Thursday, December 29, 2005

Cops: Woman Didn't Eat Phone Voluntarily

Via The Chicago Tribune:
Police responded to a call from a Blue Springs man who said his girlfriend was having trouble breathing, and when they arrived, they found a woman with a cellular phone lodged in her throat.

Wednesday, December 28, 2005

Nurse Who Killed His Patients Can Donate Kidney, but He Must Get His Sentence First

From The New York Times:
A former nurse who pleaded guilty to killing 29 patients at hospitals in New Jersey and Pennsylvania has received permission to donate a kidney to an acquaintance in New York, as long as he first appears at his own sentencing.
Technorati Tags: Kidney Transplantation, Transplantation, Charles Cullen

Quote of the Day

"This disease has a high incidence on the medical board exam."

Monday, December 26, 2005

Danger to Kidneys May Lurk in Some Sodium Phosphate Preparations for Colonoscopy (Phosphate Nephropathy)

From The New York Times:
No one disputes that colonoscopies save lives. But recent research has prompted concern that in rare instances certain popular bowel-cleansing preparations that patients gulp down the day before a procedure can severely damage the kidneys.

The products are oral preparations made with sodium phosphate and they include Visicol tablets, sold by prescription, and over-the-counter solutions like Fleet Phosphosoda and store-brand versions that contain the same active ingredients.

A team of doctors from the Columbia College of Physicians and Surgeons recently reported 21 cases of acute kidney failure from such products, including three that led to permanent dialysis and one to a kidney transplant. The study appeared in the November issue of The Journal of the American Society of Nephrology.
For references on phosphate nephropathy, see this post.

Technorati Tags: Phosphate Nephropathy, Fleet Phosphosoda, Visicol, Colonoscopy, Kidney Failure

The Battle Over Books -- Google Print (Google Book Search) Debate at the New York Public Library

"Tonight, we have a contentious smackdown at the New York Public Library."

I just finished listening to an MP3 of a recent debate at the New York Public Library over the legality of Google Print (now Google Book Search). The debate featured Authors' Guild president Nick Taylor, Google VP David Drummond, Stanford Law prof Lawrence Lessig, Association of American Publishers VP Allan Adler, and Chris Anderson of Wired as the moderator.

The MP3 and video torrent can be downloaded here. An analysis at mediabistro is here.

A description of the event:
Last December, Google launched its Print Library Project to scan books from the collections of several major libraries: Harvard, Michigan, Stanford, Oxford, and the New York Public Library.

Google explained: "Our ultimate goal is to work with publishers and libraries to create a comprehensive, searchable, virtual card catalog of all books in all languages that helps users discover new books and publishers find new readers."

Sounds like a win-win-win-win for readers, authors, publishers, and libraries alike, right? But as we have seen with other media migrating to the Internet, such a project raises a number of questions about intellectual property rights, fair use, piracy, access, ownership, distribution, compensation, and control. This fall, the Authors Guild and the Association of American Publishers filed lawsuits against Google, citing massive copyright infringement.

The NYPL and WIRED Magazine present a provocative discussion about the competing interests and issues raised by the Google Print Library Project, and whether a universal digital repository of our collective knowledge is in our future.
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Sunday, December 25, 2005

Rivals Laying Siege to Amgen's Near Monopoly in Anemia Drugs

From The New York Times:
For years, the biotechnology giant Amgen has wielded a near monopoly over its industry's most lucrative franchise, the anemia drugs on which hundreds of thousands of American kidney and cancer patients and their insurers spend billions of dollars each year. But now, Amgen's money machine is coming under attack.

A host of companies - ranging from the Swiss giant Roche to Silicon Valley start-ups - are developing anemia drugs to compete against Epogen and Aranesp, the blockbusters that will account for nearly half of Amgen's expected $12 billion in revenues this year.
Technorati Tags: Amgen, Aranesp, Epoetin, Procrit, Roche, CERA

Indian Police Defend Doctor Who Removed Kidney During Appendectomy

Via The Indian Express:
Thirty-year-old Surendra Das, a rickshaw-puller, died on Friday night after remaining on dialysis for 20 days. This was after a doctor near his village in Munhar allegedly took out his lone kidney while removing his appendix.

Police, however, say Dr R P Gupta did it unknowingly...
Technorati Tags: Kidneys, Kidney Transplantation, India

Happy Holidays! / Simon Sez Santa

Happy Holidays!

Today's link is Simon Sez Santa, a close relative of Subservient Chicken.

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Saturday, December 24, 2005

Post-Traumatic Strike Disorder

Via Slate:
Over the course of the three days of the strike, I walked barefoot through all five boroughs and urinated powerfully in every major waterway in the tri-state area. I crossed the Brooklyn Bridge nine times, often with a German shepherd sitting on my shoulders. At a bus terminal in Maine, where I was waiting for a shuttle back to Times Square, I lost six teeth to a gypsy cab driver in an illicit game of chance. I rode from Staten Island to Queens on a tandem bicycle with a paraplegic homeless man. I watched a group of rats—forced out of the subways by the sudden lack of fresh garbage—pile themselves into a 6-foot mound, put on a police uniform, and direct pedestrians into a manhole. I hotwired a police car. I traded one of my kidneys for a sip of hot chocolate. I delivered a premature baby in the back of a sinking catamaran. I had my tongue pierced in a Zoroastrian ritual while rappelling down the Chrysler Building. I became fluent in a dialect of German spoken exclusively by a colony of anarchist street dentists squatting in the nave of St. Patrick's Cathedral. I made love, against my will, to a styrofoam effigy of Mayor Bloomberg. By the time I got to work, nearly three days late, I had missed the office Christmas party and my job had been outsourced to Philadelphia.
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Friday, December 23, 2005

The Kidneys in the Bible: What Happened?

From The Kidneys in the Bible: What Happened? -- Eknoyan 16 (12): 3464 -- Journal of the American Society of Nephrology:
The kidneys, always used in the plural (kelayot), are mentioned more than 30 times in the Bible. In the Pentateuch, the kidneys are cited 11 times in the detailed instructions given for the sacrificial offering of animals at the altar. Whereas those instructions were for purification ceremonies at the Temple, sacrificial offerings were made subsequently in seeking divine intervention for the relief of medical problems. In the books of the Bible that follow the Pentateuch, mostly in Jeremiah and Psalms, the human kidneys are cited figuratively as the site of temperament, emotions, prudence, vigor, and wisdom. In five instances, they are mentioned as the organs examined by God to judge an individual. They are cited either before or after but always in conjunction with the heart as mirrors of the psyche of the person examined. There is also reference to the kidneys as the site of divine punishment for misdemeanors, committed or perceived, particularly in the book of Job, whose suffering and ailments are legendary. In the first vernacular versions of the Bible in English, the translators elected to use the term "reins" instead of kidneys in differentiating the metaphoric uses of human kidneys from that of their mention as anatomic organs of sacrificial animals burned at the altar. This initial effort at linguistic purity or gentility has progressed further in recent versions of the Bible, in which the reins are now replaced by the soul or the mind. The erosion may have begun in the centuries that followed the writing of the Bible, when recognition of the kidneys as excretory organs deprived them of the ancient aura of mysterious organs hidden deep in the body but accessible to the look of God. At approximately the same time, Greek analytical philosophy argued that the brain, which is never mentioned in the Bible, was the most divine and sacred part of the body. This argument gained ground in the past century, when the functions of the brain were elucidated, and ultimately established in the 1960s, when salvaging the kidneys for transplantation necessitated a change in the definition of death as irreversible brain function. It is ironic that advances in understanding kidney function and in nephrology that made kidney transplantation feasible may have contributed, albeit indirectly, to the gradual elimination of the metaphoric mention of human kidneys in the Bible.
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Flickr: Gibbous

"I missed the full moon, but I always find the shadowy edge of a nearly full moon (95% in this case) adds special character"

From Flickr. Uploaded by Ed Karjala on 18 Dec '05, 12.27am PST.

