The Hyperbolic Chamber

From The Onion:

OAK RIDGE, TN--After six grueling years of Herculean research, scientists at the Oak Ridge National Laboratory pronounced EHC-1 Alpha, the new hyperbolic chamber, "an unquestionably, undeniably, fantastically revolutionary milestone in the history of science, mankind, and the universe, all of which it will undoubtedly change forever."

"Hyperbole researchers have arrived at, without possibility of argument or refutation, the single greatest moment in all of creation, now and forevermore," said the project's lead scientist, Dr. Lloyd Gustaveson, activating the hyperbolic chamber's gazillion-ultra-watt semantic resonator at a gala launch party Monday. "The divine flame kindled by our new hyperbolic chamber will cast its light down through the centuries, making the Promethean fire that brought forth life on earth seem like a brief and guttering spark. Behold—we recast the cosmos in the image of the ultimate!"

Legionella Pneumonia (Legionnaires' Disease) at New York Presbyterian / Columbia University Medical Center

When I was an intern, an otherwise healthy 21 year old man who worked at a nearby pizza place was admitted with pneumonia. He rapidly went into shock and died within a few days. He had Legionella, presumably acquired from the water supply at his workplace. The most horrific cases of pneumonia I've seen in immunocompetent young people have been Legionella.

At New York Presbyterian, at least four patients recently acquired Legionella from the hospital's water supply. From the New York Times:

Legionnaires' disease is a bacterial infection with pneumonia-like symptoms that first became widely known after a 1976 outbreak killed 34 people attending an American Legion convention in Philadelphia. According to the Centers for Disease Control and Prevention, 8,000 to 18,000 people contract the disease each year in the United States, and it is rarely fatal except for people with weakened immune systems.

The hospital's disclosure deepened a mystery surrounding what had appeared to be a minor, nonlethal outbreak of the disease at the Milstein building last month. Four patients contracted the disease from the tainted water; two were treated and discharged, the hospital said, and two died...

Traces of the bacteria that cause Legionnaires' disease are almost always present in New York City's water supply. Dr. Victor Yu, the chief of infectious diseases at the Pittsburgh Veterans Administration Health Care Center and an expert on the disease, estimated that the bacteria were present in the water supplies of about 70 percent of city hospitals.

"At many hospitals there are probably people contracting it and dying from it without anyone knowing it," said Dr. Yu...

I heard Dr. Yu lecture on hospital-acquired pneumonia a few years ago. I asked whether, given the presence of Legionella in hospitals, we should be empirically treating and testing for this organism in every hospitalized patient with a new pneumonia. He said there was no right answer to this question. (For Dr. Yu's reply, see below.) It isn't standard practice to tailor the antibiotic coverage of hospital-acquired pneumonia to always cover Legionella. Should this change?

(Hospital-acquired Legionella is apparently not rare. A Medline search of "Legionella and hospital-acquired pneumonia" is here.)

Addendum: Dr. Yu was kind enough to correct my post and direct me to guidelines on Legionella. This was his response:

Thank you for referring me to your blog and your overview of Legionnaires disease.

I think there is a difference in what you remembered and what I might have said. In regard to the question as to whether "every patient hospitalized for pneumonia should undergo legionella testing given its presence in the water supply", you claimed that I said that "there was no right answer".

There certainly is a right answer and it is the one that you proposed. Absolutely, if legionella is in the water supply you MUST perform legionella testing for every hospitalized patient with a new pneumonia. That has been my message to all physicians since I first advocated it in 1986 in a review article on hosp-acquired LD for Mort Swartz/Jack Remington book on infections. It is embedded in the ACHD Guidelines on our website (www.legionella.org) and all my review articles on this subject. That is why I am such a forceful advocate for routine testing for legionella in the water. If legionella is found, the lab tests for legionella should be available in-house and performed for all patients with hosp-acquired pneumonia. If there is uncertainty on the etiology of the pneumonia, a quinolone should be given empirically, both for gram-neg rod and legionella coverage. See any of my review articles and the ACHD Guidelines, pages 6 - 7. Figs 1 and 2 on the Home Page of www.legionella.org.

