One of the more unusual forms of inflammatory arthritis
MP3 File
Palindromic rheumatism and other relapsing arthritis. Sanmarti R. Canete JD. Salvador G. Best Practice & Research in Clinical Rheumatology. 2004 Oct, 18(5):647-61.
Palindromic rheumatism: part of or apart from the spectrum of rheumatoid arthritis. Guerne PA. Weisman MH. American Journal of Medicine. 1992 Oct, 93(4):451-60.
Wednesday, August 31, 2005
Friday, August 26, 2005
MJM Wardround - Plague of Athens
The two minute tutorials this week were:
Dr Szulkowski - Typhus (6/8)
Dr Tuck - Smallpox (8/8)
Dr Queen - Typhoid (2/8)
Dr McMahon - Epidemic ergotism (not eligible for marking - too clever)
With regard to the plague of athens, Dr Jones awarded the prize best to Dr Tuck for her arguments supporting a diagnosis of smallpox. It is clearly difficult, if not impossible to know the diagnosis but if you would like to read more, there is a good discussion of the approach to diagnosis in The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43. One learning point is that the epidemiology can help differentiate infectious and non-infectious agents, but also point to the mode of transmission. This could prove life saving if you find yourself in the middle of an undiagnosed epidemic.
I would choose measles as my choice of diagnosis, but this week was an opportunity to review the clinical features of the other diseases. One paper that I found particularly interesting is Osler on typhoid fever: differentiating typhoid from typhus and malaria. Cunha BA. Infect Dis Clin North Am. 2004 Mar;18(1):111-25.
If you would like to know a little more about ergotism have a glance at:
Ergot of Rye - I: Introduction and History
Poisons of the past / ergotism
And if you feel a little more scholarly check out Convulsive ergotism: epidemics of the serotonin syndrome? Mervyn J Eadie, Lancet Neurology 2003; 2: 429–34.
The reading for next week is"Antibiotics, Microsoft® Encarta® Online Encyclopedia 2005 http://encarta.msn.com © 1997-2005 Microsoft Corporation. All Rights Reserved. (All four pages). You should also use your initiative to read a little more about the mechanisms of antibiotic resistance.
Think you know it all already...test yourself with Jeopardy
A non compulsory read is Pearls....glance at the site and see if you find any of the advice useful.
Interesting cases this week:
Late onset asthma, with eosinophilia, renal impairment, and cutaneous ulceration (will this be CSS?)
Erysipelas (do you know the three commonest organisms?)
Lacunar infarction (what are the characteristic features?)
Ace inhibitor induced acute renal failure (Do you know the incidence?)
Hepatorenal failure (what is the prognosis?)
I have still to hear back about clavulanic acid....by Tuesday please.
Don't forget your two minute tutorial...be concise and precise.
Dr Szulkowski - Typhus (6/8)
Dr Tuck - Smallpox (8/8)
Dr Queen - Typhoid (2/8)
Dr McMahon - Epidemic ergotism (not eligible for marking - too clever)
With regard to the plague of athens, Dr Jones awarded the prize best to Dr Tuck for her arguments supporting a diagnosis of smallpox. It is clearly difficult, if not impossible to know the diagnosis but if you would like to read more, there is a good discussion of the approach to diagnosis in The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43. One learning point is that the epidemiology can help differentiate infectious and non-infectious agents, but also point to the mode of transmission. This could prove life saving if you find yourself in the middle of an undiagnosed epidemic.
I would choose measles as my choice of diagnosis, but this week was an opportunity to review the clinical features of the other diseases. One paper that I found particularly interesting is Osler on typhoid fever: differentiating typhoid from typhus and malaria. Cunha BA. Infect Dis Clin North Am. 2004 Mar;18(1):111-25.
If you would like to know a little more about ergotism have a glance at:
Ergot of Rye - I: Introduction and History
Poisons of the past / ergotism
And if you feel a little more scholarly check out Convulsive ergotism: epidemics of the serotonin syndrome? Mervyn J Eadie, Lancet Neurology 2003; 2: 429–34.
