Clinical facts & curios

Q

The list of uses of botulinum A toxin continues to grow. What is the latest application of this interesting agent?

A

Animal experiments have suggested that botulinum A toxin injected into the gastric wall may reduce body weight and food intake by inhibiting the antral pump, thereby slowing gastric emptying, leading to earlier satiety. As an example in humans, a 33-year-old man with obesity (weight, 100.6 kg; height, 179 cm; body mass index, 31.4 kg/m²), dyslipidemia, and borderline hypertension underwent several unsuccessful treatments for obesity including diet and exercise, at least until he underwent

Q

Is there such a thing as a mummy's curse?

A

Probably not. The mummy's curse is now widely accepted to be derived from fictional literature. For example, in 1869, Louisa May Alcott, author of Little Women, had written a short story called, “Lost in a Pyramid: The Mummy's Curse.” About the same time, a tale was related by the US painter, Joseph Smith (1863–1950), who told of a curse on the heretic king Akhenaton, Tutankhamen's father-in-law. Akhenaton (ruled 1353–35 BC) displaced the traditional pantheistic worship by combining the

Q

This past year, in advance of the Christmas issue of the British Medical Journal, readers were asked to suggest words that should be banned from the journal. The response to this request was immediate and overwhelming and published in the journal's special “holiday” edition.

The question is, what were the top 10 words or phrases that readers objected to the most?

A

The top 10 words, phrases or jargon that readers of the British Medical Journal wanted to see eradicated not just from the journal, but also from the English language were: 9/11 (which received the overwhelming majority of votes), followed by clients (used to describe patients), kiddy porn, developed/developing (for countries), miracle (in the context of news), basically, mission statement, stakeholders, modernization, and hero (to describe someone who had the misfortune to be in the wrong

Q

In previous entries to Clinical Facts & Curios, comment was made about how unlucky the number 4 is in the Chinese and Japanese cultures. There is concern about a “hound of the Baskervilles effect” in Chinese-American and Japanese-American communities, which have been suspected to show an abnormally high cardiac mortality rate on the fourth day of each month (Philips DP, Lieu CG, Kwok K, et al. The hound of the Baskervilles effect: natural experiment on the influence of psychological stress on

A

To settle the matter once and for all, a look at California's computerized mortality records that include racial status on the death certificates settles the issue. Fortunately, or unfortunately for the theory, Californian death records do not show statistically persuasive patterns around the number 4. By the way, if the number 4 were to affect mortality, one should find similar effect with other lucky and unlucky numbers. For example, in Chinese culture, number 7 can signify death, whereas

Q

One of the great debates around screening for colorectal cancer is whether or not to require some dietary restrictions before obtaining feces for occult blood testing. It is known, for example, that if one eats a lot of red meat, there is a small but real chance that one will have a false-positive screening test. At the same time, if one requires a restrictive diet, the likelihood of compliance begins to drop significantly. Thus, some believe that it is better to initially screen without

A

If this sounds like a trick question, in a way, it is. Hemoccult is the fecal occult blood test most widely used in screening trials. It uses the peroxidase-like activity of hemoglobin derivatives passed in the stool to detect gastrointestinal bleeding. False-positive findings can result from vegetable peroxidases and red meats in the diet but are less likely with more specific tests, minimizing the number of patients undergoing unneeded colonoscopy. A major screening trial has been undertaken

Q

Your church has decided to have an ice cream social. The option is to have the ice cream social immediately before Sunday services or immediately after. If the social is to be held before Sunday services, participants may be a bit rushed and will have to eat their ice cream somewhat more quickly. The question is, from the vantage point of headaches, is it better to eat one's ice cream quickly or slowly?

A

Most people believe that cold-stimulus headache, also commonly known as ice cream headache, is a real phenomenon, one occurring perhaps in as many as one third of populations. Others, however, believe that such a phenomenon does not exist. A middle group of individuals believes that ice cream headache is inducible only in hot weather. Unfortunately, the literature does not provide any clear understanding as to the true prevalence or the specific nature of ice cream headache, which is the reason

Q

You are a pediatrician who has been in practice for many years. You therefore have the opportunity to frequently examine newborn babies. The question is, what is the likelihood you can correctly tell the sex of a newborn baby solely from the baby's facial appearance? Do you think you would be as good or better at doing this than the nurses in the normal newborn nursery?