More posts on Legionella are here.

Praising Bloglines

I regularly read over 70 feeds. Bloglines makes this absurdly simple. From the site:

Bloglines is a FREE online service for searching, subscribing, creating and sharing news feeds, blogs and rich web content. With Bloglines, there is no software to download or install -- simply register as a new user and you can instantly begin accessing your account any time, from any computer or mobile device...

Bloglines is a window to a whole new world of dynamic content that is being created and distributed over the new "live" web. You can make your own personalized news page tailored to your unique interests from our index of tens of millions of live internet content feeds, including articles, blogs, images and audio. And it's FREE!

Low Oxygen Levels in Airplane Passengers

Over half of airline passengers in this study had oxygen saturation levels of less than 94%, a level which may prompt the administration of supplemental oxygen in hospitalized patients.

The effect of high altitude commercial air travel on oxygen saturation

Anaesthesia 2005 60:5 p. 458

Air travel has increased steadily over the last decade, and its effect on the health of passengers has been the subject of much debate. There is a paucity of evidence on the effects of air travel on oxygen saturation in general populations. The peripheral oxygen saturation and pulse rate of 84 passengers, aged 1-78 years, were measured by pulse oximetry at ground level and altitude during air travel. There was a statistically significant reduction in oxygen saturation in all passengers traveling long haul and short haul flights (p < 0.05). The mean [range] (SD) SpO2 for all flights at ground level was 97% [93-100] (1.33) and at cruising altitude 93% [85-98] (2.33). Fifty-four per cent of passengers had SpO2 values of 94% or less at cruising altitude. This is a value which may prompt physicians to administer supplemental oxygen in hospital patients.

Renalase

From U.S. News & World Report:

Patients with end-stage kidney disease also face a much higher risk of heart disease. Scientists say they've uncovered a pathway that could explain this: a previously unknown protein that may act as a powerful modulator of cardiovascular function. They combed through 114 genes, looking for ones that would be particularly active in the kidneys. A deficiency of one (now dubbed renalase) looks like the culprit.

Renalase appears to help metabolize excess adrenaline, a hormone that jump-starts heart rate and blood pressure and can prompt heart attacks. Yale University's Jianchao Xu, lead author of the paper in the Journal of Clinical Investigation, speculates that renalase may someday offer a treatment for the country's No. 1 killer, heart disease.

From JCI:

Renalase is a novel, soluble monoamine oxidase that regulates cardiac function and blood pressure

The kidney not only regulates fluid and electrolyte balance but also functions as an endocrine organ. For instance, it is the major source of circulating erythropoietin and renin. Despite currently available therapies, there is a marked increase in cardiovascular morbidity and mortality among patients suffering from end-stage renal disease. We hypothesized that the current understanding of the endocrine function of the kidney was incomplete and that the organ might secrete additional proteins with important biological roles.

Here we report the identification of a novel flavin adenine dinucleotide-dependent amine oxidase (renalase) that is secreted into the blood by the kidney and metabolizes catecholamines in vitro (renalase metabolizes dopamine most efficiently, followed by epinephrine, and then norepinephrine). In humans, renalase gene expression is highest in the kidney but is also detectable in the heart, skeletal muscle, and the small intestine. The plasma concentration of renalase is markedly reduced in patients with end-stage renal disease, as compared with healthy subjects. Renalase infusion in rats caused a decrease in cardiac contractility, heart rate, and blood pressure and prevented a compensatory increase in peripheral vascular tone. These results identify renalase as what we believe to be a novel amine oxidase that is secreted by the kidney, circulates in blood, and modulates cardiac function and systemic blood pressure.

Hilarious Journal Articles Part 5

An occasional series. To recap:

• Hilarious Journal Articles, Part 4
• Hilarious Journal Articles, Part 3
• Hilarious Journal Articles, Part 2
• Hilarious Journal Articles, Part 1

If anyone has the journal reference for this, I'd appreciate it. From MSNBC and Reuters:

Penis Size among Different Nationalities

Chinese men have no reason to feel inferior about the size of their penises, according to a Hong Kong study which showed local men measured up to others elsewhere in the world below the belt. "Our conclusion is that Hong Kong people are no smaller than western men, where their penises are concerned,”" said Chan Lung-wai, director of the Urology Center at the Union Hospital, who headed the study...