Medical Blogosphere Tag Cloud Weekly Update

The following are the top 100 keywords from the Medical Blogosphere Tag Cloud, a way of seeing at a glance what people are talking about online. The full cloud with links to individual posts is here.
access ... america ... american ... american heart association ... avian flu ... bioethics ... bird flu ... blog ... blogosphere ... breast cancer ... bush ... california ... canada ... carnival ... case ... cdc ... cell research ... clinic ... community ... computer ... contact ... death ... diagnosis ... doctors ... dog ... drug benefit ... drugs ... electronic medical ... email ... family ... federal ... feed ... flu ... flu pandemic ... food and drug administration ... geena ... google ... grand rounds ... guess ... health care ... heart ... heart attack ... helen ... hospital impact ... hospitals ... hurricane katrina ... idea ... impact ... infectious ... intelligent design ... internal medicine ... job ... lead ... love ... mail ... mass ... media ... medical records ... medical school ... medications ... medicine ... merck ... money ... new england journal ... new orleans ... new york ... nurses ... nursing ... pandemic ... parents ... photo ... physicians ... podcast ... popular ... quality ... reading ... reason ... running ... san francisco ... science ... scientists ... search ... service ... south ... state ... stem cell ... stem cell research ... stem cells ... story ... tamiflu ... thankful ... thanksgiving ... therapy ... united states ... vioxx ... wall ... wall street ... wall street journal ... washington ... white
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Thursday, December 22, 2005

Conversation of the Day: What's a Treo?

Man: This is strange. I went to, and it's a Swedish website. It's run by Pfizer, the company that makes Viagra. I wonder what Treo means in Swedish?

Woman: Probably two blondes and a guy.

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Doctor Stories #10: Three Opinions

From Intueri:
Children should not be permitted to sing Christmas carols in the intensive care unit. People who have yet to lose all of their primary teeth do not need to catch glimpses of unconscious people who require mechanical ventilators to breathe. People who still have several years before they experience puberty do not need to witness people groaning with pain and discomfort while nurses pull bloody gauze packing out of a gaping surgical wound. People who do not (theoretically) understand what death fully entails (but then again, how many of us truly comprehend all the details of the cessation of life?) should not be allowed into the intensive care unit which is so often the antechamber that leads to death's door.
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Wednesday, December 21, 2005

"Bad Medical Student = Bad Doctor" -- NEJM

From the New England Journal of Medicine -- Disciplinary Action by Medical Boards and Prior Behavior in Medical School:
Results Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. Conclusions In this case–control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career.

Medicine and the New York City Transit Strike

I hitchhiked to the office this morning in a van with four strangers. People are nervous, but helpful. It reminded me of the blackout of 2004, when my wife and I walked home across Central Park at night with a flashlight. (Like others, we didn't have much of a choice.) Then as now, the strangers we met were uneasy, but friendly.

I hope the good attitude lasts. The hospitals are running smoothly, but our dialysis shifts are starting at 5 in the morning to minimize commuting problems, and soon, the health care system may start breaking down due to decreased staffing and transportation delays. The news is reporting that hospitals and EMS workers have been preparing for emergencies related to the transit strike and officials are worried about the inevitable decline in quality of care. If this continues, it won't be long until the strike causes patients to die, and the headline will be "Killed by the Transit Strike." Any sympathy people have for the striking transit workers will disappear.

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Human Brain Cells Grown in Mice

Via The Washington Post:
By injecting human embryonic stem cells into the brains of fetal mice inside the womb, scientists in California have created living mice with working human brain cells inside their skulls.

The research offers the first proof that human embryonic stem cells -- vaunted for their potential to turn into every kind of human cell, at least in laboratory dishes -- can become functional human brain cells inside a living animal, reaching out to make connections with surrounding brain cells.
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Tuesday, December 20, 2005

Couples Who Cross-Donate Kidneys

Via Slate:
When Tom Packard began suffering from kidney failure, his fiancee offered to give him one of her kidneys. But Packard, a 65-year-old Manhattan bank executive, and Ann Heavner, 59, weren't a compatible match. After two more donors fell through, the couple showed up in the office of Dr. Lloyd Ratner, director of renal and pancreatic transplantation at New York-Presbyterian Hospital/Columbia University Medical Center. Ratner punched a few keywords into his personal database and found a 71-year-old New Jersey man who could use Heavner's kidney—and whose 62-year-old wife could give hers to Packard.

So, the two couples made a deal. Last spring, in four operating rooms, four surgeons simultaneously conducted what's known as a "kidney swap." All four patients have recovered. Last month, they spent Thanksgiving together.
Technorati Tags: Kidneys, Transplantation, Kidney Transplantation, Columbia University Medical Center

Grand Rounds 2.13

Grand Rounds 2.13, this week's best posts of the medical blogosphere, is up at MedPundit.

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Google Zeitgeist 2005

Via Google:
It turns out that looking at the aggregation of billions of search queries people type into Google reveals something about our curiosity, our thirst for news, and perhaps even our desires. Considering all that has occurred in 2005, we thought it would be interesting to study just a few of the significant events, and names that make this a memorable year. (We’ll leave it to the historians to determine which ones are lasting and which ephemeral.) We hope you enjoy this selective view of our collective year.
Technorati Tags: Google Zeitgeist, Google, 2005

Monday, December 19, 2005

Hilarious Journal Articles #33: Scientist Names Cancer-Causing Gene "Pokemon," Changes Name After Nintendo Threatens to Sue.

From CNET:
The name of a cancer-causing gene has been changed from "Pokemon" to Zbtb7 after Pokemon USA threatened legal action to keep scientists from referring to the gene by the game's name, according to an article in science journal Nature.

In January's issue, geneticist Pier Paolo Pandolfi of the Memorial Sloan-Kettering Cancer Center in New York describes the cancer-causing POK erythroid myeloid ontogenic gene, calling it Pokemon.

The gene in question is part of the POK gene family that encodes proteins that turn off other genes. POK proteins are critical in embryonic development, cellular differentiation and oncogenesis, according to the National Cancer Institute.
From Nature:
Aberrant transcriptional repression through chromatin remodelling and histone deacetylation has been postulated to represent a driving force underlying tumorigenesis because histone deacetylase inhibitors have been found to be effective in cancer treatment. However, the molecular mechanisms by which transcriptional derepression would be linked to tumour suppression are poorly understood. Here we identify the transcriptional repressor Pokemon (encoded by the Zbtb7 gene) as a critical factor in oncogenesis. Mouse embryonic fibroblasts lacking Zbtb7 are completely refractory to oncogene-mediated cellular transformation. Conversely, Pokemon overexpression leads to overt oncogenic transformation both in vitro and in vivo in transgenic mice. Pokemon can specifically repress the transcription of the tumour suppressor gene ARF through direct binding. We find that Pokemon is aberrantly overexpressed in human cancers and that its expression levels predict biological behaviour and clinical outcome. Pokemon's critical role in cellular transformation makes it an attractive target for therapeutic intervention.
Technorati Tags: Pokemon, Cancer, Hilarious Journal Articles

Tandem Heart

For more information on TandemHeart, see this post.