The reading for next week is"Antibiotics, Microsoft® Encarta® Online Encyclopedia 2005 http://encarta.msn.com © 1997-2005 Microsoft Corporation. All Rights Reserved. (All four pages). You should also use your initiative to read a little more about the mechanisms of antibiotic resistance.
Think you know it all already...test yourself with Jeopardy
A non compulsory read is Pearls....glance at the site and see if you find any of the advice useful.
Interesting cases this week:
Late onset asthma, with eosinophilia, renal impairment, and cutaneous ulceration (will this be CSS?)
Erysipelas (do you know the three commonest organisms?)
Lacunar infarction (what are the characteristic features?)
Ace inhibitor induced acute renal failure (Do you know the incidence?)
Hepatorenal failure (what is the prognosis?)
I have still to hear back about clavulanic acid....by Tuesday please.
Don't forget your two minute tutorial...be concise and precise.
Sunday, August 21, 2005
Friday, August 19, 2005
MJM Wardrounds
The two minute tutorials this week were:
Dr Queen: Incidence and prevalence of upper GI bleeding (4/4)
Dr Tuck: Statin use in cerebrovascular disease (4/4)
Dr Szulakowski: Behcet's disease (4/4)
These were all well presented, hence the full four marks for each. I find it difficult to choose the best, but it must be done: Dr Queen wins this week.
I was surprised at the overall mortality for upper gi bleeds at 14%; we went on to discuss the use of Rockall scores for grading the severity of GI bleeders. You can see an explanation of Rockall scores in the GI haemorrage section of Evidence Based On-call (click on the link and go to 'guides' then 'GI haemorrhage' then 'prognosis'. )
Despite Dr Tuck's efforts I am still unclear about the use of statins in cerebral infarction when the total cholesterol is below 5mmol/l. I will seek specialist advice on this.
Following the Behcet's talk and the ensuing discussion we decided to move to combination therapy for our patient with refractory Behcet's. The patient does not wish to use Thalidomide, so we will be combining cyclosporin with pentoxifylline and colchicine.
The week's reading was The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996 Feb 28;275(8):630-4. I will look out for rulers over the next few days! I will bring in some more stuff on JVPs next week and perhaps we can have a look for some real examples?
Minor learning points from the round.
1. I have hypersensitivity to the term 'chest infection'...never again may I hear it spoken of as a diagnosis ... And beware 'coffee ground' vomit too.
2. Faecal occult blood testing is used to identify occult blood loss and is unnecessary in overt blood loss.
Dr Szulakowski has found some papers to support his contention about vitamin B12 and cancer. I have asked him to put them in the comments section.
Dr Tuck has given me a paper on statins and cerebrovascular disease...I will let you know what I think next week (can't read it just yet because I have left it at work by mistake).
On 26th August we discuss your diagnoses for the Plague of Athens... impress us with your diagnosis... then convince us you are correct. Dr Jones will choose the best effort.
Don't forget your two minute tutorial....make it concise and precise. Don't pick too large a subject.
Dr Queen: Incidence and prevalence of upper GI bleeding (4/4)
Dr Tuck: Statin use in cerebrovascular disease (4/4)
Dr Szulakowski: Behcet's disease (4/4)
These were all well presented, hence the full four marks for each. I find it difficult to choose the best, but it must be done: Dr Queen wins this week.
I was surprised at the overall mortality for upper gi bleeds at 14%; we went on to discuss the use of Rockall scores for grading the severity of GI bleeders. You can see an explanation of Rockall scores in the GI haemorrage section of Evidence Based On-call (click on the link and go to 'guides' then 'GI haemorrhage' then 'prognosis'. )
Despite Dr Tuck's efforts I am still unclear about the use of statins in cerebral infarction when the total cholesterol is below 5mmol/l. I will seek specialist advice on this.
Following the Behcet's talk and the ensuing discussion we decided to move to combination therapy for our patient with refractory Behcet's. The patient does not wish to use Thalidomide, so we will be combining cyclosporin with pentoxifylline and colchicine.