A group of scientists in Hong Kong spent five months from October last year measuring 148 ethnic Chinese volunteers aged between 23 and 93. The average length of their flaccid penises was 8.46 centimeters (3.4 inches), which compared favorably with similar studies on other men overseas.

Germans have average lengths of about 8.6 centimeters, Israelis 8.3, Turks 7.8 and Filipinos 7.35. Italians were the longest at 9 centimeters and Americans averaged 8.8...

Video of Living Donor Kidney Transplant

Realplayer video of a kidney transplant that took place at Methodist University Hospital on April 21, 2005.

Nearly 70,000 people are waiting for a kidney, according to the Organ Procurement and Transplantation Network. Many of those patients will have a long wait, on average from three to five years before they find a match. One reason for that wait is because there are not enough living donors. In efforts to highlight, educate, and empower potential donors to consider donorship, the Methodist University Hospital Transplant Institute, which is affiliated with the University of Tennessee Health Science Center, webcasted a living donor kidney transplant live on the Web on Thursday, April 21, at 3 p.m.

Short-term Risk of Death After Treatment With Nesiritide [Natrecor] for Decompensated Heart Failure

JAMA. 2005;293:1900-1905.

Context Nesiritide improves symptoms in patients with acutely decompensated heart failure compared with placebo and appears to be safer than dobutamine. Its short-term safety relative to standard diuretic and vasodilator therapies is less clear.

Objective To investigate the safety of nesiritide relative to noninotrope-based control therapies, primarily consisting of diuretics or vasodilators...

Data Synthesis In the 3 trials, 485 patients were randomized to nesiritide and 377 to control therapy. Death within 30 days tended to occur more often among patients randomized to nesiritide therapy (35 [7.2%] of 485 vs 15 [4.0%] of 377 patients; risk ratio from meta-analysis, 1.74; 95% confidence interval [CI], 0.97-3.12; P = .059; and hazard ratio after adjusting for study, 1.80; 95% CI, 0.98-3.31; P = .057).

Conclusions Compared with noninotrope-based control therapy, nesiritide may be associated with an increased risk of death after treatment for acutely decompensated heart failure. The possibility of an increased risk of death should be investigated in a large-scale, adequately powered, controlled trial before routine use of nesiritide for acutely decompensated heart failure.

Electric Sheep Screen Saver

I dislike screen savers. This one, I like:

This software owes its name to Philip K. Dick's novel, Do Androids Dream of Electric Sheep. It realizes the collective dream of sleeping computers from all over the internet.

When the screen-saver is activated, the screen goes black and an animated 'sheep' appears. Behind the scenes, the screen-saver contacts a server and joins the parallel computation of new sheep. Every fifteen minutes 24/7 a new sheep is born and distributed to all clients for display. Each sheep is an animated fractal flame...

Overheard in New York

I love this site.

A large bearded black man is holding a big white sign that reads: NINJAS KILLED MY FAMILY. I NEED $$ TO LEARN KUNG-FU AND GET REVENGE.

Drunk yuppie: Ha, ha. So dude, are you really going to become a ninja?! Ha, ha!

Black guy: Nah, man. This is just for humor. This ain't for real.

--Broadway & 76th

Sex Selection Formally Approved in Britain

In the US, my understanding is that sex selection in IVF is commonly used for sex-linked genetic conditions and less commonly for non-medical reasons. Many IVF centers in the US offer sex selection and there are no rules against it. From Slate:

Last month, a committee of the British Parliament recommended allowing couples who conceive through in vitro fertilization to screen their embryos for sex. There are good reasons to take issue with easing the way for couples to choose whether to give birth to boys or girls. But whatever you think about the parliamentary committee's conclusion, from an American perspective the committee's existence and the tone of its report are enviable. The British government is taking on hard questions raised by reproductive technology. And while the committee split 6 to 5 on sex selection and research involving cloned human embryos, the division was about principles rather than partisanship, with members of Labor and Tory lining up on both sides.

