Hutchison's Clinical Methods (23rd Ed.)

Hutchison's Clinical Methods (23rd Ed.) 

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Hutchison's Pediatrics, 2nd Edition

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SRB’s Clinical Methods in Surgery

SRB’s Clinical Methods in Surgery

 

 

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First Aid Cases for the USMLE Step 1, 3rd Edition

First Aid Cases for the USMLE Step 1, 3rd Edition 

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Macleod's Clinical Diagnosis

Macleod's Clinical Diagnosis

     

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API Textbook of Medicine (9th Ed.)

API Textbook of Medicine (9th Ed.)

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Emery & Rimoin’s Principles and Practice of Medical Genetics (6th Ed.)

Emery & Rimoin’s Principles and Practice of Medical Genetics (6th Ed.)







  

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CURRENT Medical Diagnosis and Treatment 2014

CURRENT Medical Diagnosis and Treatment 2014

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Coloring Atlas of the Human Body

Coloring Atlas of the Human Body

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Hematology - Basic Principles & Practice (6th Ed.

Hematology - Basic Principles & Practice (6th Ed.)







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The incredible story of Phineas Gage and the prefrontal cortex.

The incredible story of Phineas Gage and the prefrontal cortex.

 It’s quite possible some of you know this story already, but for the ones who don’t I’ll tell it anyway.

 The first clue of the role of the prefrontal cortex in controlling our personality and ”˜social behaviour’ (also referred to as the formation of ”˜structured event knowledge’) was derived from the near-fatal accident of the American railroad worker Phineas Gage (1823 ”“ 1860).

 On September 13, 1848, 25-year-old Gage was foreman of a work gangblasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. After a hole was bored into a body of rock, one of Gage's duties was to add blasting powder, a fuse and sand, then compact the charge into the hole using a tamping iron ”“ a large iron rod. Possibly because the sand was omitted, around 4:30 PM “the powder exploded, carrying an instrument through his head an inch and a fourth in diameter, and three feet and seven inches in length, which he was using at the time. The iron entered on the side of his face... passing back of the left eye, and out at the top of the head.” From that day forth, Gage was known as “the American Crowbar Case”, although I should point out that back then a crowbar did not have the bend or claw like it has today. Gage's tamping iron was simply a cylinder, “round and rendered comparatively smooth by use.” The drawing shows how the rod penetrated Gage’s head.


Schedel Phineas Gage.jpg Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3⁄4-mile (1.2 km) ride to his lodgings in town. The first physician to arrive was Dr. Edward H. Williams:

 “I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage's statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head.... Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.

” Dr. John Martyn Harlow took charge of the case about an hour later:

“You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage. His person, and the bed on which he was laid, were literally one gore of blood.

” But already two months later, on October 7, Gage “succeeded in raising himself up, and took one step to his chair.” One month later he was walking “up and down stairs, and about the house, into the piazza,” and while Harlow was absent for a week, Gage was “in the street every day except Sunday,” his desire to return to his family in New Hampshire being “uncontrollable by his friends... got wet feet and a chill.” He soon developed a fever, but by mid-November he was “feeling better in every respect... walking about the house again; says he feels no pain in the head.

” Unfortunately however, despite the lack of pain and his relatively well being, he was ”˜no longer Gage’. In contrary to his previous calm, responsible en socially well-adapted personality, Gage had become a rude, non-social character, seemingly caring nothing about the opinions or feelings of others. This is disputed by some researches however, claiming the personality had only changed for a short period of time and that in the end he’d become decent and vain. The second portrait would demonstrate this, Gage being well-dressed ”“ like he would always be ”“ and proudly holding his so called ”˜constant companion’.

 Portret Gage.jpg Whatever is true, the fact remains that the dreadful accident in September 1848 has led to an idea that is still recognised by scientists today, and that many similar circumstances (like soldiers having their prefrontal cortexes pierced by grenade splinters) have resulted in comparable, remarkable changes in personality.

Valentine Day And Health

Valentine Day And Health


Valentine's Day can be about more than just giving roses and a nice card to your sweetheart. You can use romance to improve your life expectancy and brain health in your later years.