The week's reading was The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996 Feb 28;275(8):630-4. I will look out for rulers over the next few days! I will bring in some more stuff on JVPs next week and perhaps we can have a look for some real examples?
Minor learning points from the round.
1. I have hypersensitivity to the term 'chest infection'...never again may I hear it spoken of as a diagnosis ... And beware 'coffee ground' vomit too.
2. Faecal occult blood testing is used to identify occult blood loss and is unnecessary in overt blood loss.
Dr Szulakowski has found some papers to support his contention about vitamin B12 and cancer. I have asked him to put them in the comments section.
Dr Tuck has given me a paper on statins and cerebrovascular disease...I will let you know what I think next week (can't read it just yet because I have left it at work by mistake).
On 26th August we discuss your diagnoses for the Plague of Athens... impress us with your diagnosis... then convince us you are correct. Dr Jones will choose the best effort.
Don't forget your two minute tutorial....make it concise and precise. Don't pick too large a subject.
Tuesday, August 16, 2005
Friday, August 12, 2005
MJM wardrounds
The two minute tutorials this week were on non-cardiac causes of ST/T changes on the ECG(Drs Queen & Tucker), Cervical radiculopathy (Dr Szulakowski), and Irritable bowel syndrome (Dr Tuck). Dr Szulokowski wins the best talk award for this week.
Richard Asher's paper Why are medical journals so dull? was the Friday discussion paper. Many of the problems he mentions, such as lack of colour, have now been eradicated in the 47 years since the paper was written. I am old enough, however, to remember journals being mailed rolled-up rather than flat and sympathise with his irritation at journals which spontaneously rolled up when being read. The concerns he raised about style are still voiced at times nowadays. Dr Szulakowski felt that some of the style of journal writing, and the associated 'dullness' was dictated by the required methodological descriptions, but I am not sure that I agree with him on this.
Asher believes that authors "clog their meaning with muddy words and pompous prolixity; they spend little time in seeking the shortest, neatest, and plainest way of putting down their meaning". I recognise this, though admittedly it is as nothing compared with some sociology texts I have read. This is not to say that the authors of scientific papers are lazy wasters; they have often put in gargantuan effort in organising and conducting their research and they then provide papers in the style the journals expect. Unfortunately the 'pompous prolixity' can be seen in speech, such as when a resident tells me that he cannot 'visualise the fundus'. My response, "your imagination must be rather poor" is usually met with incomprehension until I suggest that he did not "see" the fundus. Let's keep it plain and simple.
In order to support my argument against Dr Szulokowski I need to find examples of papers which despite their complex nature can escape dullness. Off the top of my head I wondered about Molecular structure of Nucleic Acids, Watson J D & Crick FHC. Nature 171, 737-738 (1953) . When did you last read a scientific paper with such modesty? Any other suggestions?
The reading for discussion on Friday 26th is the description of the plague of Athens in The History of the Peloponnesian War written by Thucydides in 431 B.C. If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague.
You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. Your two minute tutorials could be on some aspect of your chosen disease. I will post the discussion the following week and award a prize to the best argument/diagnosis.
This week's reading is The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996 Feb 28;275(8):630-4. Many articles from this series are available free online, but not this one. See if you can retrieve a copy from the NHSES elibrary. A copy will be in the homework folder on the ward...for the technologically challenged among you....but only if I am asked to place it there.
It was suggested during the round that treatment with hydroxocobalamin could worsen the prognosis in malignant disease...I have thrown down my don't-believe-it-gauntlet on this one. Dr Szulokowski is challenged to provide supporting evidence next week. Dr Tuck will tell us the indications for statins in acute stroke next week.
Interesting cases:
1. Behcet's refractory to steroids, azathioprine, colchicine, methotrexate and infliximab.
2. Microcytic anaemia with very low B12.
3. Stapylococcal bursitis and hypogammaglobulinaemia.
4. Neutropenia and recurrent C. difficile
Don't forget your two minute tutorial....make it concise and precise. Don't pick too large a subject.
Why not leave a comment...click on the comment button.
