Headache? It could be that blade in skull (CNN video)

CNN: "I've got these stabbing pains" - Man complains about migraine, finds he has had a knife in his brain for 4 years.

Related reading:

Daily Mail

From migrant worker to brain surgeon at Johns Hopkins

Dr. Alfredo Quiñones-Hinojosa is the Director of the Brain Tumor Stem Cell Laboratory at Johns Hopkins University School of Medicine.

Twenty years ago, Dr. Quinones-Hinojosa hopped a border fence from Mexico into the United States and became a migrant farm worker, living in the fields in a broken-down camper he bought for $300.

When told he would probably be a farm worker for the rest of his life, he signed up for English classes at a community college, where one of his teachers encouraged him to apply to UC-Berkeley. There, he developed a passion for science, and showed remarkable aptitude.

He went on to Harvard Medical School and graduated with honors, followed by a residency in neurosurgery at UC-San Francisco, where he completed a postdoctoral fellowship in developmental and stem cell biology.



References:
Dr. Alfredo Quinones-Hinojosa. BigThink.com.

Kidney Transplant Overview - Mayo Clinic Video

Mayo Clinic emphasizes living donor kidney transplants as the best option for patients. Martin Mai, M.D., nephrologist at Mayo Clinic offers information about living donation, statistics, including the fact that living donor kidneys last longer. Half of living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of cadaveric kidneys will fail in the first 10 years.



Candy and Ellen's Story.

Oral factor Xa inhibitor apixaban - more effective than enoxaparin for thromboprophylaxis after knee replacement

Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:

Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. The Lancet, Volume 375, Issue 9717, Pages 807 - 815, 6 March 2010.

Image source: Apixaban, Wikipedia, public domain.

Barbara Walters, US TV Anchor, to Undergo Heart Surgery to Replace a "Faulty Valve" - Sounds Like Aortic Stenosis

Walters announced that she will undergo surgery to replace a "faulty" heart valve later this week.

"You know how I always say to you how healthy I am. ... I've never missed a day's work," she began. "Later this week, I'm going to have surgery to replace one faulty heart valve."

From her description, the valve defect sounds like aortic stenosis. For a variety of reasons, mitral stenosis is a less likely possibility in the differential diagnosis.

Best wishes for successful surgery and speedy recovery!

References:
Barbara Walters to Undergo Heart Surgery. ABC.

Barbara Walters' Heart Surgery. WebMD.

Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections

Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism.

Eradication of colonization with S. aureus by screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections.

In a randomized, double-blind, placebo-controlled trial, S. aureus nasal carriers were treated with mupirocin nasal ointment and chlorhexidine soap.

A total of 6771 patients were screened on admission, 1270 nasal swabs from 1251 patients were positive for S. aureus. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin.

The rate of S. aureus infection was 3.4% in the mupirocin–chlorhexidine group, as compared with 7.7% in the placebo group (relative risk of infection, 0.42). The effect of mupirocin–chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21).

References:

Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM, 1/2009.
GIANTmicrobes in Toys & Games section of Amazon.com http://goo.gl/gMrf

Concussions dangerous to teen brains - a hard to watch CNN video

"4 million sports and recreation-related concussions occur each year. The vast majority are suffered at the high school level, but few schools have rules governing how concussion is treated -- and few coaches are trained to identify it."

References:
Concussions extra dangerous to teen brains. CNN, 2010.

AP Video: Chopstick Pierces Toddler's Brain in China (Recovered After Surgery)

A 14-month-old toddler was playing in the kitchen when he fell, sending a chopstick up his nose. Surgeons were able to remove the chopstick.

Atul Gawande: "Doctors are human. We miss stuff" - Checklists can help

Atul Gawande on NPR:

Doctors are human, and that their profession is like any other.

"We miss stuff. We are inconsistent and unreliable because of the complexity of care," Gawande says. "I got a chance to visit Boeing and see how they make things work, and over and over again they fall back on checklists. The pilot's checklist is a crucial component, not just for how you handle takeoff and landing in normal circumstances, but even how you handle a crisis emergency when you only have a couple of minutes to make a critical decision."

References:
Atul Gawande's 'Checklist' For Surgery Success. NPR.

Related:

Whiplash injury: 2% are permanently disabled

Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck. Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including falls from bicycles or horses.

Most cases of whiplash injury occur as the result of rear-end vehicle collisions at speeds of less than 14 mph.

Patients present with:

- neck pain and stiffness

- occipital headache

- thoracolumbar back pain and upper-limb pain

- paraesthesia

Over 66% make a full recovery and 2% are permanently disabled.

References:
Whiplash injury. G. Bannister et al. Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 7, 845-850. doi: 10.1302/0301-620X.91B7.22639

Related:

Whiplash (medicine). Wikipedia.

Image source: A side collision in Tokyo, Japan. Wikipedia, Shuets Udono, Creative Commons Attribution ShareAlike 2.0 License.

TED Talks: Surgery's past, present and robotic future

"Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating -- but not for the squeamish."

LRG urine test may help diagnose appendicitis

From Reuters:

Appendicitis is the most common emergency in childhood, yet 3-30% of appendectomies may be unnecessary. Urine test for leucine-rich alpha-2-glycoprotein (LRG) may help diagnose appendicitis in children.


Inflamed appendix removal by open surgery. Image source: Wikipedia, Dr Vgaikwad, Creative Commons Attribution 3.0 Unported License.


An example of a leucine-rich repeat protein, a porcine ribonuclease inhibitor. Image source: Wikipedia, GNU Free Documentation License.

Twitter comments:

hjluks better to remove a few normals than miss an appy that perforates. about 6 hours ago from Tweetie in reply to AllergyNotes