How about this big boy? 

A Chance to Cut is a Chance to Cure

Check out this surgeon's website: A Chance to Cut is a Chance to Cure. There are some good cases and picures in the 'Tales from the OR' and 'Tales from the Trauma Service' sections which can be found in the sidebar.

sushi run

Is it possible to make a run without BB?

Another toothbrush in another strange place

Please see page 273 of your Feb. issue of Consultant for the picture Joe posted. I'm sorry to intervene here but that was definitely a violation of copyright.

The Mythical Methicorn

From the archives of the Bibb Mobile: After an outbreak of "spider bites" at the local county jail a few years back, in addition to the baseline number of "spider bites", mostly located in the antecubital fossae of some of our most upstanding patients, a bright young doctor put forth a very interesting theory. He proposed that these people were not victims of spiderbites at all, but rather the victims of a much more sinister being. This creature was once thought to be merely a myth, but we now know that he exists from the trail of abcesses left in his wake. He prefers to attack at night when only the most vunerable individuals have been awake for 36-48 hours. His method of attack: walk right up and stick his needle-like appendage right in the most exposed vein, usually in the AC fossa. Fearing vengance from this creature, all of his victims have been unwilling to name it as the culprit. They instead give the next most believable explanation, spider bite.

Brad, this one's for you! At the Tavern on the Green in Central Park. 

A bike for the CC no one knows where we are going! 

MA with the gates of Christo and Jean Claude 

And also Joe with Hamilton, aren't you sorry you didn't stay for the WHOLE slide show? 

Here is the ultimate end of frisbee with fine china. Found at the Museum of Modern Art, or MoMA as we know it. 

juxtaposition

I must give a juxtaposition of two words, used in conversation today "a hiatus of disinterest".
Of course, I love juxtaposition also, and use it when I can which is not often.

There will be additional information re: frisbee with fine china AND Alexander Hamilton from NYC,upcoming please be patient.

Satellite Mallard Tracking

You duck hunters may have known about this already, but I just found this site and thought is was neat. From the Arkansas Game and Fish Commission comes Satellite Mallard Tracking Last March, they released 28 ducks carrying transmitters. Now only 7 are alive and transmitting. Several transmitters quit working, several ducks died before they got out of Arkansas last March, several died on the breeding grounds and 1 was harvested in North Dakota. Although they have lost quite a few transmitters, they were still able to gain insight into their migration patterns and breeding areas. In the near future, they will post a complete report detailing the fates of each of the 28 transmitters they released last year. The batteries used in these transmitters have a life of about 12 months so they expect to lose even more before too long.
This February, 53 more transmitters will be deployed and will be tracked on this site.

Oscillococcinum for influenza

Today, as I recover from the throes of my recent influenza or influenza-like-illness, I opened a package that has been sitting on my desk for a week, that came in the mail. It contained a free sample of oscillococcinum, the accompanying material claims that it is proven to reduce the severity and duration of the flu if given at the early onset of symptoms.
What is Oscillococcinum? The box says Anas barbarie hepatis et cordis extractum, aka heart and liver extract from the Muscovy Duck.
I did a Medline search and found this:
The Cochrane Database of Systematic Reviews,Volume (4),2004, Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes,Vickers, AJ; Smith, C. Here are some excerpts:

Conclusions: Though promising, the data are not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndrome. Further research is warranted but required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.

That is a little different from the study quoted in the literature that came with my free sample, Casonova et al 1983. This is what the Cochrane review says about that study in particular:

The main difficulty is that one of the trials, Casanova (Casanova 1984), was not published in a standard medical journal, contains little experimental detail, does not report withdrawals and analyses a suspiciously round number of patients. Moreover, the difference between groups in the meta-analysis only just reaches statistical significance. It is arguable that a question as scientifically controversial as whether homeopathic medicines are always equivalent to placebo would require more statistically robust data.

A final word on the implications for further research from this study:

It is open to debate whether further research is warranted on homeopathic medicines to prevent influenza and influenza-like syndrome. Using the control event rate from the meta-analysis of Attena (Attena 1995) and Nollevaux (Nollevaux 1990) (24%), a minimal, clinically significant difference of five per cent and a power of 90 per cent gives 1457 patients per group. Such a trial would require significant resources, the investment of which is questionable given the equivocal nature of the current data.

My free sample is now in the trash, but for some the placebo effect may be worthwhile if it is cheap and safe. However what I find interesting is the homeopathic rationale for this treatment, 'let like be cured by like' based on the fact that these migratory waterfowl are the major reservoirs for the virus. It is also interesting that the method of producing this medicine dilutes it so extensively that a typical dose doesn't even contain a single molecule of the active ingredient(Kayne SB. Homoeopathic pharmacy 1997;Churchill Livingstone, Edinburgh.). If the 'like cures like' model were effective, I would think stopping in at KFC a couple of times a week would really do the trick.

Here is a story from Homeowatch that gives the history of this product's use and makes note of the fact that even the scientific name of the duck is wrong. It makes the use of this stuff seem just plain silly.

Sushi lovers do the darndest things...

Been reeding Reuters again. Found a short article about a Japanese man holding up a store and demanding sushi. The article is so short, I will post it below.

Hungry Man Holds Up Store, Demands Sushi
Mon Feb 14, 9:17 AM ET

Oddly Enough - Reuters
TOKYO (Reuters) - A Japanese man pulled a knife in a convenience store early Sunday morning and threatened to kill himself unless he was given a meal of the choicest sushi.