Richard Asher's paper Why are medical journals so dull? was the Friday discussion paper. Many of the problems he mentions, such as lack of colour, have now been eradicated in the 47 years since the paper was written. I am old enough, however, to remember journals being mailed rolled-up rather than flat and sympathise with his irritation at journals which spontaneously rolled up when being read. The concerns he raised about style are still voiced at times nowadays. Dr Szulakowski felt that some of the style of journal writing, and the associated 'dullness' was dictated by the required methodological descriptions, but I am not sure that I agree with him on this.
Asher believes that authors "clog their meaning with muddy words and pompous prolixity; they spend little time in seeking the shortest, neatest, and plainest way of putting down their meaning". I recognise this, though admittedly it is as nothing compared with some sociology texts I have read. This is not to say that the authors of scientific papers are lazy wasters; they have often put in gargantuan effort in organising and conducting their research and they then provide papers in the style the journals expect. Unfortunately the 'pompous prolixity' can be seen in speech, such as when a resident tells me that he cannot 'visualise the fundus'. My response, "your imagination must be rather poor" is usually met with incomprehension until I suggest that he did not "see" the fundus. Let's keep it plain and simple.
In order to support my argument against Dr Szulokowski I need to find examples of papers which despite their complex nature can escape dullness. Off the top of my head I wondered about Molecular structure of Nucleic Acids, Watson J D & Crick FHC. Nature 171, 737-738 (1953) . When did you last read a scientific paper with such modesty? Any other suggestions?
The reading for discussion on Friday 26th is the description of the plague of Athens in The History of the Peloponnesian War written by Thucydides in 431 B.C. If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague.
You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. Your two minute tutorials could be on some aspect of your chosen disease. I will post the discussion the following week and award a prize to the best argument/diagnosis.
This week's reading is The Rational Clinical Examination. Does this patient have abnormal central venous pressure? Cook DJ, Simel DL. JAMA 1996 Feb 28;275(8):630-4. Many articles from this series are available free online, but not this one. See if you can retrieve a copy from the NHSES elibrary. A copy will be in the homework folder on the ward...for the technologically challenged among you....but only if I am asked to place it there.
It was suggested during the round that treatment with hydroxocobalamin could worsen the prognosis in malignant disease...I have thrown down my don't-believe-it-gauntlet on this one. Dr Szulokowski is challenged to provide supporting evidence next week. Dr Tuck will tell us the indications for statins in acute stroke next week.
Interesting cases:
1. Behcet's refractory to steroids, azathioprine, colchicine, methotrexate and infliximab.
2. Microcytic anaemia with very low B12.
3. Stapylococcal bursitis and hypogammaglobulinaemia.
4. Neutropenia and recurrent C. difficile
Don't forget your two minute tutorial....make it concise and precise. Don't pick too large a subject.
Why not leave a comment...click on the comment button.
Thursday, August 11, 2005
Wednesday, August 10, 2005
Tuesday, August 09, 2005
MJM Wardrounds
Tuesday:
The questions posed for this Friday were:
1. Indications for statins in CVA?
2. Non-cardiac causes of ST/T changes on the ECG?
2. Use of Ampicillin in meningitis?
The reading for the week is "Why are medical journals so dull" by Richard Asher. Originally published in the BMJ in 23 August 1958 but reprinted in The Healing Arts by Robin Downie. I have given a photocopy of the article to Patryk.
Interesting cases so far this week:
- Tension pneumothorax
- Phlegmasia cerulens dolens (was I correct to treat this with alteplase?)
Don't forget your two minute tutorials...make them concise but precise.
MJM
The questions posed for this Friday were:
1. Indications for statins in CVA?
2. Non-cardiac causes of ST/T changes on the ECG?
2. Use of Ampicillin in meningitis?
The reading for the week is "Why are medical journals so dull" by Richard Asher. Originally published in the BMJ in 23 August 1958 but reprinted in The Healing Arts by Robin Downie. I have given a photocopy of the article to Patryk.
Interesting cases so far this week:
- Tension pneumothorax
- Phlegmasia cerulens dolens (was I correct to treat this with alteplase?)
Don't forget your two minute tutorials...make them concise but precise.
MJM
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