Minerva

Women with polycystic ovarian syndrome can find it difficult to conceive. Some are given clomiphene to induce ovulation, but it doesn't always work. Given that insulin resistance may play a key role in the syndrome, some people think that metformin (a drug that reduces insulin resistance) may help as a pretreatment. But in a randomised placebo controlled double blind crossover study of 26 women, metformin produced no difference in ovulation rates (British Journal of Clinical Pharmacology 2002;53:469-73).

It's been a while since leukotriene modifiers such as montelukast arrived on the asthma scene. They haven't really caught on in Britain. A multicentre randomised double blind double dummy trial comparing long term inhaled fluticasone with oral montelukast in the United States now finds that the inhaled steroids are more effective as a first line maintenance treatment for chronic asthma (Mayo Clinic Proceedings 2002;77:437-45).

Minerva has long believed that stress can trigger skin complaints, although some dermatologists disagree. A direct link between oily skin and acne and the stress hormone corticotropin releasing hormone is now established. Corticotropin releasing hormone apparently sits in—and acts on—the sebaceous glands responsible for producing oily skin. Scientists detected the hormone in a study of cultured cells taken from human sebaceous glands, and the production of sebaceous oil rose when the hormone was released (Proceedings of the National Academy of Sciences 2002;99:7147-53).

Children with acute leukaemia fortunately do very well these days. But the treatment for acute lymphoblastic leukaemia can be toxic to the nervous system, and in one follow up study performed five years after treatment had finished, neurological symptoms persisted in a third of the children. Their main problems were fine or gross motor difficulties (including clumsiness) caused by demyelinating lesions in the peripheral nerves (Cancer 2002;94:2466-73).

Closing traumatic wounds with Steristrips without extensive cleaning and using local anaesthetic first sounds less than ideal. Though such methods don't adhere to the “sacred tenets” of wound closure, there are times when they are the only available option. A prospective analysis of 147 lacerations dealt with in such a way in one large casualty department in Trinidad found this technique to be cheap, quick, and effective, and it resulted in a sepsis rate of just 1.4% (Postgraduate Medical Journal 2002;78:181-2).

People with Alzheimer's disease tend not show the same degree of conditioned responses to fear as healthy people, putting them at greater risk of injury than others. Fear conditioning relies on a form of memory dependent on the amygdala, and this has now been shown to be impaired in Alzheimer's disease (Neuropsychologia 2002;40:1187-95).

Prenatal scanning is now so sophisticated that in Britain over half of all cases of hypoplastic left heart and atrioventricular connections involving a single ventricle are now diagnosed before birth. Early diagnosis allows considered decision making about palliative surgery. Prenatal listing for transplantation is also staring to occur. Despite such advances, a writer in Heart (2002;87:405-6) says it remains difficult to advocate a population screening programme on the basis that it will result in improved outcome.

A 47 year old man presented with hoarseness and difficulty swallowing one hour after injuring the left side of his neck with a ski pole. External examination of his neck was unremarkable. Laryngoscopy (left) showed a large supraglottic haematoma on the left side. The left vocal cord was immobile. Computed tomography (right) showed a soft tissue swelling from the level of the hyoid bone to the left vocal cord, occluding 50% of his airway in its widest diameter. The laryngeal cartilages were intact. The haematoma was managed conservatively and resolved almost completely within three weeks. At this time the left vocal cord was mobile and his voice had returned to normal.

Y Wales, senior house officer, L J Clark, consultant, department of otolaryngology, head and neck surgery, Victoria Infirmary, South Glasgow University Hospitals NHS Trust, Glasgow G42 9TY

Avoiding the sun is critical for albino people. One specialist clinic in Tanzania found that its patients had a reasonable understanding of the risks of skin cancer and methods of avoiding the sun. Fashion and cultural beliefs, however, often stand in the way of following advice, such as wearing sun hats. Thanks to a donation of sewing machines, the women now make sun hats and supply them to others. The result is a more practical, less stigmatising article of clothing (Archives of Dermatology 2002;138:629-32).

A national survey is following a sample of all single, legitimate births that occurred during one week in March 1946 has found that leg length and trunk length in adulthood are positively associated with birth weight, breast feeding, and weight at 4 years of age. Trunk length was negatively associated with serious illness in childhood and possibly also parental separation (International Journal of Epidemiology 2002;31:383-90). Death of a parent did not seem to influence growth, suggesting that chronic discord between parents is more serious.

Pompe's disease is a rare and fatal cardiomyopathy affecting babies, but it also presents as a chronic asymmetric proximal myopathy in children and adults. It's caused by an autosomal recessive gene that results in acid maltase deficiency, leading to cellular overload of glycogen. With enzyme replacement therapy appearing on the horizon, the Association for Glycogen Storage Diseases (UK) is compiling a database of patients who might benefit. So far only 40 families have been identified, so there must be many more out there. If you know of any patients (or possible patients) please contact Dr Clive Tonks at cmtonks{at}aol.com or visit http://www.agsd.org.uk/home/index.asp [ed. note added 27 May 2002: the correct url for the AGSD(UK) website is http://www.agsd.org.uk/home/index.asp. The Pompe's Disease Page can be found directly on http://www.pompe.org.uk/]