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Counterfeit Tamiflu Seized

Via The Wall Street Journal Avian Flu News Tracker:
U.S. customs agents intercepted more than 50 shipments of counterfeit Tamiflu, the antiviral flu drug, marking the first such seizures in the U.S. The first package was intercepted Nov. 26 at an air-mail facility near San Francisco International Airport, said Roxanne Hercules, a spokeswoman for U.S. Customs and Border Protection. Since then, agents have seized 51 separate packages, each containing up to 50 counterfeit capsules labeled generic Tamiflu. The fake drugs had none of Tamiflu's active ingredients, and officials were running tests to determine what the capsules did contain.
Technorati Tags: Avian Flu, Avian Influenza, Bird Flu

Sunday, December 18, 2005

Flickr: Christmas in Rockefeller Center

"my perfect Christmas moment in New York City"

From Flickr. Uploaded by mihay on 2 Dec '05, 4.51am PST.

Wikipedia Founder Jimmy Wales Shot Dead (According to Wikipedia)

From The Register:
Wikipedia founder Jimmy Wales has been shot dead, according to Wikipedia, the online, up-to-the-minute encyclopedia.

Apparently, the assassin was a "friend" of the victim of a recent controversy which ironically, smeared former Robert F Kennedy aid John Seigenthaler as a suspect in the assassination of both Kennedy brothers. That claim, which the site carried for several months, along with the assertion that Seigenthaler had lived in Russia, was eventually proved false.

"At 18:54 EST on December 12, John Seigenthaler's wife, who was infuriated at Wikipedia regarding the recent scandal regarding his role in the Kennedy Assassination, came into the house, where Jim was having dinner. Wearing a mask, he [sic] shot him three times in the head and ran," reported the online reference source.
Technorati Tags: Wikipedia

Daughter Donates Kidney to 80-Year-Old Father

From the Alamogordo Daily News:
Cheryl DeHart Mollison's father gave her life -- and on Sept. 7, she helped extend his.

Mollison donated one of her kidneys to her 80-year-old father, Ted DeHart, while he was suffering from chronic kidney failure. Without the transplant, DeHart was facing dialysis.

"I said, 'No, we're not going that route," Mollison said. "We're doing the transplant."
Technorati Tags: Transplantation, Kidney Transplantation

Saturday, December 17, 2005

Stress: the Holiday Grinch (From the Google Blog)

Dr. Taraneh Razavi continues to use the Google Blog to communicate public health recommendations. (As an aside, she probably shouldn't be referred to as a "resident physician," which invites confusion with medical residents.) Topics of other posts have included deep venous thrombosis and avian influenza.
Watching scenes of fists flying over an LCD monitor during a holiday sale made me wonder about stress, and how one can maintain a holiday spirit at a stressful time of year. According to Stedman's Medical Dictionary, it's stress, not the holidays, that make the body react to "forces of a deleterious nature that disturb its normal physiologic equilibrium." That sounds bad.

There is extensive research that confirms the harmful effects of stress when it occurs continuously with out the relaxation phase. In the international INTERHEART study, patients with a first heart attack reported significantly more stress in financial, home and work-related situations than the control studies. In another study of 1055 medical students who were followed for 36 years, it was found that those who had a higher anger response to stress had higher risk of developing premature heart disease (before age 55). Even exposure to traffic has been implicated. ( has more references if you are interested.)
While I'm a fan of UpToDate, I was unable to find any references to stress in the patient information section. The INTERHEART Study, published in the Lancet, is freely available here.

Technorati Tags: Stress

What Happens to Bad Scientists? (Lock the labs, sequester the notebooks.)

Via Slate:
Superstar stem-cell researcher Hwang Woo Suk was accused of major scientific fraud on Thursday. A collaborator now claims Hwang faked much of the data for the groundbreaking research he published in May; earlier in the week, a co-author from the University of Pittsburgh withdrew his name from the work. Investigations are now underway in Pittsburgh and Seoul. How do you investigate scientific misconduct?

First, interview everyone who might be involved. In the United States, research institutions conduct their own inquiries into scientific wrongdoing. If the allegation seems credible, a small committee will spend up to a month quietly looking into the matter. They'll talk to witnesses—most likely members of the lab, collaborators, and the person who made the charge—before confronting the accused researcher with the charges against him. If the committee decides there's reasonable evidence for misconduct, the issue passes to a larger committee for a formal investigation.
Technorati Tags: Hwang Woo Suk, Stem Cells

Flickr: Safeco Stadium

"...and traffic flowing onto I-90"

From Flickr. Uploaded by .roland.rodriguez. on 12 Dec '05, 4.36am PST.

"A Somewhat Comprehensive Overview of the Hwang Woo-Suk Stem Cell Fabrication Matter"

On Friday December 16th, Dr. Hwang Woo Suk set reporters straight about the stem cell matter:

"I want you to listen to me. I'm going to say this again ... These allegations are false."

Wait, sorry, I confused the quotes I keep in my "it isn't the mistake it is the cover-up" file. Wrong object lesson. But Dr. Hwang might as well have said that the fraud charge by his colleagues "depends on what the meaning of 'is' is." In fact his response to accusations of misconduct was so complicated on Friday that all of the reporters there seem to have come away oblivious to what he had said or how it differered from prior accounts.
Technorati Tags: Hwang Woo Suk, Stem Cells

Friday, December 16, 2005

'West Wing' Star John Spencer Dies at 58

From Reuters:
John Spencer, star of NBC television drama "The West Wing," died on Friday at a Los Angeles hospital after suffering a heart attack, his spokesman Ron Hofmann said.
Technorati Tags: John Spencer, West Wing

Flickr: Kerry McLean, 225-horsepower gasoline-powered monowheel

"Today's Maker from our new book Makers - Kerry McLean, Wall Lake, Michigan. 225-horsepower gasoline-powered monowheel. "You may be hauling ass, but you feel like you're floating," says McLean. The metal fabricator and machinist built his first monowheel in 1970 and has been obsessively perfecting the design ever since. "I don't feel like anyone has seen it through," he says. "You hear words like 'trial and error.' That's just some hillbilly stuff. Broomsticks and baling wire. I'm doing R&D." Makers: page 20. View photo! See previous Makers of the day here. View sample PDF. Click here to get Makers the book before the holidays!"

From Flickr. Uploaded by pt on 15 Dec '05, 1.28am PST.

You've Got Mail -- And Maybe Gonorrhea

Via Reuters AlertNet:
You've got mail -- and possibly gonorrhea, HIV or another sexually transmitted disease.

E-mail sent through Web sites launched in Los Angeles and San Francisco is providing people with a free, sometimes anonymous, way to tell their casual sex partners they might have picked up more than they bargained for.

Los Angeles County health officials launched this week in a bid to reduce the rapidly rising spread of STDs by encouraging sexually active men and women to get tested.
Technorati Tags: Gonorrhea, HIV, Sexually Transmitted Diseases, Inspotla

On the Trail of a Giant Scorpion

From The Washington Post:
About 330 million years ago, for questionable reasons, a water scorpion the size of a small human lurched out of the lake where it lived and lumbered slowly across the sand, dragging its tail behind.

