Wednesday, October 15, 2008

Netter for the iPhone

Would have loved this during anatomy. Looking at the video, I can almost smell the gristle and formaldehyde again. This is one of the few medical apps I haven't used, though — any medical students find it helpful?

Saturday, October 4, 2008

Precious Bodily Fluids, a New Nephrology Blog

de: Struktur von Milchsäure; en: Structure of ...Image via Wikipedia
Dr. Joel Topf is one of only two or three blogging nephrologists (including Dr. Arnold Kim, who publishes, so that may not count). Joel writes the excellent Precious Bodily Fluids blog. PBF not only contains a wealth of clinical information, but scores huge points for the Dr. Strangelove banner. He's also the author of The Fluid, Electrolyte, and Acid-Base Companion, perhaps the easiest-to-understand primer on these brain-twisting disorders. Via Precious Bodily Fluids:
Yesterday I gave a great lecture on interpreting ABG results. I added a problems set for gap-gap analysis and added a section on the osmolar gap. I also improved the anion gap section with my new favorite mnemonic. Forget PLUMSEEDS, forget MUDSLEEPS, forget MUDPILES. The new hotness is GOLD MARK:

* G Glycols
* O 5-Oxoproline (pyroglutamic acid)
* L L-Lactic acid
* D D-Lactic acid

* M Methanol
* A Aspirin
* R Renal failure
* K Ketoacidosis

Thursday, September 25, 2008

Sparklines and Hantavirus Nephropathy

Monday, September 15, 2008

How to Blog, by Merlin Mann

How To Blog
View SlideShare presentation or Upload your own. (tags: advice blogging)
And the talk itself, here.

Saturday, August 30, 2008

Transitioning Blog Comments to Disqus

I'm transitioning Kidney Notes' blog commenting system to Disqus. The old comments will — hopefully — still be there, but things may look strange for a bit.

Reblog this post [with Zemanta]

Thursday, July 31, 2008

Hello Health

Hello Health, originally uploaded by KidneyNotes.

Monday, July 7, 2008

The Controvery Over Cardiac CTAs

heart with coronary arteriesImage via Wikipedia
A few minutes later, Dr. Hecht studied the results. As he had expected, the angiogram revealed that Mr. Franks’s arteries were healthy. In some places, plaque had blocked 25 percent of their blood flow, but in general, cardiologists do not consider blockages clinically relevant until they reduce blood flow at least 70 percent.

After Mr. Franks finished dressing, he joined Dr. Hecht, who went over the results, explaining that his heart appeared healthy and that he would not need a stent. Still, Dr. Hecht recommended that Mr. Franks have another CT angiogram next year to check that the plaque was not thickening. Mr. Franks agreed, pronounced himself satisfied and left.

For Mr. Franks, the test was quick and painless. But it subjected him to a significant dose of radiation.

Based on a reporter’s notes about the duration of the scan and the power output reported by the scanner, Dr. Brenner of the Center for Radiological Research estimated that Mr. Franks had received 21 millisieverts of radiation — even more than a typical test, equal to about 1,050 conventional chest X-rays.

Given the radiation risks, Dr. Ralph Brindis, another cardiologist, said Dr. Hecht had erred. Because Mr. Franks had already taken a nuclear stress test with normal results, he did not need a CT angiogram, said Dr. Brindis, vice president of the American College of Cardiology. And particularly because the scan’s results were benign, he said, Dr. Hecht should not have recommended a follow-up test.

“The biggest problem we have with radiation is that the doses are cumulative and additive,” Dr. Brindis said. “So the concept of doing serial CT testing on asymptomatic patients, I think, is abhorrent. I cannot justify that.”

Dr. Hecht said he sharply disagreed with Dr. Brindis. The scan was appropriate for Mr. Franks, despite his normal results from the nuclear stress test, because of Mr. Franks’s other risk factors for heart disease, including his higher-than-average calcium score, Dr. Hecht said. And he said he recommended a follow-up scan next year so he could see how quickly the plaque in Mr. Franks’s arteries was thickening.
The article attempts to reconcile two sharply opposing points of view. In my opinion — and I hasten to add that I'm not a cardiologist or radiologist — cardiac CTAs are at the same level of clinical usefulness and acceptance now that CTAs of the pulmonary arteries were several years ago. It took years for a CTA of the pulmonary arteries to a widely accepted test for diagnosing or excluding pulmonary emboli. Within the next several years, I would expect that CTAs of the coronary arteries will become a well-accepted test for diagnosing or excluding coronary disease.