 Studies have shown that individuals who consume a diet rich in anti-oxidants, enjoy a rich social life, and constantly challenge their bodies and brains in pleasurable ways often live longer -- and happier -- lives than their counterparts who aren't so inclined.

 So this Valentine's Day, see how many items you can check on this romance, health and longevity scorecard:

-- Eat dark chocolate
-- Drink red wine
-- Go ballroom dancing
-- Stay happily married
-- Have more sex So men


, take your paramour out to dinner, order some red wine and chocolate, go dancing, and after that...well, the rest is up to you.

And if you really want to score with your sweetie, plan your retirement so that she's guaranteed a lifetime retirement income.


This way, when you're gone, you won't be sorry that she's become an impoverished widow. After all, "love means never having to say you're sorry."

Alien Hand Syndrome

Alien Hand Syndrome


There is a very real, very disturbing, and very rare medical condition called “Alien Hand Syndrome” (AHS). An individual with this neurological disorder has full sensation in the rogue hand, but is unable to control its movements, and does not feel that it is a part of their body. The hand becomes personified, as if it has a will of its own, and its owner will usually deny ownership of the limb.

 Though AHS was first identified in 1908, it was not clearly defined until 1972. Depending on the cause of the injury, the movements may be random or purposeful, and may effect the dominant or non-dominant hand. The symptoms are brought on by an injury to the brain, such as head trauma, stroke, tumor, or infection, but it can also be a side effect of a certain kind of brain surgery where the patient has the two lobes of the brain separated to relieve severe epilepsy.

 As a side effect of brain surgery, or an injury to the corpus callosum (the area of the brain which connects the two halves of the brain), the movements are usually grasping motions in the non-dominant hand. When caused by head trauma, similar grasping and groping motions will often involuntarily occur in the dominant hand.

 When the condition is brought about by a brain tumor, aneurysm, or a stroke, the alien hand may also engage in complex purposeful behavior, such as compulsive manipulation of tools, undoing buttons, or tearing clothes. Sometimes the sufferer is completely unaware of what the hand is doing until it is brought to his or her attention, or until they happen to see it themselves.There is currently no treatment for Alien Hand Syndrome, but the symptoms can often be relieved by giving the rogue hand an object to manipulate, to keep it occupied.

Would you work in a hospital where a close relative of yours died?

Would you work in a hospital where a close relative of yours died?

What is your opinion about this situation , would you accept it ?

New drug to treat enlargement of the prostate

New drug to treat enlargement of the prostate


U.S. drug regulators approved Eli Lilly's Cialis drug to treat enlargement of the prostate, expanding use of the blockbuster impotence medicine.

 The Food and Drug Administration said Cialis could be labeled for treatment of the signs and symptoms of a non-cancerous enlarged prostate, called benign prostatic hyperplasia (BPH), and also be used for people who have both BPH and erectile dysfunction.

 About half of men over 50 suffer from prostate problems, which can cause difficulty urinating.


 "BPH can have a big impact on a patient's quality of life," said Scott Monroe, director of the FDA's division of reproductive and urologic products. "Cialis offers these men another treatment option, particularly those who also have ED (erectile dysfunction), which is also common in older men.


" U.S. researchers reported in the journal Urology in 2008 that impotence drugs could help reduce the symptoms caused by an enlarged prostate.


 The FDA said it has approved eight other drugs to treat BPH, including Merck & Co's Proscar, GlaxoSmithKline's Avodart and Pfizer's Cardura.

 In an interview in July, Eli Lilly CEO John Lechleiter said he expects the longer-lasting Cialis to overtake Pfizer's Viagra to become the market leader for impotence drugs.