Paleontologist Martin A. Whyte recently found the creature's tracks imprinted in a stretch of sandstone in Scotland. The trail includes the prints of six feet flanking the groove cut by the tail. Whyte estimates that the scorpion was about 5 feet, 3 inches long and about 3 1/2 feet wide.
Technorati Tags: Paleontology, Scorpions, Scotland

Scientists Find A DNA Change That Accounts For White Skin

From The Washington Post:
Scientists said yesterday that they have discovered a tiny genetic mutation that largely explains the first appearance of white skin in humans tens of thousands of years ago, a finding that helps solve one of biology's most enduring mysteries and illuminates one of humanity's greatest sources of strife.

The work suggests that the skin-whitening mutation occurred by chance in a single individual after the first human exodus from Africa, when all people were brown-skinned. That person's offspring apparently thrived as humans moved northward into what is now Europe, helping to give rise to the lightest of the world's races.
Technorati Tags: Skin Color

Thursday, December 15, 2005

Flickr: Moonrise Over Campfire

From Flickr. Uploaded by Steve took it on 10 Dec '05, 6.19pm PST.

New York City Orders Labs to Submit Data From Tests of Diabetics (HgA1c's)

I don't mind much when insurance companies send letters reminding about screening tests, medications, or disease control -- but will New York City start doing the same to doctors and patients? Receiving an official letter from NYC that your HgA1c is 11 and your diabetes is wildly out of control is unlikely to motivate people much, but it would be simple to study. From The New York Times:
As part of a broad new effort to better understand how diabetics manage their illness, the New York City Board of Health is ordering laboratories to pass along detailed information on individual tests that measure blood sugar levels to the city's health department.

It is the first such reporting and tracking effort in the country, and it is being closely watched by public health officials nationwide wrestling with ways to better control the epidemic of diabetes...

However, some critics of the effort worry that it is an invasion of patient privacy, especially since people will not be given the chance to opt out of having their information collected. There is also a fear that the information could find its way into the hands of insurance providers, who could, in turn, use it to discriminate against patients.

"I am shocked and dismayed to hear this news about A1c blood test results being given to the health department without patient knowledge or consent," said Robin Kaigh, a New York lawyer who has tracked medical privacy issues. She added, "In addition, this landmark step will cause other databases of sensitive patient information or disease registries to be seriously contemplated in the future..."
Technorati Tags: Diabetes, New York City, Medicine

Our Creepiest Genetic Invention, The Dog

Having recently adopted a French Bulldog puppy, I've developed a collection of posts on dogs. The latest is an introduction to the genetics of dogs in Slate:
Have you heard the latest news? We've decoded the DNA of dogs. Here's how the media-approved version of the story goes: We're showing our love for "man's best friend" by discovering and treating the genetic causes of his ailments. In return, we'll learn to treat the same ailments in ourselves.

It's a heartwarming story, but it's a fraud. The reason we targeted the dog genome for decoding is that it's useful for genetic research. The reason it's useful for genetic research is that dogs are neatly divided into breeds, each of which is plagued by specific diseases. And the reason dogs are divided into diseased breeds is that we made them that way. Dogs are the world's longest self-serving, ecologically reckless genetic experiment, perpetrated by the world's first genetically engineering species: us.
Technorati Tags: Dogs, Genetics

Wednesday, December 14, 2005

Nephrology Cases #9: Severe Metabolic Acidosis During A Suicide Attempt

From the New England Journal of Medicine:
A 73-year-old man presented with a self-inflicted stab wound to the abdomen. A plasma ethanol level of 27 mg per deciliter was found on preliminary toxicologic screening; the results of chemical analyses were normal. No internal injuries were found on exploratory laparotomy. Eight hours postoperatively, the patient became confused and was intubated because of respiratory distress. Arterial blood gas measurements showed a pH of 6.91, partial pressure of carbon dioxide of 12 mm Hg, and base excess of –30 mmol per liter. Blood chemical analyses showed a bicarbonate level of less than 5 mmol per liter, a creatinine level of 1.4 mg per deciliter (123.8 µmol per liter), an anion gap of 26, and serum osmolarity of 346 mOsm per liter with an osmolar gap of 38 mOsm per liter...
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Tuesday, December 13, 2005

Grand Rounds 2.12

Grand Rounds 2.12, this week's best posts of the medical blogosphere, is up at In The Pipeline.

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Betting on Bird Flu

On Nov. 1, Intrade, a Web site that allows people to bet on the likelihood of future events, issued a press release titled "Trading on Bird Flu -- 65% probability of U.S. case by March 2006!" The release announced that the trading activity on the exchange's bird flu contracts -- offering savvy "investors" a chance to gamble on when the first strain of the deadly H5N1 will be confirmed in the United States -- had doubled in the last month. The report, put out by Intrade P.R. executive Mike Knesevitch, ended with an ominous, sobering claim:

"Can these markets give us insight into global events like pandemics, hurricanes and politics? In the short history Intrade has put together, the answer is YES."
Technorati Tags: Avian Influenza, Avian Flu, Salon, Intrade

Monday, December 12, 2005

Awful British Hospital Humor

From Bad Signal:
I always thought HOUSE missed
a step by not adapting the hideous
acronymic codes used by doctors
in their notes. The British ones
were discovered first, but they're
used everywhere. The most famous
one is FLK, for Funny-Looking Kid,
sometimes modified by JLD -- Just
Like Dad, and, brilliantly, Normal
For Norfolk, a rural county of
tractors and farming communities.
CTO means Circling The Drain and
GPO is Good For Parts Only, not
things you want to see on the chart
when you've been in hospital a
while with a nasty cough. There's
also a Rule Of Five -- if you've got
more than five tubes in you, you're
fucked. PFO is a favourite: Pissed,
Fell Over. The Dirtbag Index is
horrendous -- divide the number
of tattoos by the number of teeth
to find how many baths the patient
has taken that year.
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"Doomsday Scenario is Unlikely" -- USA Today

Via USA Today:
So much for staying up at night worrying about "a transition to a lower vacuum state propagating outwards from its source at the speed of light," one of their catastrophe scenarios. But insomniacs still have some fodder, the pair concludes. Their estimate "does not apply in general to disasters that become possible only after certain technologies have been developed, for example, nuclear annihilation or extinction through engineered microorganisms. So we still have plenty to worry about."
Technorati Tags: Doomsday, Black Holes

Sunday, December 11, 2005

Coca-Cola Blak -- Coca-Cola with Coffee

From The Coca-Cola Website:
The Coca-Cola Company today announced that it will launch Coca-Cola Blāk in January in France, the first of several countries – including the United States - that are expected to introduce the new Coca-Cola and coffee fusion in 2006.

Coca-Cola Blāk is an invigorating and stimulating blend that has a perfect balance of the effervescent taste sensation of Coca-Cola and natural flavors, with real coffee. The lightly carbonated, mid-calorie beverage, which is designed to appeal to adult consumers, is yet another example how The Coca-Cola Company reaches out to new audiences and addresses new beverage occasions.
More on Slashdot.

Technorati Tags: Coca Cola Blak, Coca Cola

UK Patients Receiving Kidneys from Executed Chinese Prisoners

From Guardian Unlimited:
Kidney patients who need a transplant in Britain are being targeted by a medical group offering them new organs taken from executed Chinese prisoners...

The internet company makes it clear that the organs are from prisoners who are about to be executed. The prisoners apparently give their consent and are told that their families will receive money for the 'donation'.