Zemanta Pixie

Thursday, June 26, 2008

Resistant Hypertension: Diagnosis, Evaluation, and Treatment, from the AHA

Conventional (mechanical) sphygmomanometer with aneroid manometer and stethoscopeImage via Wikipedia
Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research -- Calhoun et al. 51 (6): 1403 -- Hypertension
Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.
Zemanta Pixie

Tuesday, June 24, 2008

Gastric Bypass May Improve Renal Function in Obesity Related Glomeruopathy

Roux-en-Y gastric bypass.Image via Wikipedia
Gastric Bypass Can Improve Renal Function in Patients With Morbid Obesity, Via Medscape:
Patients with morbid obesity who also have chronic renal disease (CRD) may improve or stabilize renal function after gastric bypass, according to a study presented here at the American Society for Metabolic & Bariatric Surgery 25th Annual Meeting.
[Interesting. Obesity related glomerulopathy is mediated by hyperfiltration, which might theoretically be reversible with gastric bypass.]
Zemanta Pixie

Monday, June 2, 2008

Life Hacks for Doctors: An Introduction

The Efficient MD Blog
The Efficient MD Wiki

Life Hacks for Doctors is the Slideshow of the Day on Slideshare

Just received this email:
Your slideshow Life Hacks For Doctors has been selected as the 'Slideshow of the Day' on the SlideShare homepage.

Our editorial team would like to thank you for this awesome creation.

- The SlideShare team
Nice start to the week. On the home page, Slideshare also highlights other slideshows on Doctors, Medicine, and Web 2.0.

Sunday, June 1, 2008

Manhattan Solstice

Thursday, May 29, 2008

Fierce on fungus. Kinder to kidneys.

Saturday, May 24, 2008

Nephrogenic Systemic Fibrosis

Nephrogenic systemic fibrosis, a scleroderma-like condition, is related to the use of gadolinium in patients with severe renal failure. This dialysis patient developed nephrogenic systemic fibrosis just 3 months after being exposed to gadolinium for an MRA.

Monday, May 12, 2008

Introducing The Efficient MD Wiki

Visit the Efficient MD Wiki at

Wikis — collaborative websites — are powerful tools for education. The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine.

Although this Wiki is currently in its infancy, it is growing rapidly and needs your help. Please post your ideas, mnemonics, best practices, tricks, timesavers, presentations, helpful links, or other advice you'd care to share. (Don't worry if your writing is disorganized. Someone will always edit it later.)

While posting anonymously is allowed, if you'd like to have a link to your personal website added to the home page — as our way of saying thanks — please join the wiki and send us a message.

Please see the posting guidelines and disclaimer. The Efficient MD Wiki is an ongoing experiment, and comments are welcome.


Joshua Schwimmer, MD, FACP, FASN; The Efficient MD Blog (in association with the American College of Physicians); Clinical Instructor in Medicine, Columbia University College of Physicians & Surgeons and Clinical Assistant Professor of Medicine, New York University School of Medicine

Ves Dimov, MD; Clinical Cases and Images; Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

(Also posted on The Efficient MD Blog.)

Wednesday, May 7, 2008

"Lipitor titration is a failed step."

AtorvastatinLipitor Image via WikipediaThree Vytotin/Zetia reps just came to me and said, "When do you feel comfortable using Zetia? After all, Lipitor titration is a failed step. It only reduces LDL by 6%."

I gently referred them to the PROVE IT trial, asked them to come back when they had positive mortality data, and walked away.

Has anyone else encountered this strategy by the Zetia reps?

Tuesday, May 6, 2008

You'd Never Confuse Diabetes Mellitus With Diabetes Insipidus. The New York Yimes Has It Wrong.

Mechanism of insulin release in normal pancreatic beta cells.  Insulin production is more or less constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuoles pending release, via exocytosis, which is triggered by increased blood glucose levels.Image via WikipediaI'm still puzzling over this article in the New York Times, "Some Diabetics Don't Have What They Thought They Had." The article seems to imply -- and some other news outlets have picked up -- that some children diagnosed with type 1 diabetes mellitus (DM) actually have diabetes insipidus (DI). What the article means to imply, I think, is that some children with type 1 DM actually have maturity onset diabetes of the young (MODY). (I've looked, but I could not find a situation in which you'd ever confuse type 1 DM and DI. In DI, for example, you wouldn't have glucose in the urine.)