Cialis, which the FDA approved for impotence in 2003, posted sales of $1.7 billion in 2010, up nine percent from the previous year, while global Viagra sales climbed two percent last year to $1.9 billion

Change Your Breath From Bad to Good

Change Your Breath From Bad to Good

Don't let your tongue become a dirty carpet

 Bad breath often strikes when people aren't properly taking care of their oral health. The odor is usually caused by decaying food particles and bacteria in your mouth. That's why brushing and flossing your teeth is so important, but don't forget to gently brush your tongue to get rid of even more bacteria. A clean tongue goes a long way to warding off bad breath, says Stephen Z. Wolner, a dentist in private practice in New York City. "Your tongue microscopically is like a shaggy carpet. There are millions of filaments on your tongue that trap tiny food particles and bacteria," he says. Get in the habit of regularly cleaning your tongue using a toothbrush, the edge of a spoon, or a tongue cleaner. If you have any mouth guards or oral devices, make sure to clean them thoroughly before putting them back in your mouth. Mouthwash isn't a bad idea, but it's only a temporary fix. Granted, a little mouthwash comes in handy before a romantic dinner for two, but it masks the odor instead of tackling the source of your problem.

Chew gum like it's going out of style

 Believe it or not, saliva is your best weapon against bad breath. That's why dry mouth, often caused by certain medications or medical conditions, leads to odor problems. By washing away food particles and bacteria, saliva helps to eliminate odor, too. If you're wondering why your breath stinks in the morning, it's largely because saliva production slows while you sleep, allowing particles and odor to linger longer. That's where sugarless gum comes in handy, as chewing it will stimulate saliva production. Mints, on the other hand, don't usually stimulate saliva production and only temporarily mask bad odor. "When you chew gum it makes you salivate, and the more saliva you have in your mouth the fewer bacteria you have. It not only mechanically washes bacteria out, but we have antiseptic and enzymes in our saliva that kill bacteria," says Wolner. While anything that makes you salivate will improve your breath, a gum that is sweetened with xylitol is your best option. Xylitol is a sugar substitute that not only increases salvation but also works to prevent bacteria from replicating in the mouth.

 Choose cinnamon -- it's sweeter

 A recent study of the cinnamon-flavored gum Big Red found that cinnamon might have breath-odor fighting abilities. Unlike other flavors, cinnamon is not just a cover-up, Wolner tells WebMD. In fact, he says, an ingredient in the flavoring appears to actually decrease the bacteria in your mouth. The only problem is that sugar gums are bad for your teeth, so stick to sugarless cinnamon-flavored gum instead.

 Drink more water

Wolner says the older you get the more likely you are to get dehydrated. You might not even notice you're thirsty, he says, so make drinking water a habit, because water will help keep the bacteria in your mouth to a minimum. Drinking water has a lot of health benefits, and preventing bad breath is one of them.

Rule out rare causes for bad breath

 While most bad breath can be banished with simple hygienic steps, there are times when dental or medical conditions might be the culprit. Make an appointment with your dentist if an unsavory odor takes residence in your mouth. "If there is a persistent odor in your mouth, and you know it's not from the pasta you ate last night, see a dentist," Wolner tells WebMD. Your dentist will be able to pinpoint any cavities or decay, or even periodontal (gum) disease, that might be causing your bad breath. Because on rare occasions bad breath can signal a larger problem, including infection, and even kidney or liver failure, you should also visit a doctor if your dentist doesn't find a cause for your bad breath problem.

 Have a slice of bread

 If you're on one of the many popular low-carb diets, remember that bad breath or "ketone breath" is a potential side effect when you always have that burger sans bun. You can try different methods of masking the odor, such as gum or tart candies, but adding a few carbs to your daily diet might also do the trick. Get a water pick You can't really clean your entire mouth with a toothbrush. "Using an irrigator or water pick cleans everything out around and under your gums and between your teeth," says Wolner. "If food lingers between your teeth where a toothbrush doesn't reach, it's fermenting." Next time you floss, take a whiff of your floss after you're done, and you'll have a good idea about what fermented or rotten food particles smell like.

Don't let bad breath go to your head

If you think you have bad breath, get a second opinion. "A large proportion of people who think they're social pariahs with terrible breath don't have bad breath at all," says Wolner.