The 68-year-old unemployed man barged into the store in the western city of Osaka after first setting fire to his nearby apartment, police said Monday. Newspapers said the man claimed he couldn't eat because his state benefit payments had been stopped.
Police overpowered the man after about an hour, during which time he ate bananas and helped himself to alcoholic drinks and vitamin supplements. Police declined to say whether he got any sushi.

I think it is plausible we can safely replace the crazy Japanese man in this story with Brad.

Frisbee with fine china

Frisbee with fine china. I had this thought after feeding my dogs some scraps off a dinner plate. Noting the plate looked and felt somewhat like a frisbee. If the really great frisbee players had to use expensive fine china plates it might be exciting(especially for people who watch Antique Roadshow on public tv). You would lose, of course, if you did not catch the "frisbee" and it broke. Or if you sailed an uncatchable plate.

The point system could be devised by others(maybe the rule maker--who could that be?)

Well, if bleeding scroti are the sole sorce of interest in our entertaining and enlightening blog, I might suggest we discuss other BLEEDING SITES. How about
BLEEDING EYEBALL?, or a BLEEDING PENIS?, or a BLEEDING PINNA?, and so how boring can we make this process? We must rise above bleeding and "cogitate our facilities".

Any body feel the earth quake today? Didn't feel anything myself, have been in quakes here in Jb, Mexico City, and LA.

Glad you are BACK

I am sooo glad that you survived your "flu-like illness" even though you only got credit for a SUPER bowl.

Your post about the homepathic med.(I threw mine in the trash), brought to mind some recent conversations I have had with Lewis and Clark and the Corp of Discovery. Especially when Lewis and Clark were trying to decide if the north or the south fork were the correct Mo. R. and Lewis said "we must cogitate our facilities" . I love this phrase and suggest it might be our mission statement for the CC.

On a somewhat differnet note--my lawyer friend whom I recently removed a benign lesion from his ear, at our Rotary club mtg. today at "good news" noted he had SURVIVED my surgery.
My retort was I operated on his ear and then received a letter that he was sueing me for leaving an instrument in his body.

Causes of Scrotal Bleeding

As I mentioned to some of you yesterday, I have found it quite interesting that one of the greatest sources of hits to our site is from various search engines where people are looking for causes of Scrotal Bleeding. This is thanks to the Flash's piece on the shorn scrotum. I'm sure that it is also partly due to the fact that there is not a lot of material out there on scrotal bleeding. When I see these hits from the search engines, I just can't help but picture an intern getting a call in the middle of the night from the floor or ER to go see a patient with a bleeding scrotum that just won't stop. I thought we should do our best to give help on this subject on which there is obviously a deficiency of literature available. So I will get the ball rolling (pun intended), but will also count on input from the bossman who is the only member of the CC who can proudly boast that he has intentionally caused bleeding of the genitalia of any kind, through circumcision, on a another member of the CC.

Trauma- Since trauma is by far the most common cause of scrotal bleeding the discussion may need to focus on what to do about it.
Obviously any large trauma to the genitalia would require the consultation of a urologist or general surgeon, and therefore be out of the scope of this text.
For smaller infractions however, you have to address a key point. Is the degree of bleeding appropriate for the injury? If so then a thourough exam and wound closure may be all that is required. As noted by the Flash in his experience, chemical cauterization was attempted with apparent initial success. But when he began bleeding again, the area was sutured, with success.
If the scrotal bleeding appears to be greater than you would expect from the size of the injury you have to ask yourself what else is going on.
-Is there a clotting disorder? I believe brad told me that this guy was on coumadin which may have contributed, or what about haemophilia, von Willebrand's disease, and thrombocytopenia? Does he have Liver disease?
Or, as the bossman did mention, there could be vascular ectasia, and he therefore gets partial credit, but did not mention by name a specific disorder known as Angiokeratoma of Fordyce. This is a condition in which you may see typically asymptomatic, 2- to 5-mm, blue-to-red papules with a scaly surface located on the scrotum, shaft of penis, labia majora, inner thigh, or lower abdomen. It is benign and the main complication is bleeding. Spontaneous resolution has not been described and it has been treated with excision, cryotherapy, electrocautery, and laser treatment. Another related disorder is known as Angiokeratoma Circumscription, also here is an interesting case of case of angiokeratoma corporis diffusum.

That is about all I could find today. Luckily I have not encountered any bewildering cases of scrotal bleeding, but hopefully when I do, I will at least be able to sound smart if I can remember to say "He could have Angiokeratoma of Fordyce"

Whoa Nelly!! I almost forgot the Classic "There's Something About Mary" Trapped Zipper Syndrome! Obviously that won't be a mystery but, here are some Clinical Practice Guidelines Man, I'm glad I didn't let someone else have that one.

Sherry enema

I found a story on Reuters about a woman giving a sherry enema to her alcoholic husband because he had a sore throat and couldn't drink it. If a police officer pulled this guy over and got this story, would he have to fart in the breathalyzer? Here's the link.

http://today.reuters.com/news/newsArticle.aspx?type=oddlyEnoughNews&storyID=2005-02-03T153626Z_01_N02590067_RTRIDST_0_ODD-ODD-SHERRY-DC.XML

Medical-Legal-Ethical Issues

You may notice that I removed the head scan with toothbrush post. I am just not sure how to deal with: (a) the potential legal consequences of publishing medical photos, x-rays or scans of people without their permission even if their is no identifying info on it. (b) the ethical issues related to making light of someone's medical misfortune in a public forum, using privileged information, even if their is no identifying information. So I just removed it, because it kind of bothered me.

I was thinking of asking a patient to let me photgraph a large spider bite wound and maybe posting it. I know that my clinic has form for patients to sign allowing photos to be taken, but I don't think it mentions publishing.

Does anyone have any input on these issues?