Why is this important? Because if the myth propagates through the media that you can easily confuse DI and DM, countless younger adult patients with DM will approach their doctors demanding that they be tested for DI, which will require a lengthy explanation of how the two could not be confused...

On the other hand, I've seen patients with MODY misdiagnosed as having type 1 DM -- and they eventually are able to stop insulin and switch to oral therapy. This is the real message of the NYT article, I think, and it's great when it happens.

Thursday, May 1, 2008

Acute Renal Failure Associated with Cosmetic Soft-Tissue Filler Injections of Silicone in the Buttocks

The moral of the story? Do not get injections of silicone in the buttocks by an unlicensed practitioner. Via the MMWR:
Soft-tissue fillers are substances injected to augment or enhance the appearance of lips, breasts, buttocks, or other soft tissues. Previous reports have linked the administration of soft-tissue fillers, usually liquid silicone, by unlicensed practitioners to severe adverse events, including death On December 27, 2007, the North Carolina Division of Public Health (NCDPH) was notified of three cases of renal failure occurring among women who had received cosmetic soft-tissue filler injections at a facility in North Carolina (facility A). This report summarizes the clinical findings for these cases and describes the subsequent public health investigation. All injections were administered by a practitioner with no medical training or supervision (practitioner A). Investigators were not able to identify the substances injected. Although records indicated that the injections contained liquid silicone, this substance has not been associated previously with renal failure. These findings underscore the risks posed by cosmetic injections administered by unlicensed practitioners. Public health officials should be alert for adverse events associated with these injections and take all necessary actions to prevent additional injuries.

Case Reports

Case 1. On December 8, 2007, a District of Columbia woman aged 42 years, who was previously healthy except for a history of anemia, received cosmetic soft-tissue filler injections in her buttocks at facility A. Records specifying the substance injected were unavailable. On December 22, the woman received additional injections at facility A. According to facility records, 300 mL of "dermal silicone/saline solution" were injected into each buttock (600 mL total) during the December 22 visit. The woman experienced headache and vomiting within 30 minutes of these injections and noted that her urine looked like purple blood. She went to an emergency department (ED) in Maryland on December 24 with fatigue, vomiting, and headache and was found to be in acute renal failure, with a serum creatinine level of 4.2 mg/dL (normal: 0.8--1.4 mg/dL). Laboratory investigations, including urine testing for heavy metals, did not reveal a specific etiology. Her serum creatine phosphokinase (CPK) level was 411 U/L on the day of admission (normal: 25--200 U/L). She remained hospitalized for 10 days. Hemodialysis was not required, and her serum creatinine level subsequently returned to normal.

Case 2. On December 8, 2007, a previously healthy Illinois woman aged 26 years received cosmetic soft-tissue filler injections in her buttocks at facility A. Records indicated that she received 500 mL of "25% silicone dermal filler and 75% saline solution" in each buttock (1,000 mL total). She received additional injections at facility A on December 22. Records from December 22 indicate that 400 mL of a "50% concentration of silicone oil dermal filler and saline solution" were injected into each buttock (800 mL total). Within 1 hour of these injections, she experienced headache and nausea and noted that her urine had a burgundy color. She went to an Illinois ED on December 23 with nausea, headache, and fatigue and was found to be in acute renal failure, with a serum creatinine level of 4.0 mg/dL. Serum CPK was 517 U/L on the day of admission. The patient's renal function worsened, and hemodialysis was initiated. A renal biopsy on December 27 revealed severe acute tubular necrosis with cast formation. The casts were not myoglobin or hemoglobin; pathologists were unable to determine their composition, despite the use of specialized stains. No heavy metals were identified in urine specimens, and no other specific etiology was identified. The woman remained in the hospital for 13 days. Hemodialysis was discontinued after 5 weeks, and the woman subsequently regained normal kidney function.

Case 3. A previously healthy Maryland woman aged 26 years received soft-tissue filler injections in her buttocks at facility A on December 8, 2007, and again on December 22. No records were available from either date. The woman developed abdominal pain, lightheadedness, and nausea within 1 hour after the second procedure. She went to an ED on December 26 with fatigue and vomiting and was found to have a serum creatinine level of 11 mg/dL. Hemodialysis was initiated. A renal biopsy on January 11, 2008, demonstrated acute interstitial nephritis with substantial numbers of eosinophils, consistent with a toxic or allergic etiology. Eosinophilia was not found on peripheral blood smears. No heavy metals were identified in urine specimens. She remained in the hospital for 14 days; hemodialysis was discontinued within 1 week after discharge, and her serum creatinine level subsequently returned to normal.
Image: Wikipedia

Tuesday, April 22, 2008

Kidney Dissection

Photo: William B. Gruber

"This dissection of the kidneys was done after red latex was injected into the arteries and blue latex into the veins."