Under the heading 'Where do kidneys come from?', the company states: 'A cadaveric kidney comes from a dead person and in the majority of cases in China, the dead people are prisoners, which allows for us to know at least two weeks ahead of time when the kidney will be ready.'
Technorati Tags: Kidney Transplanation, UK, China

Saturday, December 10, 2005

Flickr: Turkish Delight

"bought at the British import store in Poulsbo

tasty, but not sure it was worth the price paid for it in Narnia..."

From Flickr. Uploaded by Julie Leung on 7 Dec '05, 4.06pm PST.

The Lion, the Witch, and the Really Foul Candy - In Pursuit of Turkish Delight

Via Slate:
And so, with anticipation, I took a bite of the Turkish Delight. And a second later, spat it into my hand. It tasted like soap rolled in plaster dust, or like a lump of Renuzit air freshener: The texture was both waxy and filling-looseningly chewy. This … this? ... was the sweetmeat that led Edmund to betray his siblings and doomed Aslan to death on a stone slab? Watching the movie last week, I cringed watching Edmund push piece after squidgy red piece into his drooling mouth, shuddering to think that children in theaters everywhere were bound to start yammering for the candy and that on Christmas morning or Hanukkah nights, their faces would crumple with disappointment as their teeth sank into the vile jelly they had thought they wanted.
Technorati Tags: Slate, Turkish Delight

News from New York #18: Hazards of the Streets

Via The New York Daily News:
At least a dozen dogs were jolted yesterday when they stepped on an electrically charged sidewalk on the upper East Side, witnesses said.

None of the animals or their owners was injured, but the incidents raised fears that the streets of New York are still dangerous in foul weather.

Con Ed stepped up repairs and inspections of underground cables two years ago after 30-year-old Jodie Lane was killed when she stepped onto an electrified cable cover on E. 11th St. while walking her dogs...

Con Ed also was investigating two manhole explosions that destroyed a van in Brooklyn.

The explosions on Fifth Ave. in Park Slope within 10 minutes of each other sent pedestrians fleeing for cover, but there were no injuries.
Technorati Tags: News from New York, Electricity, Explosions

Flickr: Rainbow lights

From Flickr. Uploaded by King'76 on 6 Dec '05, 4.56pm PST.

Flickr: Kinkakuji - Golden Pavilion

"Japan - Kyoto

Best viewed in large size 1000 x 665"

From Flickr. Uploaded by Magall on 5 Dec '05, 12.18am PST.

Friday, December 9, 2005

Israelis Develop "Sabbath Clock" to Facilitate Passive Euthanasia

From the British Medical Journal:
A response delayed by a timer attached to a patient's ventilator will solve the Israeli government's wish to introduce passive euthanasia for terminally ill people and to allow them to die with dignity...

If a terminally ill patient older than 17 has requested in a living will that his life should not be extended by artificial means, a doctor will be allowed by law to carry out the patient's wish. An adult who has power of attorney may also make such a request on someone else's behalf. Being terminally ill is defined as having less than six months to live.

Active euthanasia and the withholding of nutrition will not be permitted under the new law because they violate Jewish law. But the legislation, expected to come into effect within a year, will allow the halting of ongoing support using a timer device. The family of a terminally ill patient will no longer have to go to court for permission to stop artificial life support if the patient has previously made it clear that that is his or her wish.

The timer, based on the idea of the Sabbath clock, used in religious Jewish homes to turn electrical devices on and off on Saturday, would operate for 24 hours at a time and set off a red light or alarm after 12. The patient or their representative could at any time request an extension. But if the dying person were determined not to have their life extended, the timer would turn off the ventilator at the end of the cycle.

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Meta Analysis in Lancet Finds No Unique Kidney Benefit for ACE Inhibitors or ARBs

An article published in the Lancet argues that there is no particular renoprotective effect of ACE inhibitors or angiotensin receptor blockers. As always, the results of meta analyses are questionable, but the results are provocative and go against current clinical guidelines. Via MedPage Today:
The best way to protect kidneys of diabetic patients is to lower blood pressure. Period.

So says Juan P. Casas M.D. and colleagues of the British Heart Foundation Laboratory at University College London, who reported that a meta-analysis of 127 randomized trials did not confirm a renoprotective effect for either ACE-inhibitors or angiotensin receptor blockers.

The purported benefit of either ACE inhibitors or ARBs comes from placebo-controlled studies, Dr. Casas and colleagues reported in the Dec. 10 issue of The Lancet. But when these agents were compared with other antihypertensive drugs that also substantially reduce blood pressure "there was no evidence of a significant salutary effect of ACE inhibitors or ARBs on renal outcomes in patients with diabetes."
From the Lancet:
Background A consensus has emerged that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-II receptor blockers (ARBs) have specific renoprotective effects. Guidelines specify that these are the drugs of choice for the treatment of hypertension in patients with renal disease. We sought to determine to what extent this consensus is supported by the available evidence.

Methods Electronic databases were searched up to January, 2005, for randomised trials assessing antihypertensive drugs and progression of renal disease. Effects on primary discrete endpoints (doubling of creatinine and end-stage renal disease) and secondary continuous markers of renal outcomes (creatinine, albuminuria, and glomerular filtration rate) were calculated with random-effect models. The effects of ACE inhibitors or ARBs in placebo-controlled trials were compared with the effects seen in trials that used an active comparator drug.

Findings Comparisons of ACE inhibitors or ARBs with other antihypertensive drugs yielded a relative risk of 0·71 (95% CI 0·49–1·04) for doubling of creatinine and a small benefit on end-stage renal disease (relative risk 0·87, 0·75–0·99). Analyses of the results by study size showed a smaller benefit in large studies. In patients with diabetic nephropathy, no benefit was seen in comparative trials of ACE inhibitors or ARBs on the doubling of creatinine (1·09, 0·55–2·15), end-stage renal disease (0·89, 0·74–1·07), glomerular filtration rate, or creatinine amounts. Placebo-controlled trials of ACE inhibitors or ARBs showed greater benefits than comparative trials on all renal outcomes, but were accompanied by substantial reductions in blood pressure in favour of ACE inhibitors or ARBs.

Interpretation The benefits of ACE inhibitors or ARBs on renal outcomes in placebo-controlled trials probably result from a blood-pressure-lowering effect. In patients with diabetes, additional renoprotective actions of these substances beyond lowering blood pressure remain unproven, and there is uncertainty about the greater renoprotection seen in non-diabetic renal disease.
Technorati Tags: ACE Inhibitors, Angiotensin Receptor Blockers, Kidney Disease

Medical Blogosphere Tag Cloud Weekly Update

The following are the top 100 keywords from the Medical Blogosphere Tag Cloud, a way of seeing at a glance what people are talking about online. The full cloud with links to individual posts is here.
access ... american ... american heart association ... avian flu ... bioethics ... bird flu ... blog ... blogosphere ... boston ... bush ... california ... canada ... carnival ... case ... cdc ... cell research ... clinic ... community ... computer ... contact ... death ... diagnosis ... doctors ... dog ... drugs ... email ... family ... federal ... feed ... flu ... flu pandemic ... food and drug administration ... google ... grand rounds ... guess ... health care ... heart ... heart attack ... heart disease ... holiday ... hope ... hospital impact ... hospitals ... hurricane katrina ... idea ... impact ... infectious ... intelligent design ... internal medicine ... job ... kent ... lead ... love ... mail ... media ... medical malpractice ... medical school ... medical students ... medications ... medicine ... merck ... money ... nejm ... new england journal ... new orleans ... new york ... nurses ... nursing ... pandemic ... parents ... photo ... physicians ... podcast ... popular ... product ... quality ... reading ... reason ... running ... science ... scientists ... search ... service ... south ... state ... stem cell ... stem cell research ... stem cells ... story ... tamiflu ... thanksgiving ... therapy ... united states ... vioxx ... wall ... wall street ... wall street journal ... war ... washington ... white
Technorati Tags: , , ,

Thursday, December 8, 2005

The Theory of Incompetent Design

Via Seed:
Don Wise, professor emeritus of geosciences at the University of Massachusetts Amherst, is the nation's foremost proponent of ID. No, Wise isn't getting ready to testify on behalf of the school board in Dover, PA. Rather, he advocates for a different version of the acronym: "incompetent design."

