by Paul Rega, MD — published on July 4th, 2009
Zeugma: the use of a word to modify two or more words in such a way that it applies to each in a different sense or makes sense with only one
As in: “Torpedoes hit their mark! Ship and many hopes sink!” said the headline, employing vivid zeugma.
So? Why do we care? Well, in the early 1970s, a chemistry professor named Paul Lauterbur developed a technique for producing images of internal organs. He called it “zeugmatography,” because it involved the joining of magnetic fields. Lauterbur was awarded a Nobel Prize, but the name he chose didn’t stick. The technique is known today as magnetic resonance imaging, or MRI.
Imagine if the name stuck…” Dammit! That blasted zeugmatograph is down again! When the hell will they fix…
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by Paul Rega, MD — published on July 4th, 2009
Coffee grounds emesis: Not just an upper GI bleed
Published online: 29 June 2009
Jad Z. Bou-Abdallah, Uma K. Murthy, Nilish Mehta, Heramba N. Prasad, Vivek Kaul
DOI: 10.1016/j.jemermed.2009.05.008
Journal of Emergency Medicine
Background: Acute upper gastrointestinal (UGI) bleeding manifests as hematemesis, melena, or hematochezia. Initial management is identical, irrespective of nasogastric (NG) aspirate results. Current practice includes early upper endoscopy. Significantly fewer high-risk bleeding lesions are found on endoscopy in patients with coffee grounds vs. bloody NG aspirates.
Objective: We present a case series to illustrate that patients with coffee grounds emesis (CGE) often have other unsuspected illnesses that may be overlooked due to preoccupation with the GI bleed.
Case Reports: A retrospective chart review of a series of 6 patients presenting with CGE and admitted for upper GI bleeding was…
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by Paul Rega, MD — published on July 4th, 2009
Penile incarceration secondary to an S-shaped lead pipe: removal with dremel moto-tool
Sangeeta Lamba, Nitin N. Patel, Sandra R. Scott
The Journal of Emergency Medicine – 29 June 2009 (10.1016/j.jemermed.2009.05.006)
Background: Penile incarceration or strangulation is a urologic emergency.
Objectives: Several techniques to remove metallic objects strangulating the penis are described in the literature. The method utilized depends on the severity of the incarceration and the tools that are readily accessible. Prompt action and resourcefulness, with expeditious removal, prevents organ ischemia and vascular or mechanical sequelae.
Case Report: We describe a case in which a Dremel Moto-Tool was used to remove a lead pipe strangulating a penile shaft, after failure of the string technique.
Conclusion: A hospital-based Emergency Medical Services and Rescue program is a valuable resource to provide the tools…
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by Paul Rega, MD — published on July 3rd, 2009
1. Only in America……can a pizza get to your house faster than an ambulance.
2. Only in America……are there handicap parking places in front of a skating rink.
3. Only in America……do drugstores make the sick walk all the way to the back of the store to get their prescriptions while healthy people can buy cigarettes at the front.
4. Only in America……do people order double cheese burgers, large fries, and a diet Coke.
5. Only in America……do banks leave both doors to the vault open and then chain the pens to the counters.
6. Only in America……do we leave cars worth thousands of dollars in the driveway and put our useless junk in the garage.
7. Only in America……do we use answering machines to screen calls and then have call…
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by Paul Rega, MD — published on July 3rd, 2009
by Paul Rega, MD — published on July 3rd, 2009
Munster VJ, de Wit E, van den Brand JM, et al. Pathogenesis and transmission of swine-origin 2009 A(H1N1) influenza virus in ferrets Science 2009 Jul 2; early online edition
Pathogenesis and Transmission of Swine-Origin 2009 A(H1N1) Influenza Virus in Ferrets
Vincent J. Munster 1, Emmie de Wit 1, Judith M. A. van den Brand 1, Sander Herfst 1, Eefje J. A. Schrauwen 1, Theo M. Bestebroer 1, David van de Vijver 1, Charles A. Boucher 1, Marion Koopmans 2, Guus F. Rimmelzwaan 1, Thijs Kuiken 1, Albert D. M. E. Osterhaus 1, Ron. A. M. Fouchier 1*
1 National Influenza Center and Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands.
2 National Influenza Center and Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands.; National Institute for Public Health and the…
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by Paul Rega, MD — published on July 3rd, 2009
Transmission and Pathogenesis of Swine-Origin 2009 A(H1N1) Influenza Viruses in Ferrets and Mice
Taronna R. Maines 1, Akila Jayaraman 2, Jessica A. Belser 3, Debra A. Wadford 1, Claudia Pappas 1, Hui Zeng 1, Kortney M. Gustin 1, Melissa B. Pearce 1, Karthik Viswanathan 2, Zachary H. Shriver 2, Rahul Raman 2, Nancy J. Cox 1, Ram Sasisekharan 2, Jacqueline M. Katz 1, Terrence M. Tumpey 1*
1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
2 Harvard-MIT Division of Health Sciences and Technology and Koch Institute for Integrative Cancer Research, Department of Biological Engineering, Massachusetts Institute of Technology, E25-519, Cambridge, MA 02139, USA.
3 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta,…
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by Paul Rega, MD — published on July 2nd, 2009
On this date, in 1937, aviatrix extraordinaire, Amelia Earhart disappeared over the Pacific as she was attempting the first round-the-world plane trip. She was later found in Argentina shacked up with Maria.
But I digress….