See The Body in Depth from The New York Times.

Monday, April 21, 2008

Russian Starbucks, Brighton Beach, Brooklyn

Thursday, April 17, 2008

Hilarious Journal Articles #98: In Jazz, Brain Takes Five

An MRI scan of a human head, an example of a  biomedical engineering application of electrical engineering to diagnostic imaging.  Click here to view an animated sequence of slices.Image via WikipediaNeural Substrates of Spontaneous Musical Performance: An fMRI Study of Jazz Improvisation:
To investigate the neural substrates that underlie spontaneous musical performance, we examined improvisation in professional jazz pianists using functional MRI. By employing two paradigms that differed widely in musical complexity, we found that improvisation (compared to production of over-learned musical sequences) was consistently characterized by a dissociated pattern of activity in the prefrontal cortex: extensive deactivation of dorsolateral prefrontal and lateral orbital regions with focal activation of the medial prefrontal (frontal polar) cortex. Such a pattern may reflect a combination of psychological processes required for spontaneous improvisation, in which internally motivated, stimulus-independent behaviors unfold in the absence of central processes that typically mediate self-monitoring and conscious volitional control of ongoing performance. Changes in prefrontal activity during improvisation were accompanied by widespread activation of neocortical sensorimotor areas (that mediate the organization and execution of musical performance) as well as deactivation of limbic structures (that regulate motivation and emotional tone). This distributed neural pattern may provide a cognitive context that enables the emergence of spontaneous creative activity.
The collection of Hilarious Journal Articles is here.

Wednesday, April 16, 2008

Hilarious Journal Articles #97: People Who Wear Glasses Aren't Geeks

The dome of the Dining building in Newman College, University of Melbourne, as seen from the courtyard.Image via WikipediaThe Genes in Myopia (GEM) Twin Study: “We have literally busted the myth that people who wear glasses are introverted or have particular personality characteristics. They are more likely to be agreeable and open, rather than closed and introverted,” said Prof Paul Baird of the University of Melbourne’s Centre for Eye Research Australia.

The collection of Hilarious Journal Articles is here.

Drug Advertising Has Gone Viral: Anti-Claritin Pro-Zyrtec Ad in NYC

"Missing: 2 hours. Last seen: while waiting for Claritin to start working. If found please call: 1-800-4-ZYRTEC." Apparently, drug advertising has gone viral.

Hilarious Journal Articles #96: Chocolate Milk Better Than No Milk at All

Banana, strawberry, caramel and lime flavoured milk in a New Zealand supermarket.Image via WikipediaFrom The Journal of the American Dietetic Association, "Drinking Flavored or Plain Milk Is Positively Associated with Nutrient Intake and Is Not Associated with Adverse Effects on Weight Status in US Children and Adolescents":
Children and adolescents who included flavored milk in their diets reported higher total milk intakes than consumers of exclusively plain milk. Intakes of vitamin A, calcium, phosphorus, magnesium, potassium, and saturated fat (adjusted for energy intake and age) were generally comparable among milk drinking groups, whereas intakes by milk nondrinkers were significantly lower. Among females aged 12 to 18 years, calcium intakes by flavored and exclusively plain milk drinkers were 992+/-41.5 and 1,038+/-22.5 mg/day, respectively, whereas intake by nondrinkers was 576+/-11.7 mg/day. Intake of added sugars did not differ between flavored milk drinkers and milk nondrinkers. BMI measures of milk drinkers were comparable to or lower than measures of nondrinkers.
The collection of Hilarious Journal Articles is here.

Tuesday, April 15, 2008

Hilarious Journal Articles #95: Other People Slow You Down

Seeing vs. believing: Is believing sufficient to activate the processes of response co-representation?:
It has been suggested that the observation of another person's action affects the behavior of the observer because the observation of action leads to the excitation of similar response codes in the observer. It is unknown, however, if one must witness the action or if it is sufficient for one to believe that the other agent is responding for response co-representation to occur. To this end, participants in the present study performed a joint spatial-compatibility task with a confederate when: (1) the confederate sat beside the participant; and, (2) the confederate left the room and told the participant that they would continue to perform their component of the task on a networked computer in another room. Even though participants believed that the confederate performed the task in another room, joint spatial-compatibility was only observed when the confederate was present. These results reveal that the actions of another person may only be represented by the observer when the observer is able to witness a portion of the action.