Wise cites serious flaws in the systems of the human body as evidence that design in the universe exhibits not an obvious source of, but a sore lack of, intelligence...
Technorati Tags: Incompetent Design, Evolution

New England Journal Says Merck Concealed Vioxx Data

Via The New York Times:
Merck misrepresented the results of a crucial clinical trial of Vioxx to play down the drug's heart risks, The New England Journal of Medicine said today.

The Journal's allegation may play a critical role in the thousands of lawsuits that Merck faces over Vioxx, a once-popular painkiller that has been linked to heart attacks and strokes. In the three lawsuits that have reached trial so far, Merck has contended that it promptly disclosed information about Vioxx's heart risks...

In an "Expression of Concern" posted this afternoon on its Web site, The Journal said the authors of the study had deleted data on strokes and other vascular problems suffered by patients in the Vigor trial two days before it submitted the results to the publication.

The authors also underreported the number of heart attacks suffered by patients taking Vioxx, claiming that there were 17 heart attacks when there were actually 20, The Journal said. The authors have been asked to correct the study, The Journal said.
The "Expression of Concern" is here.

Technorati Tags: Merck, Vioxx, New England Journal of Medicine

Nicotine Vaccine Shows Promise

From Reuters:
Research with a new nicotine vaccine shows that the vaccine is safe and well tolerated, with higher doses producing a greater rate of abstinence.

"We were pleased to see that because that indicates this vaccine does indeed have a significant impact on smoking behavior," Dr. Dorothy K. Hatsukami of the Tobacco Use Research Center in Minneapolis told Reuters Health. The finding of increased abstinence, she added, was "surprising.
Technorati Tags: Nicotine Vaccine, Smoking

Doctors in Voronezh, Russia: "Idiots are more dangerous than AIDS"

Regarding the Russian blood supply HIV contamination scandal, translated from the Russian, via Regnum:
Specialists of the Voronezh Regional Administration Healthcare Department are worried by the clamor stirred by some media concerning a case of HIV infection of one of the donors in Voronezh. “We are attentively studying the publications on the subject, and we do not rule out that we have to undertake measures to especially inventive ones,” an expert from the commission to investigate the incident told REGNUM. “Some of them have come to the point of speaking about hundreds of infected people, and about nearly general infection of the whole city. Have a look at the headlines in the Internet: ‘Medications from HIV-infected blood transfused to hundreds of Voronezh residents’, ‘Doctors in Voronezh have contaminated 208 people by HIV, including an infant’… Blood from one donor can be transfused to 208 patients only by a medicine dropper! Well, one of the media has reported that ‘208 donors were in infected by AIDS in Voronezh’. Really, there is a disease more dangerous than AIDS, and it is called idiotism.”
Technorati Tags: HIV, AIDS, Regnum

FDA Advises of Risk of Birth Defects with Paxil

From the FDA:
The Food and Drug Administration today is alerting health care professionals and patients about early results of new studies for Paxil (paroxetine) suggesting that the drug increases the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy. Paxil is approved for the treatment of depression and several other psychiatric disorders. FDA is currently gathering additional data and waiting for the final results of the recent studies in order to better understand the higher risk for birth defects that has been seen with Paxil.
Technorati Tags: Paxil, FDA, Birth Defects, Pregnancy

Pet Ownership and Human Health

From The Washington Post:
While many pet owners are sure their companions benefit their health, few take that belief as far as Mike Lingenfelter. The Alabama man credits Dakota, his Labrador retriever, with detecting several heart attacks before Lingenfelter knew he was having them...

The pet owning study reviewed research conducted since the 1980s that has helped popularize what BMJ called the "view that pet ownership could have positive benefits on human health." Reputed benefits include higher survival rates from heart attack, lower use of doctors' services, a reduced risk of asthma and allergies in children exposed to pets during the first year of life, reduced risk of cardiovascular disease and better physical and psychological well-being in the elderly.
The paper from the British Medical Journal is Pet Ownership and Human Health: A Review of Evidence and Issues.

Health Technorati Tags: Pets, Dogs, Myocardial Infarction, Heart Attack

"Trees May Be Bad for You"

From The New York Times:
In the effort to slow earth's rising temperatures, even a well-intentioned proposal could backfire, scientists said Wednesday.

One suggestion has been to grow more trees, which absorb carbon dioxide, the gas blamed for trapping heat. More trees mean more carbon dioxide removed from the air.

New computer simulations, however, indicate that establishing new forests across North America could provide a cooling effect for a few decades to a century, but that after that, they would lead to more warming.
Technorati Tags: Trees, Global Warming

Wednesday, December 7, 2005

Computerized Physician Order Entry is an Independent Risk Factor for Death?

Via Dr. Andy:
Computerized physician order entry (CPOE) is looked on as a panacea which will decrease medical error, improve efficiency, and improve patient safety. Only it looks like it has some major, unintended consequences, like increasing death according to an article titled "Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System" in this months Pediatrics.
GruntDoc also comments on this topic. The paper is here.

Technorati Tags: Computerized Physician Order Entry, Medical Informatics

Hilarious Journal Articles #32: Infant Masturbation Mistaken for a Movement Disorder

From Pediatrics:
Masturbation in Infancy and Early Childhood Presenting as a Movement Disorder: 12 Cases and a Review of the Literature

Purpose. Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements. Extensive and fruitless investigations may be pursued before establishing this diagnosis. Sparse literature is available regarding masturbatory behavior as a whole, but literature available as case reports describes common features. The purpose of this case series is to describe consistent features in young children with posturing accompanying masturbation.

Methods. Twelve patients presenting to a pediatric movement disorders clinic with a suspected movement disorder were determined to have postures and movements associated with masturbation. We reviewed the clinical history, examination, and home videotapes of these patients.

Results. Our patients had several features in common: (1) onset after the age of 3 months and before 3 years; (2) stereotyped episodes of variable duration; (3) vocalizations with quiet grunting; (4) facial flushing with diaphoresis; (5) pressure on the perineum with characteristic posturing of the lower extremities; (6) no alteration of consciousness; (7) cessation with distraction; (8) normal examination; and (9) normal laboratory studies.

. The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing. Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.
Thanks to Kevin, MD.

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Researchers Decode Dog Genome

From The New York Times:
Researchers have decoded the dog genome to a high degree of accuracy, allowing deep insights into the evolutionary history not only of Canis familiaris but also of its devoted companion species, Homo sapiens.