7 Crazy Weight-Loss Methods You Should Never Try

7 Crazy Weight-Loss Methods You Should Never Try

Just when I think I’ve seen it all, another quick fix weight-loss method pops up. Over the years I’ve heard about weight-loss lollipops, diet chopsticks, even slimming sunglasses (designed to change the color of food and make it unappetizing). There will always be silly and trendy get-slim-quick tricks, but what really worries me are approaches that are invasive, extreme, and downright dangerous. Here are seven I hope you’ll never, ever try:

Plastic tongue patch

 Created by a Beverly Hills plastic surgeon, this yet-to-be FDA-approved patch is sewn onto the tongue with six stitches in about 10 minutes, at a cost of roughly $2,000. The device and sutures make eating solid food so excruciatingly painful, patch wearers are forced to adhere to a liquid-only diet, which supplies about 800 calories a day.

Tube feeding

 When I first heard about this trend, I was speechless. To lose weight quickly, women, including many brides-to-be, are opting to have a feeding tube inserted through their noses, which travels through the esophagus into the stomach, remaining in place 24 hours a day. For 10 days, eating is avoided completely, and a high protein, low carb formula is fed through the tube, delivering roughly 800 daily calories. The medical procedure, which costs about $1,500, is normally used to nourish people who cannot eat due to illness or injury.

Drunkorexia

Drunkorexia is a relatively new term for the overlap of binge drinking and disordered eating. The pattern can involve behaviors like: restricting calories to “save them up” for alcohol; drinking excessively to the point of throwing up as a way to purge; overexercising before drinking or the following day; or starving the day after a night of binge drinking. The potential side effects of combining alcohol with undereating and/or purging are serious, including trouble concentrating, and difficulty making decisions, in addition to a weakened immune system, and a greater risk of injuries and acute alcohol poisoning. This is a trend I’ve noticed not just in college students, but also among women in their 20s, 30s, and 40s.

Tapeworms

 While possessing tapeworms is illegal in the U.S., I regularly hear about people seeking them out for weight loss. The sad reality is that many people who unintentionally become infected with tapeworms in the United States suffer from serious dangers, including digestive blockages, organ function disruption, brain and nervous system damage, and even death.

 Starvation

Your body is like an engine that’s always turned on – from head to toe, every cell needs a constant source of fuel to perform its job. In addition, your structure is in a continual state of repair, healing, and regeneration, so your cells needs a steady supply of “building blocks,” including protein and healthy fats, to maintain your tissues. When needed fuel and essential raw materials don’t show up for work, or you consume less than your body requires to support a healthy weight, the deficits trigger a cascade of side effects. Even semi-starvation (less than about 1,000-1,200 calories per day for most women, depending on height and frame size, or more if you’re active) can lead to fatigue, depression, the breakdown of muscle, organ and bone tissue, suppressed immunity, hair loss, hormone imbalances, sleep disturbances, and an increased injury risk.

Smoking

I wish this wasn’t the case, but I have had clients tell me they took up smoking specifically to lose weight, fully knowing the unhealthy consequences. It is true that smoking dulls taste buds, suppresses appetite, and slightly increases metabolism. But the health risks are so great that experts estimate they’re equal to gaining 100 pounds (not to mention the impact on aging your skin).

Stimulants

 Throughout my years specializing in weight loss and disordered eating, I’ve seen many women and men fall into the trap of using stimulant drugs to lose weight, then becoming addicted, and ending up in rehab, or worse. And even without dependence, over-the-counter, prescription, or illegal stimulants are risky, with potential side effects ranging from poor judgment, impulsivity and mood swings, to dangerously high blood pressure, seizures, and stroke.

How much sex is considered exercise?

How much sex is considered exercise?

Have sex in the morning; you can roll out of bed and right into your morning workout and you're already warmed up!

STORY HIGHLIGHTS

 Sex lasts six minutes on average and only burns about 21 calories, study says
 30 minutes of sex can burn in the neighborhood of 85 to 100 calories
 Incorporating some of your favorite yoga poses may up the caloric ante

The rumor: A bout of sexual activity can burn between 100 and 300 calories

 We hear all the time that sex is a great workout, but what are the hard facts? How much sex is considered exercise? On a scale from fast asleep to Brangelina, where does the average sexual encounter lie on the calorie-burning scale?