Monday, April 14, 2008

Hilarious Journal Articles #94: Roads Not Taken Disappear More Quickly Than We Realize

Potato ChipsImage via WikipediaWhy People Misimagine the Future: The Problem of Attentional Collapse:
Gilbert presents the results of four experiments, all involving predicted versus actual enjoyment of a very simple experience—eating potato chips. In three of the experiments, participants predicted how much they would like eating potato chips before, after, or instead of eating a much better food (chocolate) or a much worse food (sardines). They then ate the chips and reported how much they liked them. The results showed that the chocolate and the sardines had a large impact on participants’ predictions, but no impact whatsoever on their actual experiences. Those participants who compared the chips to sardines overestimated how much they’d enjoy eating the chips, and those who compared them to chocolate underestimated how much they’d enjoy eating the chips.
The collection of hilarious journal articles is here.

Tuesday, April 1, 2008

Hilarious Journal Articles #93: Gossip Boosts Cognitive Functioning

The scope of social psychological research. Adapted from Cote and Levine (2002).Image from WikipediaVia the Personal and Social Psychology Bulletin:
Social interaction is a central feature of people's life and engages a variety of cognitive resources. Thus, social interaction should facilitate general cognitive functioning. Previous studies suggest such a link, but they used special populations (e.g., elderly with cognitive impairment), measured social interaction indirectly (e.g., via marital status), and only assessed effects of extended interaction in correlational designs. Here the relation between mental functioning and direct indicators of social interaction was examined in a younger and healthier population. Study 1 using survey methodology found a positive relationship between social interaction, assessed via amount of actual social contact, and cognitive functioning in people from three age groups including younger adults. Study 2 using an experimental design found that a small amount of social interaction (10 min) can facilitate cognitive performance. The findings are discussed in the context of the benefits social relationships have for so many aspects of people's lives.
The collection of Hilarious Journal Articles is here.

Thanks to Joe.

Monday, March 31, 2008

Stroke of insight: Jill Bolte Taylor on

"Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story of recovery and awareness -- of how our brains define us and connect us to the world and to one another."

Hilarious Journal Articles #92: Happy Hours in the Lab are OVER

Alcoholic beveragesImage from WikipediaSent to me by a cardiologist friend with the subject, "Happy Hours in the lab are OVER." Thanks, Huck.

"A possible role of social activity to explain differences in publication output among ecologists:"
Publication output is the standard by which scientific productivity is evaluated. Despite a plethora of papers on the issue of publication and citation biases, no study has so far considered a possible effect of social activities on publication output. One of the most frequent social activities in the world is drinking alcohol. In Europe, most alcohol is consumed as beer and, based on well known negative effects of alcohol consumption on cognitive performance, I predicted negative correlations between beer consumption and several measures of scientific performance. Using a survey from the Czech Republic, that has the highest per capita beer consumption rate in the world, I show that increasing per capita beer consumption is associated with lower numbers of papers, total citations, and citations per paper (a surrogate measure of paper quality). In addition I found the same predicted trends in comparison of two separate geographic areas within the Czech Republic that are also known to differ in beer consumption rates. These correlations are consistent with the possibility that leisure time social activities might influence the quality and quantity of scientific work and may be potential sources of publication and citation biases.
The collection of Hilarious Journal Articles is here.

New Articles of Note from the New England Journal of Medicine

Structural diagram of ramipril. Created using ACD/ChemSketch 8.0 and Inkscape.Image from WikipediaTelmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

ACE Inhibitors in Cardiovascular Disease — Unbeatable?

Treatment of Hypertension in Patients 80 Years of Age or Older

Tuesday, March 25, 2008

Questionable Choice for Doctor's Lobby Decor

Wednesday, March 12, 2008

Green Urine. Happy St. Patrick's Day!

Via The New England Journal of Medicine. Thanks to my wife, who's great at finding stuff like this.

Thursday, February 28, 2008

NYC Subway Ads -- Lung Cancer

NYC Subway Ads -- Lung Cancer, originally uploaded by KidneyNotes.

Tuesday, February 26, 2008

Nephritic Syndrome Workup

Nephritic Syndrome Workup, originally uploaded by KidneyNotes.