The dog whose genome has been sequenced is Tasha, a female boxer whose owners wish to remain anonymous, said Kerstin Lindblad-Toh, a biologist at the Broad Institute in Cambridge who led a large group of colleagues in the DNA sequencing effort. Their findings are being reported in Thursday's issue of the journal Nature.
From Nature:
Here we report a high-quality draft genome sequence of the domestic dog (Canis familiaris), together with a dense map of single nucleotide polymorphisms (SNPs) across breeds. The dog is of particular interest because it provides important evolutionary information and because existing breeds show great phenotypic diversity for morphological, physiological and behavioural traits. We use sequence comparison with the primate and rodent lineages to shed light on the structure and evolution of genomes and genes. Notably, the majority of the most highly conserved non-coding sequences in mammalian genomes are clustered near a small subset of genes with important roles in development. Analysis of SNPs reveals long-range haplotypes across the entire dog genome, and defines the nature of genetic diversity within and across breeds. The current SNP map now makes it possible for genome-wide association studies to identify genes responsible for diseases and traits, with important consequences for human and companion animal health.
Technorati Tags: Dogs, Genetics

Tuesday, December 6, 2005

Grand Rounds 2.11

Grand Rounds 2.11, this week's best posts of the medical blogosphere, is up at the Examining Room of Dr. Charles.

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Monday, December 5, 2005

Links to New CPR Guidelines from the American Heart Association

The 2005 CPR Guidelines contain many important changes. These changes are summarized in the Winter 2005-2006 issue of Currents. Highlights include
  • The ratio of compressions-to-ventilations has been changed to 30:2
  • Rescuers now deliver 1 shock (360J monophasic) followed by CPR, not 3 shocks
  • Lay rescuers no longer check for circulation
  • Many other algorithms have been simplified
The guidelines are published in the Nov 29, 2005 issue of Circulation. The following links have been formatted for easy printing and reading.
Part 1: Introduction
Part 2: Ethical Issues
Part 3: Overview of CPR
Part 4: Adult Basic Life Support
Part 5: Electrical Therapies. Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing
Part 6: CPR Techniques and Devices
Part 7.1: Adjuncts for Airway Control and Ventilation
Part 7.2: Management of Cardiac Arrest
Part 7.3: Management of Symptomatic Bradycardia and Tachycardia
Part 7.4: Monitoring and Medications
Part 7.5: Postresuscitation Support
Part 8: Stabilization of the Patient With Acute Coronary Syndromes
Part 9: Adult Stroke
Part 10.1: Life-Threatening Electrolyte Abnormalities
Part 10.2: Toxicology in ECC
Part 10.3: Drowning
Part 10.4: Hypothermia
Part 10.5: Near-Fatal Asthma
Part 10.6: Anaphylaxis
Part 10.7: Cardiac Arrest Associated With Trauma
Part 10.8: Cardiac Arrest Associated With Pregnancy
Part 10.9: Electric Shock and Lightning Strikes
Part 11: Pediatric Basic Life Support
Part 12: Pediatric Advanced Life Support
Part 13: Neonatal Resuscitation Guidelines
Part 14: First Aid
Major Changes in the 2005 AHA Guidelines for CPR and ECC. Reaching the Tipping Point for Change
Management of Conflict of Interest Issues in the Activities of the American Heart Association Emergency Cardiovascular Care Committee, 2000-2005
...and if you want more to read, see the Circulation supplement 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

For more lifehacks for healthcare, innovations, and best practices, see The Efficient MD.

(This post is for informational purposes only. Please see the disclaimer.)

Technorati Tags: , ,

Printing Organs on Demand

Via Wired News:
Led by University of Missouri-Columbia biological physics professor Gabor Forgacs and aided by a $5 million National Science Foundation grant, researchers at three universities have developed bio-ink and bio-paper that could make so-called organ printing a reality.

Here's how it works: A customized milling machine prints a small sheet of bio-paper. This "paper" is a variable gel composed of modified gelatin and hyaluronan, a sugar-rich material. Bio-ink blots -- each a little ball of cellular material a few hundred microns in diameter -- are then printed onto the paper. The process is repeated as many times as needed, the sheets stacked on top of each other.

Once the stack is the right size -- maybe two centimeters' worth of sheets, each containing a ring of blots, for a tube resembling a blood vessel -- printing stops. The stack is incubated in a bioreactor, where cells fuse with their neighbors in all directions. The bio-paper works as a scaffold to support and nurture cells, and should be eaten away by them or naturally degrade, researchers said.
Technorati Tags: Bioprinting

Study Suggests Caffeine Can Help Liver

Perhaps Nestle can use this to help market their fermented coffee beer. From The Washington Post:
Coffee and tea may reduce the risk of serious liver damage in people who drink too much alcohol, are overweight or have too much iron in the blood, researchers reported yesterday.

The study of nearly 10,000 people showed that those who drank more than two cups of coffee or tea per day developed chronic liver disease at half the rate of those who drank less than one cup each day.
Technorati Tags: Caffeine, Alcohol, Beer, Liver Disease

Sunday, December 4, 2005

Hilarious Journal Articles and

Scientific journal articles may be insightful, clever, and important -- and sometimes unnecessary, obvious, and dull -- but they may also be hilarious. For the last half year, I've collected over thirty examples of journal articles that are, in my opinion, exceedingly funny. Often these articles are humorous by intent -- and science is often dry, so humor is appreciated -- but sometimes the humor is unintended by the authors.

Examples of articles that have made the list include Big Bottoms Weaken Effectiveness of Injected Drugs, Honeymoon Meningitis, the Dangers of Sword Swallowing, Using Viagra Helps Protect Endangered Species, Scanning the Brains of Anxious People Saves Money, and the first in the series, Accidental Anal Intercourse: Does it Really Happen?

The full collection of articles may be found on is an online bookmarking service that allows you to easily browse links and share them with others, and it's been a useful way to organize the collection of Hilarious Journal Articles. Other topics that I've organized on include Doctor Stories, Patient Quotes of the Day, Nephrology Cases, Coffee Notes, and Avian Influenza. A complete list of categories may be found in the links section of the sidebar.

Technorati Tags: , , ,

Ultrafiltration, Congestive Heart Failure, & the RAPID-CHF Trial

For patients with fluid overload without severe renal failure, fluid removal via ultrafiltration with peripherally inserted IVs is an alternative to SCUF (slow continuous ultrafiltration) which uses conventional dialysis or hemofiltration machines and requires central IV access. The advantages of ultrafiltration (also called "aquafiltration") include
  • peripheral vs. central access
  • floor vs. ICU care
  • ultrafiltration may be performed by cardiologists and intensivists without needing to call a nephrologist (which potentially, might be a disadvantage to the patient)
CHF Solutions has been aggressively marketing the Aquadex FlexFlow Fluid Removal System which can remove up to half a liter of fluid an hour. Two small studies of ultrafiltration have been published in this month's Journal of the American College of Cardiology. Larger studies are underway. From the Press Release:
A device that performs ultrafiltration of blood, without requiring specialized nursing care or invasive central intravenous access, can reduce fluid overload in patients with congestive heart failure, according to a new study in the Dec. 6, 2005, issue of the Journal of the American College of Cardiology.

"We found that this form of ultrafiltration therapy was safe, effective and successfully applied to patients in a variety of hospital settings. Compared to patients receiving standard treatment with intravenous diuretics, patients undergoing ultrafiltration had more fluid removed in the first 24 and 48 hours and improved symptoms of heart failure and shortness of breath at 48 hours," said Bradley A. Bart, M.D., F.A.C.C., from the Minnesota Heart Failure Consortium in Minneapolis, Minnesota.