Big news on the anti-smoking drugs , Chantix and Zyban. There’s concern that they could trigger depression and suicide. In fact, a boxed warning has been mandated. Of course, the drug companies have problems with this stigma. I’d be depressed too if I wasn’t able to enjoy all that carcinogenic heat waft through my bronchi and nest in my alveoli.
http://omniphysicians.com/2009/07/02/fda-news-release-on-chantix-and-zyban/
http://omniphysicians.com/2009/07/02/chantix-and-zyban-i-could-just-kill-myself/
Do you think you can’t see free air on a flat-plate belly film? Think again. Here is a case and x-rays on a guy with pneumoperitoneum.
http://omniphysicians.com/2009/07/02/find-the-free-air-on-a-kub/
Here is the news and the study abstract indicating…
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by Paul Rega, MD — published on July 2nd, 2009
Miami Physician Sentenced to 97 Months in Prison for Role in $10 Million Medicare Fraud Scheme
WASHINGTON – Miami physician Roberto Rodriguez, 54, was sentenced today to 97 months in prison for his role in a Medicare fraud scheme involving HIV infusion services, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS). Rodriguez was also ordered to pay more than $9 million in restitution to the Medicare program during today’s sentencing hearing before U.S. District Judge Paul C. Huck.
Rodriguez pleaded guilty before Judge Huck on March 23, 2009, to conspiracy to commit healthcare fraud. In…
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by Paul Rega, MD — published on July 2nd, 2009
Lantus (insulin glargine)
Audience – Diabetes healthcare professionals, patients
FDA notified healthcare professionals and patients that it is aware of four recently-published observational studies that looked at the use of Lantus (insulin glargine) and possible risk for cancer in patients with diabetes. Three of the four studies suggest an increased risk for cancer associated with use of Lantus. Based on the currently available data, the FDA recommends that patients should not stop taking their insulin therapy without consulting a physician, since uncontrolled blood sugar levels can have both immediate and long-term serious adverse effects.
FDA is currently reviewing many sources of safety data for Lantus, including these newly published observational studies, data from all completed controlled clinical trials, and information about ongoing controlled clinical trials, to better…
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by Paul Rega, MD — published on July 2nd, 2009
FDA NEWS RELEASE
For Immediate Release: July 1, 2009
Media Inquiries: Karen Riley, 301-796-4674; karen.riley@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
FDA: Boxed Warning on Serious Mental Health Events to be Required for Chantix and Zyban
The U.S. Food and Drug Administration today announced that it is requiring manufacturers to put a Boxed Warning on the prescribing information for the smoking cessation drugs Chantix (varenicline) and Zyban (bupropion). The warning will highlight the risk of serious mental health events including changes in behavior, depressed mood, hostility, and suicidal thoughts when taking these drugs.
“The risk of serious adverse events while taking these products must be weighed against the significant health benefits of quitting smoking,” said Janet Woodcock, M.D., director, the FDA’s Center for Drug Evaluation and Research. “Smoking is the leading cause of preventable disease, disability,…
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by Paul Rega, MD — published on July 2nd, 2009
NEJM Volume 361:e1
A 40-year-old man presented with intractable pruritus within portions of a tattoo imprinted with red ink on the left leg (Panel A). The intense localized itching had begun approximately 4 months after placement of the tattoo. Topical and intralesional corticosteroids and laser therapy all had no effect. Histologic sections of the resected skin revealed an intense, chronic inflammatory reaction to tattoo pigment, characterized by moderate, irregular epidermal hyperplasia, marked dermal fibrosis, and a dense, patchy infiltrate of lymphocytes and histiocytes surrounding the areas of granular, refractile red pigment (Panel B, arrows). Other areas, nearly devoid of inflammation and fibrosis, showed only granular black pigment between collagen bundles of the superficial dermis (Panel B, arrowhead). Allergic reactions to tattoos are a recognized complication of…
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by Paul Rega, MD — published on July 2nd, 2009
NEJM Volume 361:73
A 56-year-old man presented to the emergency department with a 3-day history of diarrhea and dull epigastric pain. The diarrhea had responded to antidiarrheal agents. However, the epigastric pain had worsened on the day before presentation and had become sharp, severe, and diffuse. The patient reported having had no bloody or tarry stool and having taken no nonsteroidal antiinflammatory drugs. On physical examination, the patient appeared to be in great distress and was tachycardic, with otherwise normal vital signs. His abdomen was diffusely tender with rebound; bowel sounds were absent. The rectal examination revealed occult blood. Laboratory evaluation showed leukocytosis, with a white-cell count of 20,400 per cubic millimeter and 82% segmented neutrophils. No anemia was found. Supine plain radiography of the abdomen…
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by Paul Rega, MD — published on July 2nd, 2009
NEJM Volume 361:22-31
Background It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.
Methods We examined fee-for-service Medicare data from 1992 through 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. We examined temporal trends in the incidence of CPR and the rate of survival after CPR, as well as patient- and hospital-level predictors of survival to discharge.
Results We identified 433,985 patients who underwent in-hospital CPR; 18.3% of these patients (95% confidence interval [CI], 18.2 to 18.5) survived to discharge. The rate of survival did not change substantially during the period from 1992 through 2005. The overall incidence of CPR was 2.73 events per 1000 admissions; the incidence was higher among black and other nonwhite patients. The proportion of patients undergoing in-hospital CPR…
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by Paul Rega, MD — published on July 2nd, 2009
LA Times, 7/1/09: Americans are fat and getting fatter, according to a new report that finds that adults and children in the U.S. continue to pack on the pounds.
Adult obesity went up in 23 states, according to the report released today by advocacy groups Trust for America’s Health and the Robert Wood Johnson Foundation. If that weren’t bad enough, in 30 states, the percentage of overweight or obese children is at or above 30%.
Take a bow, Mississippi, you’re No. 1 for the fifth year in a row, with an adult obesity rate of 32.5%. Colorado ranks lowest at 18.9%. And California is in 41st place with 23.6%. Mississippi also holds the No. 1 spot for obese and overweight children ages 10 to 17, with a rate of 44.4%. Ouch. Utah and…
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