A

Believe it or not, someone actually did a study to answer this precise query. Thirty babies, born at term, were consecutively enrolled on the postnatal ward at Guy's Hospital in Great Britain. With permission of families, photographs were taken of babies who were wrapped, with only the face left fully exposed. These photographs were randomly shown to 53 adults, who were asked to provide an opinion as to the baby's sex. Of the observers, 21 were men, 12 were pediatricians, 14 were pediatric or

Q

Your practice includes a large number of high school and college students. You seem to see an increasing trend in the frequency of anorexia and bulimia. You also sense that there has been a trend over time among young adult men towards a greater affinity to women with a lower body mass index.

What type of study might you undertake to determine whether your beliefs are in fact reflective of reality?

A

Although this query may seem a bit frivolous, body mass index and waist:hip ratio in women are linked to health-related issues including fertility, endocrine status, and the risk of major diseases and longevity. Some have also suggested that health-related optimums for body mass index (20 or slightly lower) and waist:hip ratio (0.7 or lower) are also maximally attractive to the male gender. It has been speculated that men's taste in this regard may have changed within our own generation. To

Q

One of the notions that exists today within academic medicine is that if you wish to have a manuscript published more easily, pick a title that catches the eye of the reviewer or the reader. Papers with “interesting” titles work best.

The question is, is this belief true, and how would you study the question?

A

A young investigator has actually looked at this question. The premise was that titles need to contain phrases that are in popular use and suggest innovation and exploration. This hypothesis was tested by examining the use of two such phrases that are, or have been, in popular use: “paradigm shift” and “pushing the envelope.” Atkin explored PubMed with a query to search for published articles containing these two phrases. Searches were limited to “paradigm and shift” and were limited to title

Q

Regarding blood transfusion, who is generally considered to be the father of blood transfusion therapy and how does the University of Edinburgh figure in the evolution of such therapy?

A

James Blundell of London is credited with introducing blood transfusion into the practice of medicine. It is he who publicized the procedure throughout the world in his influential writings on obstetrics. He was a graduate of Edinburgh in 1813. Actually, Blundell's experiments with transfusions between animal groups and humans followed on the heels of graduate work of a man named John Henry Leacock, a graduate of the University of Edinburgh, School of Medicine, in 1870. In his dissertation “on

Q

Alcohol breath testing: Have you ever wondered how the devices work?

A

Alcohol breath screening testing devices generally all work on the same principle. This principle is that in the presence of a catalyst, oxygen and a sample of expired air convert any alcohol present in breath into acetic acid and then to water and carbon dioxide. A fuel cell converts the chemical energy released when oxidation occurs into a detectable electrical voltage. The higher the voltage, the more alcohol is present in the sample. Accuracy depends on the sample of breath being deep lung

Q

If you were trying to trace the history of hypothyroidism through time in order to determine when epidemics of hypothyroidism might have occurred, how might you go about doing so?

A

One way to deal with this question is to recall that the most common form of hypothyroidism historically is iodine deficiency, which leads to goiter. Investigators in Switzerland recognized one way of approaching this question is by examining 5493 historical portraits of people living in and around Bern, Switzerland, portraits going back seven centuries (Als C, Stüssi Y, Boschung U, et al. Visible signs of illness from the 14th–20th century: Systematic review of portraits. BMJ 2002;325:1499).

Q

Is there such a thing as “death by toenail?”

A

Indeed there is. Recently, a pathologic report appeared in the literature that summarized the autopsy of a man 93 years old, who was found exsanguinated while in bed. The lower half of his mattress was saturated with blood, and toward his demise he must have realized that something was wrong, since he sat up and placed his feet on the floor only to accelerate his death. In the autopsy room, it was observed that there were varicosities of his right short saphenous vein. Just below and forward

Q

Is it possible to contract malignant melanoma from a donated organ?

A

Yes, as verified by two recent cases. A woman with polycystic disease of the kidney received a kidney transplant in 1998. The graft functioned well. In November 1999, routine mammography showed a nodule in her left breast, and a biopsy specimen was obtained. The patient was thought to have breast cancer. Almost simultaneously, however, pain and swelling then developed over the kidney transplant, and two subcutaneous nodules were found. Biopsy confirmed the presence of a secondary melanoma. No