The verdict: Sex burns a few calories, but frequent friskiness isn't going to replace the gym

You may not be getting quite as good of a workout between the sheets as you think. According to a study conducted by the New England Journal of Medicine, sex lasts six minutes on average and only burns about 21 calories. As an exercise physiologist and someone who even finds ways to burn calories while driving and working on my computer, I found this to be a very disappointing statistic. According to WebMD, 30 minutes of sex can burn in the neighborhood of 85 to 100 calories; if you feel like you have a pretty vigorous sex life, you're probably on the higher end of that statistic. This got me thinking. While it appears that we probably shouldn't be giving up our gym memberships in the name of sex anytime soon, there are ways we can optimize our sexercise. Here are some ideas:

 Sex before breakfast.

Having sex in the morning is a great idea for several reasons. A man's testosterone levels are the highest between 7 and 8 a.m., for one. Also, if you make time for a half-hour morning session, you can roll out of bed and right into your morning workout and you're already warmed up! Now that's something worth setting your alarm for.

Flexi-sex. In the average yoga class, you can burn anywhere between 100 and 300 calories per half hour. Incorporating some of your favorite yoga poses into your sex life can definitely up the caloric ante and stretch your hip flexors at the same time. (I'll let you take creative liberty with this one.)

 Eating for endurance. Incorporating some endurance-boosting foods can also help when trying to kick it up a notch in the sex department. Foods such as figs, oysters, celery, blueberries, peanuts, bananas, garlic and even chocolate have the potential to boost a man's sexual stamina. (Note: Carb-loading the night before your morning sexathon is not recommended and will likely be counterproductive.)

 Switch it up. With sexercise -- as with any workout -- it's important to try new and different things all the time. By trying more challenging and adventurous positions, you use different muscles for stabilization, constantly surprising your body (and maybe your partner), and getting a better workout. If you find yourself in the same few positions every time and your most adventurous sex location is the foot of the bed (yawn), it's definitely time to mix it up.

 Core-gasm. Engage your core at all times while having sex. Focusing on your core and isolating the muscles around your pelvic floor will not only strengthen your six-pack, it'll make your tummy look flatter in the moment. Also, there's increasing evidence that the right core workouts can induce orgasm. Talk about double the pleasure!

Cross-train. We've already established that sex doesn't really count as your primary form of exercise, so why not exercise for better sex? Research shows that women who regularly exercise have more active sex lives, reach orgasm more quickly and are more easily aroused than sedentary women. Furthermore, in the study, women were more sexually responsive following 20 minutes of vigorous exercise. Among males, short intense exercise is linked with increased testosterone levels, which may stimulate sexual interest and behavior. Looking for the perfect warm-up and foreplay for a steamy hot shower session? A sexy morning workout with your other half may do the trick. Focus your workout on isolating muscles that will help you while in the sack. Pelvic thrusts are a must!

Oh please, not the “sex causes heart attack” story again

Oh please, not the “sex causes heart attack” story again


Sexual activity nearly triples the risk of having a heart attack, report researchers from Tufts University and the Harvard School of Public Health in yesterday’s Journal of the American Medical Association.

For anyone who is sexually active—especially anyone worried about his or her heart—that’s an eye-catching and fear-inducing finding. It’s a message reinforced by television (Downton Abbey, Mad Men, and Rescue Me are just a few series that have used heart attack after sex as a plot device).