American conservatives sometimes belittle British bioethics as chatter among liberals who inevitably say yes to whatever new practice is on the table. But a broader range of opinion in Congress hasn't led the U.S. government to say no to sex selection or other questions raised by the genetic screening of embryos, like whether the parents of a child with a rare genetic disease should be able to test for a tissue match so they can bear a life-saving sibling. Instead, there's been little civic debate on these topics at all...

Neuromarketing

From Frontline:

Montague had his subjects take the Pepsi Challenge while he watched their neural activity with a functional MRI machine, which tracks blood flow to different regions of the brain. Without knowing what they were drinking, about half of them said they preferred Pepsi. But once Montague told them which samples were Coke, three-fourths said that drink tasted better, and their brain activity changed too. Coke "lit up" the medial prefrontal cortex -- a part of the brain that controls higher thinking. Montague's hunch was that the brain was recalling images and ideas from commercials, and the brand was overriding the actual quality of the product. For years, in the face of failed brands and laughably bad ad campaigns, marketers had argued that they could influence consumers' choices. Now, there appeared to be solid neurological proof. Montague published his findings in the October 2004 issue of Neuron, and a cottage industry was born...

Phosphate Binder Wars

From Bioworld Online:

Earlier this month, powerhouse Genzyme Corp. disclosed its launch of Phase III trials with the toxin binder tolevamer for patients with Clostridium difficile-associated diarrhea - a compound that derives from the same platform that yielded Renagel, the phosphate binder approved for end-stage renal disease that pulled in $364 million in revenue last year, up 29 percent over 2003.

While the news about tolevamer proved worthy of headlines, Renagel (sevelamer hydrochloride) has been more a focus of interest lately, as the competition between phosphate binders heats up.

The latest player on the field is Fosrenol (lanthanum carbonate), from Shire Pharmaceuticals Group plc, approved by the FDA in October - a move that triggered an $18 million licensing payment to AnorMed Inc., per their agreement.

Fosrenol looks strong. Data reported the same month at the American Society of Nephrology meeting showed treatment for up to five years caused no deterioration in bone health...

Gmail

Gmail just hit 2100 megabytes (and counting) of free email storage. Damn.

Rooter: A Methodology for the Typical Unification of Access Points and Redundancy

This is a paper accepted for submission to the World Multiconference on Systemics, Cybernetics and Informatics to be held July 10-13 in Orlando, Florida. It was produced by a computer program written by two MIT graduate students. The program writes gibberish. Here's a selection:

Many physicists would agree that, had it not been for congestion control, the evaluation of web browsers might never have occurred. In fact, few hackers worldwide would disagree with the essential unification of voice-over-IP and public-private key pair. In order to solve this riddle, we confirm that SMPs can be made stochastic, cacheable, and interposable...

One must understand our network configuration to grasp the genesis of our results. We ran a deployment on the NSA’s planetary-scale overlay network to disprove the mutually largescale behavior of exhaustive archetypes. First, we halved the effective optical drive space of our mobile telephones to better understand the median latency of our desktop machines. This step flies in the face of conventional wisdom, but is instrumental to our results. We halved the signal-to-noise ratio of our mobile telephones. We tripled the tape drive speed of DARPA’s 1000-node testbed. Further, we tripled the RAM space of our embedded testbed to prove the collectively secure behavior of lazily saturated, topologically noisy modalities. Similarly, we doubled the optical drive speed of our scalable cluster. Lastly, Japanese experts halved the effective hard disk throughput of Intel’'s mobile telephones.

I Hate Hepatorenal Syndrome

This condition occurs in people with cirrhosis who are infected, or dehydrated, or sometimes it just happens for no good reason. It is characterized by slowly or rapidly progressive kidney failure and -- almost inevitably -- death. I rarely take care of people with hepatorenal syndrome, since I don't practice in a liver transplant center. Every single person I've seen with hepatorenal syndrome has died -- except one, who I treated with a combination of midodrine and octreotide (1,2). After a month, she fully recovered. (She isn't a transplant candidate due to a history of recently treated cancer.) The reason I'm depressed, and the reason for this post, is that she was readmitted, and she has hepatorenal syndrome again. This time, I hope she survives.

1. Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide. Hepatology 1999 Jun;29(6):1690-7.
2. Octreotide/midodrine therapy significantly improves survival in Type I hepatorenal syndrome: analysis of 53 treated patients and 21 controls (abstract). Gastroenterology 2003;124:A718.

Addendum (4/25/5): I hate hepatorenal syndrome.

"Without Conscience" by Elie Wiesel

N Engl J Med 2005 352: 1511-1513

This is one of those stories that invite fear.

Now we know. During the period of the past century that I call Night, medicine was practiced in certain places not to heal but to harm, not to fight off death but to serve it.

In the conflict between Good and Evil during the Second World War, the infamous Nazi doctors played a crucial role. They preceded the torturers and assassins in the science of organized cruelty that we call the Holocaust. There is a Talmudic adage, quite disturbing, that applies to them: Tov she-barofim le-gehinom — "The best doctors are destined for hell." The Nazi doctors made hell.

Inspired by Nazi ideology and implemented by its apostles, eugenics and euthanasia in the late 1930s and early 1940s served no social necessity and had no scientific justification. Like a poison, they ultimately contaminated all intellectual activity in Germany. But the doctors were the precursors. How can we explain their betrayal? What made them forget or eclipse the Hippocratic Oath? What gagged their conscience? What happened to their humanity?

Hyponatremia among Runners in the Boston Marathon

New England Journal of Medicine 2005 352:1550-1556

Background Hyponatremia [low blood sodium] has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia and to identify the principal risk factors.

Methods Participants in the 2002 Boston Marathon were recruited one or two days before the race. Subjects completed a survey describing demographic information and training history. After the race, runners provided a blood sample and completed a questionnaire detailing their fluid consumption and urine output during the race. Prerace and postrace weights were recorded. Multivariate regression analyses were performed to identify risk factors associated with hyponatremia.

Results Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses, hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. On multivariate analysis, hyponatremia was associated with weight gain (odds ratio, 4.2; 95 percent confidence interval, 2.2 to 8.2), a racing time of >4:00 hours (odds ratio for the comparison with a time of <3:30 hours, 7.4; 95 percent confidence interval, 2.9 to 23.1), and body-mass-index extremes.

Conclusions Hyponatremia occurs in a substantial fraction of nonelite marathon runners and can be severe. Considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia, whereas female sex, composition of fluids ingested, and use of nonsteroidal antiinflammatory drugs were not.

Tips for Medical Documentation and Coding

Documentation and coding are not taught well in training programs. When I started practicing, I was frustrated by my lack of knowledge about coding and I dislike mindless repetitive paperwork, so I designed my own templates for outpatient and inpatient consult, admission, and follow up notes. Since they're individualized, they're a pleasure to use. The templates save me hours per week, ensure that I can always code at the highest level, and allow me to concentrate on the most important parts of the note, the assessment and plan. Here are tips I found helpful:

1. Print out and read the Center for Medicare and Medicaid Services 1995 Documentation Guidelines for Evaluation and Management Services.
2. Do the same with the 1997 Documentation Guidelines for Evaluation and Management Services.
3. If you have a Palm, download the demo for Stat E&M Coder at statcoder.com. This program allows you to punch in elements of the history, physical exam, and medical complexity and shows you what level you can code. It makes the 1995 and 1997 E&M Guidelines much easier to understand.
4. Using a word processor or spreadsheet, craft a note template which includes checkboxes for the parts of the history, review of systems, and physical exam that you would typically perform or that would be easy to complete.
5. Use Stat E&M Coder or the Guidelines to ensure that you have all the elements necessary to code at the highest level (assuming a case of appropriately high complexity).
6. Design different templates for consults, new patients, and followups. (My templates are 3 pages for new patients and consults and 1 page for followups.)
7. Put your contact information at the bottom of each template.
8. Print the templates and copy them onto progress note paper if needed. Similar templates could also be designed for dictated notes or electronic medical record systems.

It takes some time and effort to create the templates, but it's worth it.