Patients admitted to the hospital with acute decompensated heart failure are suffering from symptoms primarily related to fluid build-up and congestion, including swelling around the feet and ankles, bloated abdomens, cough and shortness of breath.

The RAPID-CHF trial is the first randomized controlled trial of ultrafiltration for acute decompensated heart failure. As blood passes through the device, ultrafiltration removes water and some small molecules through a membrane, before the blood is returned to the patient.

Researchers randomly assigned 40 hospitalized patients to receive either usual care, including diuretic medicine in most cases, or a single eight-hour ultrafiltration treatment, in addition to usual care. The ultrafiltration was performed with a device that has been approved by the federal Food and Drug Administration for use outside of intensive care units and without specialized nursing or central intravenous access. The manufacturer of the device, CHF Solutions Inc., funded this study.
Thanks to Clinical Cases and Images for pointing me to the free full-text versions of the articles online.

Technorati Tags: Ultrafiltration, CHF Solutions, Aquafiltration, Heart Failure, Congestive Heart Failure, RAPID-CHF

Hepatitis Viruses: Collect Them All

Via Overheard in New York:
Chick: ...wait, what?
Man: Yeah, I have hepatitis.
Chick : Which one?
Man: ...A and C.

--Yaffa Cafe, St. Marks
Technorati Tags: Overheard in New York, Hepatitis

Doctor Stories #9: Conversation with a Psychopath

Conversation with a Psychopath is on Intueri, which wins my vote for best literary medical weblog.

Technorati Tags: Doctor Stories

Saturday, December 3, 2005

Is Human-To-Human Spread of Avian Flu Occuring?

Via WorldNetDaily:
Officials in at least two nations now suspect the avian flu bug has mutated into a virus that is being transmitted from human to human – a development world health authorities have estimated could result in the deaths of tens of millions...

Dr. Charoen Chuchottaworn, an avian-flu expert at the Public Health Ministry [in Thailand], said doctors reviewing the cases were alerted by the very mild symptoms present in both patients, neither of whom had had any recent contact with birds or poultry.

The doctors are unsure as to how either of the infected contracted the disease and have raised the possibility that the virus has traded its pathogenicity for ease of transmission.

Meanwhile, in Indonesia, the disease is spreading so rapidly, particularly in the capital of Jakarta, some health officials strongly suspect the long-dreaded mutation has already occurred.
Technorati Tags: Avian Flu, Avian Influenza

Friday, December 2, 2005

Patient Quote of the Day #7: "I'm willing to try it."

An 87 year old woman with irritable bowel syndrome: "I just saw an interview with Melissa Etheridge on TV. She said that smoking pot helped her stomach problems. I just want you to know, if you think I should smoke marijuana, I'm willing to try it."

Technorati Tags: ,


A woman in the subway is playing what I believe is the Harry Potter theme -- on a *saw* -- perfectly.

Clostridium Difficile Is Becoming A Wider Threat

From The New York Times:
A deadly bacterial illness commonly seen in people taking antibiotics appears to be growing more common, even in patients who are not taking such drugs, federal health officials warned on Thursday.

The bacterium, Clostridium difficile, has become a menace in hospitals and nursing homes, and last year it was blamed for 100 deaths over 18 months at a hospital in Quebec.

Recent cases in four states show that the bacteria are appearing more often in healthy people who have not been admitted to hospitals or even taken antibiotics, according to the Centers for Disease Control and Prevention.

"What exactly has made C-diff act up right now, we don't know," said Dr. L. Clifford McDonald, an epidemiologist at the centers.
From the CDC, Severe Clostridium difficile--Associated Disease in Populations Previously at Low Risk --- Four States, 2005:
Clostridium difficile is a spore-forming, gram-positive bacillus that produces exotoxins that are pathogenic to humans. C. difficile--associated disease (CDAD) ranges in severity from mild diarrhea to fulminant colitis and death. Antimicrobial use is the primary risk factor for development of CDAD because it disrupts normal bowel flora and promotes C. difficile overgrowth. C. difficile typically has affected older or severely ill patients who are hospital inpatients or residents of long-term--care facilities. Recently, however, both the frequency and severity of health-care--associated CDAD has increased; from 2000 to 2001, the rate of U.S. hospital discharge diagnoses of CDAD increased by 26% (1). One possible explanation for these increases is the emergence of a previously uncommon strain of C. difficile responsible for severe hospital outbreaks (2). Although individual cases of CDAD are not nationally reportable, in 2005, the Pennsylvania Department of Health (PADOH) and CDC received several case reports of serious CDAD in otherwise healthy patients with minimal or no exposure to a health-care setting. An investigation was initiated by the Philadelphia Department of Public Health (PDPH), PADOH, and CDC to determine the scope of the problem and explore a possible change in CDAD epidemiology. This report summarizes the results of the investigation in Pennsylvania and three other states, which indicated the presence of severe CDAD in healthy persons living in the community and peripartum women, two populations previously thought to be at low risk. The findings underscore the importance of judicious antimicrobial use, the need for community clinicians to maintain a higher index of suspicion for CDAD, and the need for surveillance to better understand the changing epidemiology of CDAD.
Technorati Tags: Clostridium difficule, C. Difficile, Medicine

Medical Blogosphere Tag Cloud Weekly Update

The following are the top 100 keywords from the Medical Blogosphere Tag Cloud, a way of seeing at a glance what people are talking about online. The full cloud with links to individual posts is here.
access ... ambulance ... american ... american heart association ... apos ... avian flu ... babies ... bioethics ... bird flu ... blog ... blogosphere ... brother ... bush ... california ... care system ... carnival ... case ... china ... cms ... computer ... contact ... death ... diagnosis ... doctors ... dog ... dogs ... drugs ... email ... emergency medicine ... exercise ... family ... fear ... feed ... fit ... flu ... food and drug administration ... friends ... google ... grand rounds ... guess ... h5n1 ... harry potter ... health care ... health care system ... heart ... heart attack ... helen ... hope ... hospital ceo ... hospital impact ... hospitals ... hurricane katrina ... icu ... idea ... impact ... intelligent design ... iowa ... job ... kentucky ... kentucky fried ... lead ... love ... mail ... media ... medicine ... medicines ... money ... nejm ... new england journal ... new orleans ... new york ... nurses ... nursing ... pandemic ... parents ... pharma ... photo ... physicians ... podcast ... popular ... reading ... reason ... science ... scientists ... search ... service ... shazam ... skeptical ... state ... stem cell research ... stem cells ... story ... submissions ... tamiflu ... theory ... therapy ... united states ... wall ... wall street journal ... washington
Technorati Tags: , , ,

LIFECOR Wearable Defibrillator

Via Medical Connectivity Consulting:
LifeVest is the world's first wearable defibrillator for patients who are at high risk for sudden cardiac arrest or sudden cardiac death.
Technorati Tags: LIFECOR, Defibrillator

Woman, 76, Donates Kidney to Son

From The Daily Mail:
A 76-year-old grandmother has become one of the oldest transplant donors in the country after she gave up a kidney to help her son, a hospital said...

A month after the operation, both are said to be doing well.

The record is believed to be held by an 81-year-old donor.
Technorati Tags: Kidney Donation, Kidney Transplanation, Transplanation