Eyespy
A 78 year old man with a history of chronic lymphocytic leukaemia and prostate cancer presented with repeated vomiting and dyspnoea. Examination showed right sided dullness, and breath sounds were absent. A chest x ray showed right sided consolidation and pleural effusion, and routine blood tests confirmed sepsis. He did not respond to antibiotic treatment. Computerised tomography seven days later confirmed a ruptured oesophagus. Boerhaave's syndrome-spontaneous rupture of the oesophagus to the left side (rarely to the right) following forceful vomiting-should be considered, especially if conventional treatment fails.
Ahmed A Mustafa Khalil, ST3, department of surgery, NHS Fife, Queen Margaret Hospital, Dunfermline KY11 8ND
Email: aamk72@doctors.org.uk
Student BMJ 2007;15:427-470 ISSN 0966-6494 | December
Does a love of coffee run in the family? Researchers from King's College, London, have found evidence that our preferences for some foods may be determined by our genetic make-up, according to the journal Twin Research and Human Genetics (2007;10:734-48). They studied more than 3000 female identical twins and worked out their broad food preferences using five types of diet-traditional English, dieting, low meat, high alcohol, and high fruit and vegetable. The results showed that 41-48% of a person's preference for a food group was influenced by their genes, and the strongest links were for garlic and coffee (http://news.bbc.co.uk/1/hi/health/7057060.stm).
Could broccoli juice be the new sun block? Broccoli contains sulforaphane, a chemical that stops tumours growing in animals. Researchers at Johns Hopkins University, Baltimore, rubbed broccoli extract on mice and people and exposed them to ultraviolet light. The treated skin became less inflamed than that of participants in control groups. The extract works by boosting the production of enzymes that protect cells from damage caused by ultraviolet light, and the protection lasts for days, even after the extract is no longer on the skin (Proceedings of the National Academy of Sciences USA 2007 Oct 23 doi: 10.1073/pnas.0708710104).
Humans are an optimistic bunch. Mostly, we expect to live longer than the population average, and we underestimate the likelihood of getting divorced. Neuroscientists from New York University have used functional magnetic resonance imaging to identify the parts of the brain that keep us looking on the bright side. When volunteers in the study imagined positive future events they showed more activity in the amygdale, located deep in the brain, and in the front portion of the anterior cingulate cortex, just behind the eyes. When the volunteers thought about negative future events, activity in these areas lessened (Nature 2007;450:102-5).
It may not seem like it in rush hour, but city living could be healthier than a rural lifestyle. An article in Newsweek magazine gave four ways that the urban lifestyle keeps you fit. Firstly, people walk more in the city (www.newsweek.com, 29 Oct 2007, "Skinny and the city"). Cities also have a good cultural scene, and studies have shown that culture and mental stimulation are linked to good health and longevity. Through sheer numbers, you are more likely to find people that you identify with in the city, and research shows that strong social networks have many health benefits, including a lower risk of heart disease and less susceptibility to the common cold. Finally, city dwellers tend to be fussier about their food. Farmers' markets are all the rage, and health food shops and eateries spring up first in the city before filtering through to the suburbs. But your health might depend on which part of the city you live in. A study of more than 1000 people by researchers at the Harvard School of Public Health, Boston, found that people living in poorer neighbourhoods were less likely to take regular exercise than their counterparts in more salubrious areas (PLoS Medicine 2007;4:1599-606).
"This study validates that getting smacked in the head is not a good thing, despite the fact that some clinicians still believe that a patient can recover fully after a concussion," said Deborah Little, the coauthor of a study done at the University of Illinois at Chicago College of Medicine. The research indicates that even mild traumatic injury may cause structural changes in the white matter of the brain that correlate with cognitive deficits related to thinking, memory, and attention. Researchers used a type of magnetic resonance imaging technology called diffusion tensor imaging to study structural changes in the white matter of patients with a range of severities of injuries to the brain. Patients with more severe injuries had larger abnormalities, representing a permanent change in the brain (www.sciencedaily.com).
The origins of medicine may lie in Egypt rather than in Greece. Biomedical Egyptologists at the University of Manchester are studying medical papyruses from 1500 BC that show that the Greeks founded medicine 1000 years after the Egyptians. The documents include Egyptian prescriptions for a myriad of medical problems. These ancient doctors were recommending castor oil, figs, and bran as laxatives; treating wounds with honey; and prescribing pomegranate to get rid of tapeworms-a treatment that was still being used 50 years ago (www.wellcome.ac.uk).
A woman with multiple personality disorder sketched all 17 of her alter egos for her psychiatrist, Richard Baer. Over the 17 year course of therapy Dr Baer had to get to know each of her personalities and persuade them to wipe out their individual identities and merge into one. It was the defining case of his career, and he describes it in his book Switching Time. Multiple personality disorder is controversial because some doctors think that people with multiple personality disorder may just be publicity seekers. Dr Baer has no doubt about his patient though: "Meryl Streep couldn't have done it," he said (www.newsweek.com, 29 Oct 2007, "Inside Karen's crowded mind").
Part of this article was first published in the BMJ (2007;335:892 doi: 10.1136/bmj.39377.450972.471).
