Invasive coronary arteriography remains the gold standard for defining the “road map” of coronary artery disease. Cardiologists exploring the use of non-invasive computed tomography have discovered that despite the advantages of using faster multislice spiral computed tomography (MSCT) scanners, the patient's resting heart rate remains a major obstacle to image quality. Their solution was to give people with a resting heart rate greater than 65 beats per minute a β blocker before the procedure. Analysis of the results showed a sensitivity and specificity for defining obstructive disease of 95% and 86% .

A study recently presented at the annual meeting of the American Society of Anesthesiologists found that white women with red hair required 20% more anaesthetic to block limb movement in response to a painful stimulus than women with dark hair. The investigating team says this has something to do with the genetic mutation in a receptor for hair pigment that only redheads have.

“To provide clinical care and education to children and adults with diabetes has been a privilege. To observe how such efforts can delay or prevent complications was an incentive. To have enjoyed 50 years of those adventures has been an unexpected bonus” says the author of a personal view in Clinical Diabetes 2002;20:173-8. Minerva wonders how many other doctors would say the same thing after five decades of hard work.

The effect of unemployment extends beyond the person who's out of work. A study from five Nordic countries found that children in families with no parents employed in the past six months had more recurrent psychosomatic symptoms and chronic illness and lower wellbeing. Even when social class, parents' immigrant status, and family type were removed from the equation, the association persisted .

Of animal bites that gave rise to claims recently dealt with by the Medical Defence Union, 42% came from man's best friend. Cats contributed 11% of the total. But cat bites have potentially more serious consequences for the bitten (and also for the medical profession), so the union reminds members that washing cat wounds and giving tetanus boosters is not enough. They suggest giving penicillin straight away to tackle Pasteurella multocida, and if a quick improvement doesn't follow, further medical help is essential (Journal of the MDU 2002 October:22-3).

It's official: outpatient clinics are the best place to meet patients early on, reports a questionnaire study of American medical students. Here, students may elicit the main complaint, generate a potential diagnosis, develop or suggest a management plan, and perform the initial examination. The authors conclude students will not automatically become competent simply through more clinical experience in other settings .

Hot on the heels of the debate about deliberately creating children who cannot hear, an epidemiological study from Saudi Arabia looks at the issue from a different cultural perspective. There, consanguineous marriage (marriages between first and second cousins) is common. In two surveys, conducted 10 years apart, the consanguinity rates were 45% and 47%; the prevalence of hereditary sensorineural hearing loss was 66% and 37%, respectively (Journal of Laryngology and Otology 2002;116:811-6).

A research paper and the accompanying editorial in the BMJ of 7 September 2002 were pessimistic about the chances of survival after cardiac arrest outside hospital. Now, researchers have reported the effects of dotting defibrillators around the terminals at three Chicago airports . Over a two year period, 18 patients had ventricular fibrillation; 10 were alive and neurologically intact one year later. Half the Good Samaritans who came to the rescue had received no specific training in the use of automated defibrillators.

Tans to die for. It's not awareness of the dangers of sun lamps that's missing, but a profound belief that tans are attractive and healthy. At one American university, 47% of students interviewed admitted they had used a tanning lamp during the preceding 12 months. Over 90% were aware that premature ageing and skin cancers were possible complications. A change in behaviour will require a fundamental change in societal belief about what is aesthetically admirable .

Heavyhearted patients often have more than depression to contend with; there's growing epidemiological data that they're also independently prone to coronary heart disease. A small case-control study found evidence that, compared with non-depressed controls, people treated for depression have impaired arterial endothelial function. Whether this abnormality is caused by the depression or the treatment (or a combination of the two) is unclear, but its presence probably directly contributes to an increased risk of developing heart disease .

Figure.

A 29 year old man presented to the accident and emergency department with chest pain, upper abdominal pain, and grunting respirations. In the past he had had a laparotomy after receiving a penetrating stab wound. Radiography showed a pneumopericardium, which increased in size over time. A water soluble contrast swallow showed a diaphragmatic hernia with a filling defect in the greater curve of the stomach and contrast medium entering the pericardial sac. He improved rapidly after needle pericardiocentesis decompression. Findings at laparotomy confirmed a pre-existing diaphragmatic defect through which a small portion of the stomach had herniated. A perforated gastric ulcer communicated directly into the pericardial sac.

David Rawlings, consultant radiologist, medical imaging department, Crosshouse Hospital, Kilmarnock KA2 0BE