's a dog's life.

With the budget approaching, the chancellor will be interested to read in Tobacco Control (2002;11:35-43) that cigarette prices have failed to keep up relative to the “Big Mac index” (a widely used indicator of purchasing power parity devised by the Economist; prices are compared to the price of a McDonald's hamburger). According to this index, tobacco products in the United Kingdom are more affordable now than in the 1960s. The authors call for the price of cigarettes to be increased, as they say it is the most effective method of curbing tobacco use.

Childhood sleep problems are more common than previously thought says the Journal of Paediatrics (2002;140:97-102). Habitual snoring was reported in 17% of 1038 children attending the paediatric outpatient department in Michigan University Hospital, Ann Arbor. Insomnia, defined as difficulty with sleep onset or maintenance or early morning wakening, was reported in 430 (41%). The importance of these findings is that sleep problems in childhood can lead to poor school performance and impaired quality of life. Minerva wonders if the impaired quality of life is impaired more for the parents or the children.

Vietnamese migrants have the highest risk of tuberculosis of any ethnic group in Australia, having a notification rate of more than 13 times the national average. Researchers found that it was their high levels of smoking that made them more susceptible to infection (Epidemiology and Infection 2002;128:37-45). Although sociodemographic variables may be a confounding factor, they say changes in immune functioning are a more likely reason for the association.

Patients with brain tumours in the right hemisphere perceive their quality of life as poorer than those patients with tumours in the left hemisphere. However, quality of life assessments by doctors found no differences between the two hemispheres in a study on 101 successive patients in Finland (Journal of Neurology, Neurosurgery and Psychiatry 2002;72:373-7). This finding, the authors say, could be due to the fact that the ability to evaluate one's condition lies in the left hemisphere of the brain. Damage to this by a tumour could therefore impair patients' ability to accurately evaluate their quality of life and functional ability.

Although 62% of Canadian rugby players believe that wearing protective headgear could prevent concussion, less that a quarter of them actually wear it (British Journal of Sports Medicine 2002;36:19-22). Their coaches were less convinced of the benefit and believed that headgear led to more cases of concussion. The main reason players gave for not wearing headgear was that it is currently not mandatory. Vanity cannot be said to be a reason—just 5% mentioned the way it looked as a reason for not using it.

Figure.

A 21 year old student presented with an acutely swollen ulcerated vulva and associated urinary retention. She was admitted to hospital, catheterised, and treated with acyclovir for presumed herpes simplex infection. However, results of vulval swabs were negative. During her stay on the ward she became more unwell, developing oral ulceration, dysphagia, and arthralgia. An endoscopy revealed extensive oesophageal ulceration. A diagnosis of Bechet's syndrome was made. She was treated with steroids and gradually improved. A diagnosis of Bechet's syndrome should be considered in patients who present with vulval ulceration.

M Willet, specialist registrar in obstetrics and gynaecology, Tameside General Hospital, Ashton Under Lyne, Lancashire OL6 9RW