 But before you swear off sex forever, realize that “triples” refers to the relative risk. It’s calculated like this: A day or two day after having a heart attack, an individual is asked to recount all of the things he or she had done in the hours before the attack. Then as a “control,” the person is asked to list what he or she had done the day before (a day without a heart attack). The various activities on the heart attack day are compared with those on the non-attack day to calculate the relative risk. But the relative risk isn’t nearly as important as the absolute risk. Here’s a calculation by Dr. James E. Muller, a cardiologist at Harvard-affiliated Massachusetts General Hospital, in an earlier article about sex and heart attack. The absolute risk of heart attack for a 50-year-old man who exercises regularly is 1 chance in a million per hour. Tripling that risk by engaging in sexual activity boosts it to 3 in one million per hour, and only for the two-hour period during and after sexual activity. For a heart attack survivor who is getting back into shape, the absolute risk of 10 in one million per hour increases to 30 in one million per hour.

 In other words, sex can trigger a heart attack, but it doesn’t happen very often. What’s more, in the JAMA study the chances of having a sex-related heart attack was lower in people who regularly exercised than it was among those who rarely exercised.

When sex is classified as a form of physical exertion, it’s pretty far down there in the mild to moderate intensity category. Sexual activity averages 2 to 3 metabolic equivalents (METs), a measure of energy expenditure, and may go up to 3 to 4 METs at orgasm. In comparison, walking slowly on level ground or doing light housework clocks in at 2 METs; climbing stairs, 3 to 4 METs; shoveling light snow, 6 to 7 METs.

The numbers for sexual activity are averages, of course. Sexual positions affect the potential effects on the heart. A study published in the Archives of Internal Medicine showed greater energy expenditure during sexual intercourse for both partners with the man on top (2.0 to 5.4 METs) than with the woman on top (2.5 to 3.0 METs). And sex with a new partner in an unfamiliar setting increases the relative risk more than sex with a familiar partner in a familiar setting.

The good news from this study is that sex is a relatively rare trigger of heart attack or sudden death—even less than shoveling snow. The even better news is that regular physical activity, like walking or having sex, reduces the relative risk of having a heart attack while exercising or having sex by five-fold or more, according to the JAMA study. Factor in the fact that regular physical activity improves sexual function, and it’s amazing that walking trails, cycling routes, and other exercise venues aren’t always mobbed.

How Can Scary Movies Affect Your Health ?

How Can Scary Movies Affect Your Health ?

Viewers who put themselves through 90 minutes of adrenaline-pumping terror can use up as much as 113 calories, close to the amount burned during a half-hour walk and the equivalent to a chocolate bar.

The movie top of the list of calorie-burners was found to be the 1980 psychological thriller The Shining, with the average viewer using up a whopping 184 calories. Jaws took the runner-up spot, with viewers burning on average 161 calories, and The Exorcist came third, with 158 calories.

The University of Westminster study measured the total energy expenditure of ten different people as they watched a selection of frightening movies.

Scientists recorded their heart rate, oxygen intake and carbon dioxide output - and discovered the number of calories used increased by on average a third during the films.

The research also revealed films featuring moments designed to make viewers jump in terror are the best calorie-burners, as they cause heart rates to soar.

Dr Richard Mackenzie, senior lecturer and specialist in cell metabolism and physiology at the University of Westminster, said: "Each of the ten films tested set pulses racing, sparking an increase in the heart rate of the case studies.

"As the pulse quickens and blood pumps around the body faster, the body experiences a surge in adrenaline.

"It is this release of fast acting adrenaline, produced during short bursts of intense stress (or in this case, brought on by fear), which is known to lower the appetite, increase the Basal Metabolic Rate and ultimately burn a higher level of calories.

" Helen Cowley, editor of the movie rental company LOVEFiLM - which commissioned the University of Westminster study - said: "We all know the feeling of wanting to hide behind the sofa or grab a pillow when watching scary or hair raising scenes, but this research suggests that maybe those seeking to burn some calories should keep their eyes on the screen."

 The top 10 calorie-burning frightening films were
1. The Shining: 184 calories
2. Jaws: 161 calories
3. The Exorcist: 158 calories
4. Alien: 152 calories
5. Saw: 133 calories
6. A Nightmare on Elm Street: 118 calories
7. Paranormal Activity: 111 calories
8. The Blair Witch Project: 105 calories
9. The Texas Chain Saw Massacre: 107 calories 
10. [Rec]: 101 calories