Rather than eyeing up beauty, babies go for novelty. Contrary to expectation, young babies seem to fix on pictures of asymmetrical faces longer than perfectly symmetrical ones, whereas their mothers considered the symmetrical faces more attractive. Minerva wonders if it's simply a case of beauty being in the eye of the beholder. Perhaps babies simply adopt different criteria for beauty than adults (Perception 2002;31:315-21).

Epididymal sperm aspiration from vasectomised men combined with intracytoplasmic sperm injection (ICSI) produces higher rates of pregnancy than reanastomosis after vasectomy. But is this success influenced by the length of time since vasectomy? One analysis of 151 ICSI cycles in vasectomised men found that pregnancy and implantation rates are negatively correlated with the time interval since vasectomy, and these differences could not be explained by male or female ageing alone (Human Reproduction 2002;17:736-40).

Some older people deny having difficulties walking but have already modified their behaviour by using walking sticks. The authors of a two year longitudinal survey study found that those who used sticks at the start of the study were more likely to have developed new mobility problems at follow up than were those who walked without aids. They suggest that asking patients about task modification rather than difficulty alone may be a more sensitive way to detect early problems (Journal of the American Geriatrics Society 2002;50:263-8).

Surgical treatment of intracranial aneurysms is becoming less common as endovascular procedures find favour. In a large Swedish case series 84.1% of the aneurysms were surgically treated, and 30% of these sustained intraoperative complications, with rupture accounting for 60% of them. The authors suggest these results support a more liberal use of temporary clips during dissection, regardless of the experience of the surgeon (Journal of Neurosurgery 2002;96: 515-22).

It may be a nuisance, but telephoning teenagers to remind them about impending appointments at adolescent health clinics significantly reduced the non-attendance rate from 20% to 8%. First appointments tend to be missed more than follow ups, so targeting these may be a more productive exercise. This innovation might benefit a wider audience (Journal of Paediatrics and Child Health 2002;38:79-83).

About 1 in 40 people have an ischaemic stroke within six months of a heart attack. After pooling risk factor data from over 100 000 patients, investigators have invented a new risk stratification score. Using it, they identified 20% of older patients who have a 1 in 25 chance of being rehospitalised for a stroke within six months of a coronary event. The critical factors are less about the characteristics of the infarct, and more about stroke risk factors in general, particularly in elderly people (Circulation 2002;105: 1082-7).

Sensory deprivation studies suggest that monotonous environments are stressful. This observation led to a wonderful sounding therapy called “Snoezelen” that purports to create a relaxing, stimulating, and failure-free environment for people to explore at their own pace. A pilot trial of Snoezelen as an intervention for agitated behaviour in people with dementia found that it was tolerated well and rated positively by participants and may have reduced their agitation during and immediately after the session (British Journal of Occupational Therapy 2002;65:61-6).

A surprising 80% of 900 people referred to a US outpatient liaison psychiatry clinic presented with somatic complaints. Of these, 41% had concurrent physical illnesses, and the most common psychiatric diagnoses were somatoform disorders. Fifty nine per cent had no previous psychiatric history, but 35% displayed significant functional impairment (Acta Psychiatrica Scandinavica 202:105:117-25).

A new device seems to take the sting out of injections for children. The prototype device known as DPL (dermal Powderject lidocaine) delivers high velocity lignocaine particles into the skin, with the aim of providing rapid skin anaesthesia. Comparisons with a sham device found the DPL superior at the antecubital fossa, but not at the back of the hand (Archives of Disease in Childhood 2002;86:309-12). Interestingly, over half of the 128 children found venepuncture painless with the sham device.

The early experiences of dogs that display avoidance behaviour or aggression seem to be critical. Non-domestic maternal environments and a lack of experience of urban environments between 3 and 6 months of age were both significantly associated with aggression towards unfamiliar people (including vets) and avoidance behaviour (Veterinary Record 2002:150:434-8). Minerva wonders if these findings can be extrapolated to children (and their reaction to doctors).

What did you do in the war, daddy? Over 200 answers can be found in The Conscript Doctors, Memories of National Service (Pentland Press, Bishop Auckland), a compendium of reminiscences collated by the Archive of National Service Doctors. For copies contact the BMJ Bookshop or Dr John Blair at 143 Glasgow Road, Perth, Scotland (tel: 01738-623739).

Figure.

This 81 year old woman developed a florid, blanching exanthematous maculopapular rash over her trunk, arms, and proximal thighs after two weeks of treatment with ciprofloxacin for a wound infection. Shortly after the rash developed, she became acutely unwell, hypotensive, and drowsy. The topical fentanyl patch used to control her arthritic pain was dry. She promptly recovered with a dose of naloxone.

This case illustrates the implications of the transdermal route for the absorption of drugs when the skin circulation is altered. In this case there was hyperaemia due to the antibiotic reaction. External heat and fever also increase the absorption rate of fentanyl via transdermal drug delivery systems, and the clearance rate of fentanyl may be greatly reduced in people over the age of 60.

S E Farmer, pre-registration house officer, C Wilson, consultant, department of orthopaedics and trauma, University Hospital of Wales, Cardiff CF14 4XW