Atypical Antipsychotics Increase Mortality in Demented Patients

The Food and Drug Administration has determined that the treatment of behavioral disorders in elderly patients with dementia with atypical (second generation) antipsychotic medications is associated with increased mortality. Of a total of seventeen placebo controlled trials performed with olanzapine (Zyprexa), aripiprazole (Abilify), risperidone (Risperdal), or quetiapine (Seroquel) in elderly demented patients with behavioral disorders, fifteen showed numerical increases in mortality in the drug-treated group compared to the placebo-treated patients. These studies enrolled a total of 5106 patients, and several analyses have demonstrated an approximately 1.6-1.7 fold increase in mortality in these studies. Examination of the specific causes of these deaths revealed that most were either due to heart related events (e.g., heart failure, sudden death) or infections (mostly pneumonia)...

Searching for Nike Subway Ad, "Tag"

I've been searching for a copy of the following poster ad that appeared in the New York City subways in 2001 - 2002. If anyone has a source I'd be grateful. The text of the ad is worth reading anyway. The ad goes like this:

"Tag" is a complex game involving many complexities. Someone must first be "it." Once that is decided this temporary pariah tries to tag someone else, using stealth, speed, resourcefulness, and predatory instincts to transfer his or her "it-ness" to the other person. You can only tag someone with your hands. So if someone who is "it" tags you (with his or her hand) then you become "it" and they are no longer "it." They are free of "it" and can return to normalcy. You cannot immediately transfer your "it-ness" back to the person who was just "it," because there are no 'tag-backs' in Tag. The only way to lose is if you're one of the last two people in earth and are tagged by the other person. (Remember, no 'tag-backs.') However, it is conceivable to procreate with this person and tag the offspring.

In Praise of Lost, the TV Show

*Warning: Minor Spoilers Ahead*



Lost is the best show on television. Besides the usual reasons like great acting, beautiful locations, and inventive scripts, here's one more: it treats complex medical issues well. This is a small sample:

• The opening sequence of triage after an apocalyptic plane crash
• The story of Locke, the disabled -- and reabled -- hunter
• The heroin-addicted ex-rock star
• The father & son surgeon team, alcoholism, and malpractice
• Deception and living related kidney transplantation
• Pregnancy and the single mom
• Aggressive interventions and medical futility

Hilarious Journal Articles Part 4

Unilateral epistaxis after swimming in a stream.

A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swum in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.

Hong Kong Med J 2005;11:110-2

Technorati Tags: Epistaxis, Foreign Bodies, Leeches, Parasitic Diseases, Rivers, Hilarious Journal Articles

Hilarious Journal Articles Part 3

Influence of the type of undertrousers and physical activity on scrotal temperature.

BACKGROUND: Testicular temperature correlates highly with scrotal temperature. The aim of this study was to evaluate the influence of the type of undertrousers on scrotal temperature during standardized periods of sitting and walking. METHODS: Fifty volunteers without a history of infertility and normal andrological examination were included for scrotal temperature evaluation. Temperatures were measured every minute with a portable data recorder connected with two thermistor temperature sensors, which were attached on either side of the scrotum. Ambient temperature in the study room was adjusted to 20 degrees C throughout the whole experiment. All volunteers started the experiment at the same time of day. Clothing of the volunteers consisted of standardized cotton wool trousers and shirts fitting to body size. Each volunteer performed six periods of 45 min, either walking on a treadmill (3.0 km/h) or sitting, and wearing in a standardized and randomized manner either tight, loose fitting or no undertrousers respectively. RESULTS: The following interactions were demonstrated by means of multivariate analysis of variance for repeated measurements: scrotal temperatures were significantly higher for tight versus loose fitting versus absent undertrousers. Furthermore, significantly lower scrotal temperatures were identified for walking versus sitting as well as for the right versus the left scrotal side. CONCLUSIONS: The present study suggests that wearing tight fitting undertrousers is associated with higher scrotal and consequently testicular temperatures than wearing loose fitting undertrousers or none.

Hum Reprod. 2005 Apr;20(4):1022-7.

