Minerva is curious about a pilot study in which 40 patients with disabling Parkinson's disease were randomised to receive either sham surgery or implantation of embryonic dopamine neurones into their brains (Neurology 2003;60: 1938-43). She was somewhat relieved to read that up to a year later neither group had any cognitive impairment. There was no mention of what happened to their motor function.

Figure 1.

A 45 year old man spent two days clearing an overgrown area in the garden of a French villa. He worked in bright sunlight, wearing only shorts, vest, gloves, and boots. Two days later he presented to the emergency department with chemical burns. The plant he was handling was Heracleum mantegazzianum, better known as giant hogweed, whose sap contains furanocoumarin, which renders the skin photosensitive. In this case exposure resulted in partial thickness burns, which were successfully treated conservatively with topical ointments, leaving minimal residual scarring. Although increasingly rare in Britain, giant hogweed is common in mainland Europe.

Ben J Challacombe, senior house officer, Garrick Georgeu, registrar, Naguib El-Muttardi, consultant, department of plastic surgery, St Thomas's Hospital, London SE1 7EH.

Stubbornly recurrent urinary tract infections may occur because bacteria multiply inside the cells that line the bladder wall, forming “pods.” Studies in mice show that bacteria like E coli cluster together in a matrix called a biofilm, with pod-like bulges sticking out on the internal bladder surface. The pods are protected from the usual host immune response until they break open, releasing the bacteria and triggering another round of inflammation and symptoms (Science 2003;301: 105-7).

An irritable bladder is arguably more frustrating than recurrent urine infections. In the United States, 71 study centres took part in the OPERA (overactive bladder:performance of extended release agents) trial, which looked at the efficacy of long acting oxybutinin and detrusitol in women. The drugs were equally good at reducing urge incontinence and were tolerated well, although oxybutinin was significantly better at reducing the number of times women had to pass urine (Mayo Clinic Proceedings 2003;78: 687-95).

A small study of injured people attending an urban emergency department in Michigan found that 14% of the injuries had directly involved violence, and over half of the participants reported a history of violence during the past year. Men were more likely to report violence than women, and violence was related to alcohol and drug use and the consequences of substance use (Academic Emergency Medicine 2003;10: 764-75).

Intrigued that by 2007 NHS spending is projected to reach £107bn a year, an economist calculated that by then “NHSland” would be larger than all but 33 of the 174 economies listed in The Economist's Pocket World in Figures (Financial Times 2003. July 2: 18).

When faced with a tiny underweight newborn it's difficult to imagine that they'd ever catch up—but apparently underweight babies do, and it depends on their sex. A follow up of a cohort of 195 very low birthweight babies (mean gestational age 30 weeks) found that girls catch up in growth by the age of 20 years, whereas boys remain significantly shorter and lighter than controls (Pediatrics 2003,112; e30-8).

The media in Belgium seem to view psychiatry more favourably than do media in the United Kingdom. In a study published in Psychiatric Bulletin (2003;27: 259-60), a quarter of all medical headlines in Flemish newspapers dealt with psychiatric subjects and the ratio of positive to negative tone was higher than found by similar studies in Britain.Somewhat counterintuitively, the broadsheets published a higher proportion of negative stories than the tabloids. Negative psychiatric stories tend to focus on the patient, whereas for other specialties, negative stories focus on both doctor and patient.

Are patients reviewed in outpatient departments out of habit, or out of necessity? A complex analysis in one cardiology department found that a high proportion of patients were reviewed at least once in primary care between their hospital visits, and many were reviewed more than once. The discharge rate from clinic was only 26%, and the hospital notes were rather vague about the reasons for further hospital review and the fact that general practitioners' reviews take place at all. As with all relationships, better communication would improve matters, the authors suggest (Journal of the Royal Society of Medicine 2003;96: 333-7).

A prospective randomised trial comparing skin adhesive and subcuticular suturing for closing laparoscopic ports found that the use of adhesive came out on top. Stitching took longer, and the adhesive gave as good a result as stitching and was equally acceptable to patients (Journal of the American College of Surgeons 2003;196: 845-53).

Minerva has often wondered what would happen if people in the United Kingdom had to pay to see a doctor. An analysis of how health services are used found that women in the United States were more affected by financial barriers than men. Men were more likely to be influenced by non-financial barriers such as long waiting times (American Journal of Public Health 2003;93: 1076-9).

The screeching of high-powered instruments makes some surgical theatres noisy places to work in. But are they too noisy? A study of noise levels produced by drills, debriders, and burrs used for current ear, nose, and throat surgery concludes that people (such as NHS consultants) who may work for at least 20 years in such places are not at risk of occupational deafness, according to health and safety guidelines (Journal of Laryngology and Otology 2003;117: 532-5).

“Nocturnal dips” are a sure sign that someone's asthma isn't as well controlled as it could be. A pilot study of people with asthma who hadn't previously used inhaled steroids found that a single dose of inhaled steroid at 4 o'clock in the afternoon prevented a significant drop in lung function 12 hours later (Thorax 2003;58: 632-3).