Monday, February 18, 2008

Hilarious Journal Articles #91: Parkinson's Disease Patients Benefit From Tango

Via the Journal of Neurologic Physical Therapy:
Effects of Tango on Functional Mobility in Parkinson's Disease: A Preliminary Study.

Recent research has shown that dance, specifically tango, may be an appropriate and effective strategy for ameliorating functional mobility deficits in people who are frail and elderly. Individuals with Parkinson's disease (PD) experience declines in functional mobility that may be even more pronounced than those experienced by frail elderly individuals without PD. The purpose of this study was to compare the effects of two movement programs: tango classes or exercise classes. Nineteen subjects with PD were randomly assigned to a tango group or a group exercise class representative of the current classes offered in our geographical area for individuals with PD. Subjects completed a total of 20 tango or exercise classes and were evaluated the week before and the week following the intervention. Both groups showed significant improvements in overall Unified Parkinson's Disease Rating Scale (UPDRS) score and nonsignificant improvements in self-reported Freezing of Gait. In addition, the tango group showed significant improvements on the Berg Balance Scale. The exercise group did not improve on this measure. Finally, the tango group showed a trend toward improvement on the Timed Up and Go test that was not observed in the exercise group. Future studies with a larger sample are needed to confirm and extend our observation that tango may be an effective intervention to target functional mobility deficits in individuals with PD.
The collection of hilarious journal articles is here.

Green iPhone Camera Problem

Wednesday, February 6, 2008

Heath Ledger's Drug Interactions

According to the Chief Medical Examiner of New York, Heath Ledger "died as the result of acute intoxication by the combined effects of oxycodone (Percocet), hydrocodone (Vicodin), diazepam (Valium), temazepam (Restoril), alprazolam (Xanax), and doxylamine (Unisom)."

To illustrate why he died, the following is a list of potential drug interactions from Epocrates, an online drug database. Nearly everything interacted with everything else:

1. diazepam <-> oxycodone
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

2. diazepam <-> temazepam
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

3. diazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

4. diazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

5. oxycodone <-> temazepam
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

6. oxycodone <-> Vicodin
caution advised, consider dose reduction: combo may incr. risk of CNS and resp. depression, profound sedation, hypotension, other adverse effects (additive effects)

7. oxycodone <-> Xanax
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

8. temazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

9. temazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

10. Vicodin <-> Xanax
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

To mitigate Pains in the Kidneys (from 1696)

Text not available

Via Google Book Search.

Tuesday, February 5, 2008

Why You Must Read Intueri

Maria writes:
Hospital staff can easily tell when the medical center has hired new telephone/paging operators: They sound absolutely terrified when they announce codes.

To their credit, they try to speak calmly and clearly, but their voices invariably betray their fears:

“Code one-nine-nine, second floor, south wing, room twenty… code one-nine-nine, SECOND floor, SOUTH wing, room TWENTY… CODE ONE-NINE-NINE SECOND FLOOR SOUTH WING ROOM TWENTY—”

oh my GOD someone just told me that someone is dying will you PLEASE hurry up and DO SOMETHING

Frozen Grand Central (from Improv Everywhere)

Monday, February 4, 2008

Pedialyte Pops

Note: If you're sick, frozen pedialyte pops aren't half bad.

Thursday, January 31, 2008

Hilarious Journal Articles #90: The Impact of Video Games on Surgeons

Arch Surg -- The Impact of Video Games on Training Surgeons in the 21st Century, February 2007, Rosser et al. 142 (2): 181:
Background Video games have become extensively integrated into popular culture. Anecdotal observations of young surgeons suggest that video game play contributes to performance excellence in laparoscopic surgery. Training benefits for surgeons who play video games should be quantifiable...

Results Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03). Overall Top Gun score (time and errors) was 33% better (P<.005) for video game players and 42% better (P<.01) if they played more than 3 h/wk. Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top tertile made 47% fewer errors, performed 39% faster, and scored 41% better (P<.001 for all) on the overall Top Gun score. Regression analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.

Conclusions Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.

At Outside Hospital, We Can Cath You.

Sunday, January 27, 2008

Flickr: NASA

209022main_image_1002_946-710, originally uploaded by warrenellis.

Wednesday, January 23, 2008

Announcement Pending

In case anyone wondered: I've been quieter than usual because I'm
working on a project behind the scenes that I hope to have permission
to announce in the next few weeks. It's big, it will involve the
medical blogosphere, and it will potentially be very useful. Things
are developing. More info to come.

Monday, January 21, 2008