Key words: genital heat stress/physical activity/scrotal temperature/testicular temperature/type of underwear

Technorati Tags: Hilarious Journal Articles

Recommended Books for Internal Medicine Residents and Interns

If I could read only four books during medicine residency, they would be these:

"The Case Against Peer Review"

Slate magazine's explainer section is often of interest. An article by Daniel Engber criticizes (of all things) peer review:

In September 2001, the Journal of Reproductive Medicine weighed in on the healing power of God. A Columbia University research group reported that patients at a fertility clinic in Seoul were twice as likely to get pregnant when Christians prayed for them. Within a month, the study was in the New York Times science section and on Good Morning America, where the medical editor for ABC News called it "very well done" and opined that "getting pregnant involves a lot of biological, psychological, maybe even spiritual factors that we don't yet understand."

The prayer study has since fallen from grace. Scientists around the world wrote angry letters to the journal attacking the methodology, and the research-protections office of the Department of Health and Human Services looked into whether the subjects had properly given consent. Last year, the study's senior author removed his name from the paper, saying that he hadn't directly participated in the research. The real lead author will not discuss the work, and the third author— -- a parapsychologist, lawyer, and convicted con man— -- is now serving time in a federal prison (for an unrelated charge of fraud)...

Gmail

Gmail, Google's free email service, has unexpectedly doubled their storage space to 2 gigabytes as a non-joke on April Fool's Day. (The first non-joke was when they announced the service last year on April 1st.)

I have too many invites. Feel free to email me if you want one.

• Search, don't sort.
  Use Google search to find the exact message you want, no matter when it was sent or received.
  
• Don't throw anything away.
  2060 megabytes (and counting) of free storage so you'll never need to delete another message.
  
• Keep it all in context.
  Each message is grouped with all its replies and displayed as a conversation.
  
• No pop-up ads. No untargeted banners.
  You see only relevant text ads and links to related web pages of interest.

Consumer Reports Best Buy Drugs

Price comparisons on beta-blockers (for blood pressure), antidepressants, statins (for cholesterol), nonsteroidal anti-inflammatory drugs (for arthritis), and proton pump inhibitors (for heartburn).

Prescription drugs can be expensive, even if you have insurance coverage. But there are medicines that can effectively meet your medical needs and give you better value for your health care dollar. Consumer Reports Best Buy Drugs is a free public education service from the nonprofit Consumers Union, publisher of Consumer Reports. Millions of Americans trust Consumer Reports to provide expert, independent information about products and services, and to help them save money.

The findings presented here combine an expert medical review of the scientific evidence on prescription drugs with their prices. The analysis compares and contrasts prescription drugs by category– -- that is, drugs in the same class that are used to treat a specific condition or illness such as high blood pressure, high cholesterol, heartburn or depression.

kidneyblogs

A recent search of technorati.com revealed these well-written blogs about kidney disease and related medical issues:

• The Ikonclast
• Fearful Symmetry
• Ladybug's Garden
• Terie and Ger's Transplant Adventure
• My Life in the Preterate

NEJM Paper on Terri Schiavo Case

This is a paper by Timothy Quill from the New England Journal of Medicine on the Terri Schiavo case. (Link to full text.)

Let us begin with some medical facts. On February 25, 1990, Terri Schiavo had a cardiac arrest, triggered by extreme hypokalemia brought on by an eating disorder. As a result, severe hypoxic–ischemic encephalopathy developed, and during the subsequent months, she exhibited no evidence of higher cortical function. Computed tomographic scans of her brain eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms have been flat, indicating no functional activity of the cerebral cortex. Her neurologic examinations have been indicative of a persistent vegetative state, which includes periods of wakefulness alternating with sleep, some reflexive responses to light and noise, and some basic gag and swallowing responses, but no signs of emotion, willful activity, or cognition.

There is no evidence that Ms. Schiavo is suffering, since the usual definition of this term requires conscious awareness that is impossible in the absence of cortical activity. There have been only a few reported cases in which minimal cognitive and motor functions were restored three months or more after the diagnosis of a persistent vegetative state due to hypoxic–ischemic encephalopathy; in none of these cases was there the sort of objective evidence of severe cortical damage that is present in this case, nor was the period of disability so long...